Anthropometric study of adult tibia bone for pre-operative determination of length of intramedullary nail

Background: The tibia is the bone that is mostly fractured in the body. Surgical fixation of tibia fractures with intramedullary (IM) nail is a common procedure around the world. Objective: This study discusses pre-operative determination of intramedullary nail length to be inserted for a fractured tibia based on  anthropometric measurements of dry tibia bones. Design: This was a prospective descriptive study. Methods: The study involved measurement of length and other parts of adult dry tibia bones. Data of patients that had tibia fracture fixation with intramedullary interlocking nails using SIgn ®nails were also retrieved. All measurements and data obtained were recorded and analyzed using STATA version 13 (StataCorp, Texas. USA). Results: The Maximum Tibia Length (MTL) of 44 adult tibia bones ranged from 35.2cm to 43.6cm with an average of 39.9 ± 2.2cm. The Bicondylar Tibial Width (BTW) ranged from 68.9mm to 80.4mm with an average of 75.1 ± 3.4mm. Tibia length (cm) can be estimated using the equation “12.6 + 3.7*{Bicondylar Tibial width (cm)} ± 3cm”. The distance of the Tibial plateau to the tubercle (TTD) ranged from 2.66cm to 3.53cm with an averageof 3.03 ± 0. 23cm. The Medial Malleolus Height (MMH) ranged from 1.20cm to 1.86cm with an average of 1.51 ± 0. 17cm. Part of the tibia bone that is usually occupied by inserted nail is MTL – (TTD + MMH). Average TTD + MMH = 4.5 ± 0.4cm. Length of intramedullary nail = MTL – 4.5cm. The average length of intramedullary nail used in our centre was 34.7 ± 2.7cm. The difference between the average tibia length and IM nail inserted was 5cm, which is closed to the findings in this study (i.e length of intramedullary nail for a tibia = maximum length of the tibia – 4.5cm). Conclusion: Pre-operative determination of intramedullary nail length for the tibia can be derived using: “Length of the tibia (from the knee joint to the tip of medial malleolus) minus 4.5cm” (for tibia tubercle as the entry point); “Length of the tibia (from the knee joint to the tip of medial malleolus) minus 1.5cm” (for entry point just below the tibia plateau; The diameter of the nail to be inserted can be estimated along with thelength of the IM nail using: Diameter of nail (mm) = {7.2 + 0.007* length of the nail (mm)} ± 1.5 mm. This study also showed that tibia length can be estimated from the equation “12.6 + {3.7*Bicondylar tibial width (cm)} ± 3cm”. This is useful in forensic medicine or when the contralateral limb is not available for use in a patient who is to undergo IM tibia nailing. Key words: Tibia fracture, Pre-operative determination, Intramedullary nail, Tibia bone fixation, Africans, Anthropometry, Tibia, Interlocking nai

Skeletal injuries in children presenting in a tertiary health facility in Lagos state, Nigeria

BACKGROUND: Injury remains a major health problem for children worldwide. Traumatic injuries cause substantial mortality and morbidity with temporary or permanent disability in childrenMETHODS: This was a prospective observational hospital based study conducted on all the patients aged 16 years and below who presented in the Accident and Emergency room and at the orthopaedic outpatient clinics in the Lagos University Teaching Hospital (LUTH) with musculoskeletal injuries over a period of fifteen months. All patients who met the inclusion criteria were recruited. Questionnaires were used for data collection. Thorough examination of the injured paediatric patient was done and finding documented in the questionnaire. Fractures of long bones were confirmed in all cases with radiographs. Data obtained was analyzed with Microsoft Excel Starter 2010 by Microsoft Corporation. Redmond, Washington.RESULTS: The age ranged from 4 day (0.01 year) to 16 year with a mean age of6.35± 4.58. Male to Female ratio was 1.9:1. Road traffic accidents were the leading cause of skeletal injuries (49.2%), followed by falls (27.0%). Fractures associated with birth trauma accounted for 12.7%. Younger children were more prone to injuries from falls. The home environment was the second most common environment for children to sustain fractures, the first being the roads. Majority (58.7%) were from families within the lower socioeconomic class. Ninety five percent (95%) of the children who got injured were without adult supervision while crossing the road. Injuries from road traffic accidents peaked between 3pm and 6pm while injuries resulting from falls peaked between 12 noon and 3pm.The femur was the most commonly fractured bone (21.7%). Green stick fractures occurred in 7.9% of the patients seen. Open fractures were seen in 6.3% of the patients. Physeal injuries occurred in 4.8% of paediatric fractures. Some injured paediatric patients (12.3%) were taken to the traditional bone setters prior to presentation at LUTH with 3(4.7%) of them presenting with gangrene of the affected limb.CONCLUSION: Road traffic accident remains the commonest cause of fractures in children. However, injuries sustained at the home environment were quite significant. Emphasis on increase supervision and safety practices at home are strongly recommended.KEY WORDS: Paediatric fracture, limb gangrene, road traffic injuries, mechanism of injury, birth traum

Validation of mangled extremity severity score in assessing the need for extremity amputation

INTRODUCTION: The decision to either salvage or amputate a mangled extremity poses great challenge to a surgeon.Different scoring systems were therefore developed to aid orthopaedic surgeons in this decision,eitherto contemplate amputation or proceed to salvage a mangled extremity. Of these scoring systems, the mangled extremity severity score (MESS) is mostly used.However,the high predictive accuracy reported by its developers has not been replicated by other authors. This study was carried out to validate the use of this scoring system in Nigeria and by extension, Africa.PATIENTS MATERIALS AND METHOD:The study was a hospital based prospective descriptive one which studied all patients with mangled extremities that were admitted into the Accident and Emergency room of the Lagos University Teaching Hospital (LUTH), Idi- Araba, from April 2014 to March 2015. Injured patients with mangled extremities were resuscitated and relevant investigations conducted. The MESS was calculated at presentation in the emergency room by two senior doctors in orthopaedic and trauma units (not lower than senior registrar cadres) independently and an average score calculated, rounded up to the nearest positive integer and documented.Type of treatment offered was based on the experience of the managing consultants. Patients' progresses were monitored and functional outcomes documented. All data generated during the study were analysed using Statistical Package for the Social Sciences (SPSS inc. Chicago, Illinois. version 21.0.Year of release - 2012).RESULTS: Twenty-nine mangled extremities in 27 patients were studied.The male: female ratio was 3.5:1.Age of patients ranged between 21-70 years with a mean age of 39.9 ±12.3years. Nineteen (65.5%) extremities were salvaged while 10(34.5%) were primarily amputated. Average MESS of all mangled limbs reviewed was 8.1+ 2.6 with scores that ranged from 3 to 13. The mean MESS for limb salvage was 7.0 +2.2while that for primary amputation was 10.1+2.0(P value- 0.01).MESS in this study had a sensitivity of 90%,specificity of 47.4%,positive predictive value of 47.4%, negative predictive value of 90%.AUROC in this study was 0.853.The cost of treatment, number of surgeries, and duration of hospital stay were higher in those with Salvaged limbs.The functional outcome for salvaged upper and lower extremities were better than for those whose limbs were amputated.Level of satisfaction was better in the limbs salvaged group than for those who had ablative surgery with statistical significance (P value- .000).CONCLUSION: This study validated the clinical utility of MESS in predicting the need for amputation in patients with mangled extremity injuries but it had a low predictive accuracy for extremities that would eventually enter the limb salvage pathway.Therefore,when contemplating limb salvage for a patient with mangled extremity,in addition to the result of the MESS score,the surgeons experience cannot be overemphasized.KEY WORDS: Open fracture,mangled limb,amputation,MESS score,classificatio

Mentorship in orthopaedic and trauma residency training programme in Nigeria: the residents' perspective

Background: Mentorship is important in residency training as it is necessary for personal and professional development of the resident traineesObjectives: This study documents mentorship in orthopaedic residency training programme in Nigeria by assessing the awareness of orthopaedic residents on the role of a mentor, willingness to be mentored and their perceived reasons for the possible lack of mentors/ participation of senior colleagues in a mentorship programmeMethod: This was a descriptive cross sectional study of 37 orthopaedic residents attending a revision course of the Faculty of Orthopaedics, National Postgraduate Medical College of Nigeria. Self-administered structured questionnaires were used to collect data. Data obtained was analyzed using SPSS version 21.0.Results: The mean age of the respondent was 34.7 ± 4.7 years. The Male: Female ratio was 19:1. The average number of years already spent in the residency programme by the respondents was 2.8 ± 0.9 years. Only 27% of residents had participated in a mentorship programme since they began residency programme but only half were still being mentored at the time of the study. Sixty-five percent reported no formal mentorship programme in their institutions. However, 73% of the respondents would want a formal mentorship programme in their institution. Ninety percent of the respondents desired to be mentored.Conclusion: Most residents are willing to be mentored. Consultants and trainers should ensure that the trainees are mentored.Keywords: Mentorship, Orthopaedic Residents, Residency Training, Fellowship Training Nigeri

Anterior knee pain associated with an anterior superior patellar bony spur: a case report

Anterior knee pain is a common presentation in Orthopaedic out patient practice. However anterior superior patellar spur is an uncommon cause.This case presentation is to highlight an anterior superior patellar spur with quadriceps tendonitis. The patient is a 52 year old man who presented with a recurrent anterior knee pain. The radiographic study revealed an anterio-superior patellar spur. The patient had a depo steroid injection as an adjunct therapy to physiotherapy and has been pain free

Self-reported risk factors for musculoskeletal disorders among solid waste workers in Lagos State, Nigeria

Background: Epidemiological studies have indicated an association between musculoskeletal disorders (MSDs) and physical work demands. Municipal Solid waste collection and disposal in most developing countries with inadequate or inappropriate waste management services and practices is physically demanding and increases the risk of MSDs among waste collectors.Objectives: This study determined the prevalence and self-perceived predisposing factors to MSDs amongst solid waste collectors in Lagos State, Nigeria.Methods: A descriptive cross-sectional design was used to survey 200 solid waste collectors selected using multistage sampling method. An interviewer-administered questionnaire was used to collect data on prevalence of MSDs. Perceived risk factors were assessed using questions on ergonomic work factors. Data was analyzed using Epi-info version 3.5.1.Results: The prevalence of MSDs among the solid waste collectors was 71.0%. The main body segment affected was the trunk- lower back (42.0%) and neck (37.5%), followed by the shoulder (31.5%). The self-reported risk of musculoskeletal discomfort was increased with workrelated factors such as repetitive movement of body parts during work, working under extensive pressure and awkward positioning of body when working.Conclusion: Despite a high prevalence of MSDs, there was poor attitude in adopting preventive measures. These solid waste collectors need to be taught how to prevent musculoskeletal discomfort through good posturing, and how to access appropriate care.Keywords: Low back pain, Solid Waste, Risk Factors, Occupational Illnes

Poor Health Literacy in Nigeria: Causes, Consequences and Measures to improve it

Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make an appropriate decisions concerning their health. It is one of the link by which the health status of individual and the health indices and statistics of our country can be improved upon. Factors influencing health literacy in Nigeria include the culture and belief system, poor and ineffective communication, lack of education and low educational level, and low socioeconomic status Low health literacy predisposes to poorer health status, poorer disease outcome, lack of understanding in the use of preventive services, frequent hospital visitations amongst others. Factors influencing health literacy must be identified and modified to help improve the health literacy level of the populace. This will invariably improve the health status of the populace with a resultant improvement in the health indices of our country. This is a call for the Government and Health Care Professionals to acknowledge low health literacy as a problem and, therefore, be willing to play their roles in tackling this problem to achieve a healthy Natio

The proximal tibia anthropometry in adult Nigerians: Correlation to tibial components of total knee replacement and equations for estimation of its dimensions

Background: The knee joint is commonly affected by osteoarthritis. Total Knee Replacement (TKR) is usually considered for knee osteoarthritis after failure of conservative management. The total knee prostheses used during this procedure are fashioned from bony dimensions of Westerners.Objective: This study compared some of the available tibial baseplate with the proximal tibiae dimension of Nigerians. It also provided equations that can be used to estimate dimensions of different parts of proximal tibia.Design: This was a prospective descriptive study.Methods: Fifty four matured tibiae, comprising 23 right and 31 left bones were measured. Ten parameters were measured and documented. Dimensions of proximal tibia bones from other regions of the world were retrieved from published articles. The dimensions of tibial baseplates were extracted from product monographs. Analyses were done with Microsoft excel 2010 (Microsoft Corporation, Redmond, Washington, United States) and STATA version 13 (Stata Corp, Texas. USA). Statistical significance was set at p ≤ 0.05.Results: There were no significant differences between the left and right tibiae. The average proximal tibia dimension differs from between racial groups. The average aspect ratio calculated was 1.51 ± 0.11. Three of the four implants have sizes that were far larger than the tibiae dimensions, with increment in sizes that were far steep compared to the dimensions of the proximal tibiae. There wasa mismatch of aspect ratio of the tibiae and those of the tibial baseplates. Equation to estimate the anteroposterior dimension for each tibia condyle was generated and tested on published values.Conclusion: This study provided equations that can be used to estimate the anteroposterior dimensions of tibial plateau, the medial and the lateral condyles with the estimated values within ±5mm of the actual value. This can be used as part of pre-operative planning. It also provided data that can be considered in the designing of a suitable tibial baseplate component of total knee prosthesis for Nigerians. Key words: Total knee replacement, Pre-operative, Planning, Proximal tibia, Tibia bone fixation, Nigerians, Africans, Anthropometry, Knee prosthesi

Proximal femoral bone morphological measurements: Relevance in orthopaedic and forensic medicine

Background: Numerous surgical procedures are performed on and around the proximal femur to restore the anatomy and maintain the function of the limb. Hip joint prostheses and surgical implants that are usually used for these procedures were manufactured using dimensions from other populations.Objective: This study documented the anatomic dimensions of proximal femur of Nigerians, devised various equations through regression analysis for pre-operative estimation of certain parts of the proximal femur and for use in forensic medicine. This study also correlated the dimensions of the proximal femur with different surgical implants available.Methods: A total of 56 adult dry femoral bones were studied. Parameters measured were Maximum Femoral Length (MFL), length of the femur between the tip of the greater trochanter and the lateral condyle (termed Trochanteric Length (TL) of the femur), Femoral Neck Length (FNL), Femoral Neck Diameter (FND), Femoral Neck Axial Length (FNAL), Femoral Neck Shaft Angle (FNSA) and Proximal Femoral Shaft Diameter (PFSD). The monographs of surgical implants were obtained. Analyses were done with Microsoft excel 2010 (Microsoft Corporation, Redmond, Washington, United States) and STATA version 13 (StataCorp, Texas. USA). Statistical significance was set at p ≤ 0.05.Results: The average measured values of the parameters were: MFL was 47.9cm, TL was 45.8cm, FNL was 22.9mm, FNAL was 96.9mm, FND was 30.3mm, PFSD was 28.4mm and FNSA was 130.8°. Regression analysis revealed significant statistical relationship between the lengths of femur and other parameters measured; with equations that can be used in clinical settings to estimate certain parameters: MFL = 2.5 + TL; range ± 1cm. FND = 6 + 0.05*TL(mm); range ± 5mm; FNAL = 5 + 0.206*TL(mm); range ± 15mm. TL was used in the equations because it can be measured easily in clinical settings. In forensic medicine, MFL can be estimated from the FND and FNAL, using the equations: MFL = 30.5 + 0.18*FNAL and MFL = 42.14 + 0.19*FND.Conclusion: This study has provided data of the dimensions of proximal femur in Nigerians. Various equations generated from this study will be useful in pre-operative planning, clinical settings and forensic medicines