The prevalence and factors associated with musculoskeletal disorders, in patients with sickle cell anaemia, at Mulago National Referral Hospital, Uganda

Background: Sickle cell anaemia (SCA) is a condition characterized by a predominance of haemoglobin S (hbss) in the red blood cells. Musculoskeletal involvement is one of the commonest clinical manifestations of SCA. There is limited information on the prevalence, patterns and factors associated with Musculoskeletal (MSK) disorders among SCA patients in African countries.Methods: This was a descriptive cross sectional study conducted in SCA clinic at Mulago National Referral Hospital, Uganda. It involved 365 SCA patients who attended the clinic between 1st August 2014 and 31st October 2014. These patients were interviewed and assessed to determine the presence of MSK, patterns and factors associated with it. The transient MSK disorders like dactylitis were excluded.Results: The prevalence of MSK disorders among SCA patients was found to be 11.5%.These disorders include avascular necrosis, spine osteonecrosis, osteomyelitis, leg ulcers, pathological fractures and flexion contractures. The age (11-20 years), highly demanding physical activity status and the annual frequency of painful crises were associated with MSK disorders.Conclusion: Musculoskeletal disorders are highly prevalent in SCA patients at Mulago National referral hospital. The femoral Avascular necrosis, spine osteonecrosis, leg ulcers and osteomyelitis were the most common MSK disorders.Keywords: Sickle cell anaemia, Musculoskeletal disorders, Avascular necrosi

Treatment outcomes of congenital pseudarthrosis of the tibia at Beit Cure International Hospital in Blantyre, Malawi

Background: Congenital pseudarthrosis of the tibia (CPT) is a rare condition. The natural history of CPT includes persistent instability and progressive deformity. Several CPT treatment methods have been practiced, however, in Africa where there is scarce information on the modalities of treatment available and their outcomes. Methods: A retrospective cross-sectional study which was conducted among patients with CPT at Beit Cure International Hospital (BCIH), Malawi. Forty-four patients were recruited in this study and their treatment modalities and outcomes were analyzed. Results: Out of 44 patients recruited in this study, majority (63.6%) were male. The majority of cases were stage 4 congenital tibia pseudarthrosis by Crawford classification. Most patients were treated by more than one surgical modality; however, surgical excision and intramedullary rodding was commonly used (54.7%). The outcomes of treatment were good in 5%, fair in 30%, with amputation in 45% and poor outcomes in 20% of the patients. Complications developed in 60% of patients, predominated by limb length discrepancy. The foot and ankle status were rated by Oxford Foot and Ankle scoring system (OxFAQ). Conclusions: Congenital pseudarthrosis of the tibia is a complex congenital disorder with multiple modalities of treatment. Majority of the patients were treated by more than one operation. Some patients ended up with amputation or poor outcome. Limb length discrepancy, deep infection and pin tract infection are among the common complications. Keywords: congenital pseudarthrosis; tibia; treatment outcomes; Malaw