Predictive factors for primary amputation in trauma patients in a Nigerian university teaching hospital

No Abstract.The East African Medical Journal Vol. 83 (10) 2006: pp. 539-54

Factors influencing the outcome of elective paediatric orthopaedic operations in Ile-Ife, Nigeria

There is a paucity of published data on the types of paediatric orthopaedic conditions that require surgery and factors infl uencing their outcome in most parts of Sub-Saharan Africa. This is a necessary audit to improve paediatric orthopaedic practice. We carried out an audit of all elective orthopaedic operations performed in children at Awolowo University Teaching Hospitals Complex in Ile-Ife, Nigeria from January 2000 through December 2005. The aim was to document the clinical outcomes and the factors that infl uence them. This is with a view to instituting necessary measures to improve paediatric orthopaedic practice in the area. A total of 146 children who had elective operations on 210 limbs were included in the study. Their mean age was 75.6±66.8 months (range 0.3-396 months). The commonest indications for surgery were angular knee deformities (from Blount\'s disease and rickets) and club foot. The mean hospital stay before surgery was 12±8.8 days (range 1-38days). The mean duration of operation was 78.4±36min. (range 30-195 min). The total length of hospitalization was 34.97±19.91 days in males and 41.97±25.15 days in females. Wound infection was the commonest postoperative complication (8.2%). The patient\'s age (P=0.002), indication for surgery (P=0.008), length of preoperative hospital stay (P=0.048), length of operation (

Major limb amputations at a teaching hospital in the sub-Saharan Africa: Any change in trend?

No Abstrac

Results of Operative Fixation of Fractures of the Ankle at a Tertiary Hospital in a Developing Country

Background: Operative fixation of ankle fractures is becoming popular in developing countries. The concern however is the outcome of care. The objective was to evaluate the results of open reduction and internal fixation (ORIF) of fractures of the ankle in our hospital.Methods: All cases ORIF of fractures of the ankle at the University College Hospital (UCH), Ibadan between March 2010 and December 2012 were recruited into the study. The indications for surgery, techniques of fixation, time interval between injury and presentation as well as outcome  measures like time to union, complications and functional outcomes were evaluated.Results: Seventy patients who had ORIF of ankle fractures were studied. Twenty-one (30%) were open fractures while forty-nine (70%) were closed. Sixty (85.7%) patients presented within the first week of injury, 4 (5.7%) after 4 weeks, 4 (5.7%) after 6 weeks and 2 (2.9%) after 52 weeks. Time to union averaged 12.6±4.1weeks. Complications included wound infection 14.3%, wound dehiscence with exposed implants 2.9%, malunion 8.6% and non union 5.7%. Good to excellent functional outcomes were achieved in 77.1% of the patients.Conclusion: ORIF is a viable option in the treatment of ankle fractures

Reasons Why Trauma Patients Request for Discharge against Medical Advice in Wesley Guild Hospital Ilesha

Background:The aim of this study was to find out the reasons why trauma victims with Orthopaedic injuries take their discharge against medical  advice.Methods: This was a prospective study conducted on Trauma victims  presenting to the Wesley Guild Hospital Ilesha who took their discharge against medical advice (DAMA) over a 2 year period. A questionnaire was designed that was used to retrieve information on the patients biodata, their injuries and the reasons why they DAMA.Results: A total of 49 patients were interviewed over this period. The mean age of the patients was 36.7 years. Students (22.4%), traders (20.4%) and artisans (24.5%) were commonly involved in this practice. Eighteen (36.7%) of the respondents claimed to have taken DAMA due to hospital cost, 18 (36.7%) also DAMA because of their believe in Traditional Bone Setters. Eleven patients (22.4%) simply said they want treatment near home while one patient each gave the fear of amputation and hospital protocol as their reasons for DAMA.Conclusion: Cost of treatment and believe in traditional bone setters were the 2 main reasons why most patients with fracture DAMA. Measures to reduce the cost of treatment and patient’s education about the dangers with unorthodox treatment of fractures and dislocations should help to reduce this behaviour

Clinical effects of Garcinia kola in knee osteoarthritis

<p>Abstract</p> <p>Objectives</p> <p>Over the past years, there has been a growing number of knee osteoarthritis (KOA) patients who are not willing to comply with long-term non-steroidal anti-inflammatory drugs (NSAID) treatment and wish to use herbal anti- rheumatic medicine. This study assessed the clinical effects of <it>Garcinia kola </it>(GK) in KOA patients.</p> <p>Patients and methods</p> <p>Prospective randomized, placebo controlled, double blind, clinical trial approved by the institutional medical ethics review board and written informed consent obtained from each patient. All KOA patients presenting at the Obafemi Awolowo University Teaching Hospital complex were recruited into the study. The patients were grouped into four (A = Placebo, B = Naproxen, C = <it>Garcinia kola</it>, D = Celebrex). The drugs and placebo were given twice a day per oral route. Each dose consisted of 200 mg of <it>G. kola</it>, Naproxen (500 mg), Celebrex (200 mg) and Ascorbic acid (100 mg). The primary outcome measure over six weeks study period was the change in mean WOMAC pain visual analogue scales (VAS). Secondary outcome measures included the mean change in joint stiffness and physical function (mobility/walking).</p> <p>Results</p> <p>143 patients were recruited, 84 (58.7%, males – 24, females – 60) satisfied the selection criteria and completed the study. The effect of knee osteoarthritis bilateralism among the subjects was not significant on their outcome (p > 0.05). The change in the mean WOMAC pain VAS after six weeks of <it>G. kola </it>was significantly reduced compared to the placebo (p < 0.001). Multiple comparisons of the mean VAS pain change of <it>G. kola </it>group was not lowered significantly against the naproxen and celebrex groups (p > 0.05). The onset of <it>G. kola </it>symptomatic pain relief was faster than the placebo (p < 0.001). However, it was slower than the active comparators (p > 0.05). The duration of therapeutic effect of <it>Garcinia kola </it>was longer than the placebo (p > 0.001). <it>G. kola </it>period of effect was less than naproxen and celebrex (p < 0.001). <it>G. kola </it>subjects had improved mean change mobility/walking after six weeks better than the control group(p < 0.001). The mean change in mobility of the <it>G. kola </it>group when compared to the active comparators was not significantly better (p < 0.05). The mean change of knee joint stiffness (p < 0.001) and the change of mean WOMAC score (p < 0.001) were improved on <it>Garcinia kola </it>as compared to the placebo. The mid term outcome of eleven <it>Garcinia kola </it>subjects after cessation of use had a mean pain relief period of 17.27 +/- 5.15 days (range: 9–26 days). There was no significant cardiovascular, renal or drug induced adverse reaction to <it>Garcinia kola</it>.</p> <p>Conclusion</p> <p><it>Garcinia kola </it>appeared to have clinically significant analgesic/anti-inflammatory effects in knee osteoarthritis patients. <it>Garcinia kola </it>is a potential osteoarthritis disease activity modifier with good mid term outcome. Further studies are required for standardization of dosages and to determine long-term effects.</p

Pattern of Congenital Musculoskeletal Abnormalities in South West, Nigeria: A Hospital Based Study

Background: Published data on congenital musculoskeletal anomaly in subsaharan Africa are few.Aim: To review the pattern of congenital musculoskeletal abnormalities seen at the Obafemi Awolowo University Teaching Hospitals' Complex (O.A.U.T.H.C) Ile-Ife.Materials and Methods: The clinical records of patients who presented to the O.A.U.T.H.C, Ile-Ife, with congenital musculoskeletal abnormalities over 7 years (July 2000 to June 2007) were reviewed. Comprising patients delivered in the hospital, referred patients seen in the Orthopaedic clinics and those admitted to the hospital Orthopaedic, Paediatric and Postnatal wards. The following data were extracted; age, gender, diagnoses, description of the abnormality and the presence of associated congenital deformities. The side of the body involved and bilaterality were noted.Result: Over this period, 123 patients met the criteria. Eighty one were males while 42 were females with a M:F= 2:1 Congenital talipes equinovarus(CTEV) deformity was the most common congenital musculoskeletal anomaly in 64(52.0%) patients. Others were Polydactyly 16 (13.0%) and syndactyly 11(8.9%). Other common congenital orthopaedic anomalies encountered include: Arthrogryposis multiplex congenital 7(5.7%), congenital knee dislocation 6(4.9%), Calcaneovalgus deformity 5(4.1%) and absent radius 5(4.1%). Among the patients with clubfoot, there was a predominance of bilateral involvement of both foot with 63.4% of the idiopathic variety showing bilaterality and 60.9% of the non-idiopathic variety having bilateral involvement. The idiopathic Variety constituted 64.1% of the club foot deformities. Spina bifida cystica was the most common associated deformity among the patients with nonidiopathic clubfoot.Conclusion: Congenital talipes equinovarus was the most common congenital Musculoskeletal anomaly seen at the Obafemi Awolowo University Teaching Hospital Ile-Ife, with a high incidence of bilaterality. Spina bifida cystica was the most associated anomaly in the non-idiopathic club foot in this centre.Keywords: Congenital, Musculoskeletal, anomaly, Tertiary, Referral, Centre

Knowledge, Attitude and Practice about the Traditional Bone Setters among Health Workersi n Federal Medical Centre, Owo, Nigeria

The practice of traditional bone setters can no longer be denied in this environment as some of the complications resulting from their treatment are still seen commonly in orthopaedic surgical practice. This study was undertaken at the Federal Medical Centre, Owo, Ondo State, Nigeria to find out about knowledge, attitude and practice about the traditional bone setters (TBS) among health workers. A pre-tested questionnaire was distributed among the health workers through their heads of departments for ease of collection. The response rate was 88.2% with a male to female ratio of 1:1.7. 88.1% were aware of the TBS practice in our environment and 32.7% got to know about them through the mass media; constituting the greatest percentage proportion. Only 19.6% of the respondents claimed the knowledge of how traditional bone setters acquired their skills, 73.6% of these responded that it was innately acquired. While most of the respondents assessed their care as inadequate and that they should not be allowed to treat patients with fractures; 12.9% believed that the TBS possessed special powers to treat fractures that is lacking in orthopaedic surgeons. Health assistants were the most likely to be believe in the possession of such powers. It was recommended that the TBS should be banned from unvented access to the use of the mass media. Within the hospital environment, there is need to organize regular update or instructional lectures for health workers, especially the health assistants who are most likely to give wrong interpretations to events surrounding the patient treatment by the orthodox practitioners. (Key words: Chronic suppurative otitis media, Pseudomonas aerugi nosa, Hearing loss). Sahel Med. J. Vol.6(3) 2003: 79-8

A Comparison of Chronic Osteomyelitis in Sickle Cell Disease and Non-Sickle Cell Disease Patients

Background: Osteomyelitis in Sickle Cell Disease (SCD) and non-SCD patients has different clinical pictures. This study was designed to compare the pattern of chronic osteomyelitis in these two populations.Method: This is a prospective study in which 30 ConsecutiveSCD patients with chronic osteomyelitis of haematogenous origin(SO) and 30 consecutive non-SCD patients with chronic osteomyelitis of haematogenous origin (NO) were compared between November 2003 and March 2005.Result: The presenting complaints were similar in both groups except for a higher incidence of bone pain among SCD patients. There was a significantly higher incidence of multifocalization (p =0.02), bilaterality (p = 0.01) and symmetry (p = 0.01) among SCD patients. SCD patients had significantly higher leucocyte count (