Pattern and Outcome of Management for Traumatic Closed Cervical Spine Injuries at The National Orthopaedic Hospital, Enugu, Nigeria.

Background: The cervical spine is an area quite prone to trauma due to its mobile character. It is placed under various significant demands during various physical activities which predispose it to various injuries. The knowledge and good understanding of the common patterns of cervical spine injuries and their mechanisms will facilitate accurate assessment, diagnoses and prompt appropriate decisions about specific management. The main thrust of the application of epidemiologic methods to the study of spinal injuries is aimed at identifying injury trends and correlating these trends with definite risk factors and preventive strategies. The aim of the study is to determine the pattern and early outcome of management of closed cervical spine injuries at Enugu.Methods: A retrospective study was done in which the records of 132 patients admitted for closed cervical spine injuries over a ten year period were analyzed and the following data extracted: demographic indices, mechanism of injury, spinal level of injury, type of vertebral injury, complications, duration of stay in hospital, nature and level of cord injury, residual morbidity at discharge, and duration of follow-up visits.Results: The age of the patients ranged from 5 - 80 years with a mean of 37 years. More males were involved (93.9%) than females (6.1%). The commonest mechanism of injury is road traffic accidents (66.7%) and the most frequently involved segment is the C6/C7. Fracture subluxation of C6 on C7 occurred in 27.3% of cases. 75.8% of cases had complete cord injury while 24.2% had incomplete lesions. Pressure sores and urinary tract infection were the commonest complications seen in 29.5% and 24.4% respectively. The length of hospital stay for the majority of the patients (47%) was between 4 weeks and 12 weeks. At discharge, 56% of all the patients were wheel chair bound, 22.7% were mobilizing with walking aids and death occurred in 21.2%, mostly high cervical cord injured patients. 93.6% of the patients with incomplete cord injury were mobilizing with walking aids at the point of discharge. 60% and 75% of the patients were lost to fellowup at one and two years respectively.Conclusion: Lower cervical spine fracture subluxation is the commonest site of cervical spine injury in our environment. Complete cord injury is commoner than incomplete cord injury. The commonest complications in our environment are pressure sores and urinary tract infection. Prevention of these injuries remains the best  management option.Key Words: cervical spine injury, pattern, outcome, Nigeria

Pattern of femoral fractures and associated injuries in a Nigerian tertiary trauma centre

Background: The femur is the strongest and largest bone in the human body. It therefore requires high-energy trauma for it to fracture unless there is an ongoing pathology that weakens the bone. Femoral fractures are thus associated with significant pain, deformities, bleeding and varying degrees of injuries. The aim of this study is to determine the pattern of femoral fractures and the associated injuries in our region while recommending possible means of averting these injuries.Materials and Methods: A 10-year retrospective study was done in National Orthopedic Hospital Enugu from 1994 to 2003. The demographic data, etiology, the part of femur affected and associated injuries were collated from the hospital records/folders. The analysis was performed using descriptive statistics in Microsoft Excel 2007.Results: A total of 562 cases were reviewed, 63.7% of all the patients were males and the most common etiological factor was road traffic accidents. The site of fracture varied with age and etiology with 26.5% occurring at the mid-shaft with an average age of 27.2 years and 16% occurring at the neck of femur, more in the elderly, with 55.6% following minor falls and trips. The most common associated injury was soft tissue injuries requiring secondary wound closure.Conclusion: Femoral fractures are common and the pattern varies with age and the mechanism of injury. They are associated with other injuries that may be life-threatening.Keywords: Associated injuries, femoral fractures, Nigeria, patter

Aetiology and pattern of bone and joint infection presenting at a regional orthopaedic hospital

BACKGROUND: Bone and joint infection is one condition that can either be rewarding,or a night mare to the surgeon.This work reports the causes and pattern of presentation of bone and joint infections in our sub region.METHOD: A retrospective review of 73 cases of non granulomatous bone infection seen over two years from January 2012 to December 2013 was done. Patients' biodata,complaint,time to presentation in the hospital and if any intervention by the traditional bone setters, limbs involved, primary cause, diagnosis, organism cultured and retroviral status were obtained from the folders.Results:Commonest age group involved was in the second decade with 21.9%. Male to female ratio is 2.2:1. Chronic osteomyelitis was the commonest infection with 46.6% (34 patients) followed by septic arthritis with 26%.The lower limb was more involved than the upper limb with a ratio of 5.6: 1.A significant number of patients 59 (80.8%) presented more than two weeks after onset of symptoms while 27 patients (36.9%) visited the traditional bone setters for treatment before presenting to the hospital. Staphylococcus aureus was the commonest organism isolated.CONCLUSION: Chronic osteomyelitis is the commonest bone and joint infections in our environment mainly from trauma and closely followed by improperly treated haematogenous acute osteomyelitis.Acute osteomyelitis is a rare occurrence as late presentation and patronage of traditional bone setters is rife.KEY WORDS: Bone infection,joint infection,aetiolog

Pattern and Outcome of Management for Traumatic Closed Cervical Spine Injuries at The National Orthopaedic Hospital, Enugu, Nigeria.

Background: The cervical spine is an area quite prone to trauma due to its mobile character. It is placed under various significant demands during various physical activities which predispose it to various injuries. The knowledge and good understanding of the common patterns of cervical spine injuries and their mechanisms will facilitate accurate assessment, diagnoses and prompt appropriate decisions about specific management. The main thrust of the application of epidemiologic methods to the study of spinal injuries is aimed at identifying injury trends and correlating these trends with definite risk factors and preventive strategies. The aim of the study is to determine the pattern and early outcome of management of closed cervical spine injuries at Enugu.Methods: A retrospective study was done in which the records of 132 patients admitted for closed cervical spine injuries over a ten year period were analyzed and the following data extracted: demographic indices, mechanism of injury, spinal level of injury, type of vertebral injury, complications, duration of stay in hospital, nature and level of cord injury, residual morbidity at discharge, and duration of follow-up visits.Results: The age of the patients ranged from 5 - 80 years with a mean of 37 years. More males were involved (93.9%) than females (6.1%). The commonest mechanism of injury is road traffic accidents (66.7%) and the most frequently involved segment is the C6/C7. Fracture subluxation of C6 on C7 occurred in 27.3% of cases. 75.8% of cases had complete cord injury while 24.2% had incomplete lesions. Pressure sores and urinary tract infection were the commonest complications seen in 29.5% and 24.4% respectively. The length of hospital stay for the majority of the patients (47%) was between 4 weeks and 12 weeks. At discharge, 56% of all the patients were wheel chair bound, 22.7% were mobilizing with walking aids and death occurred in 21.2%, mostly high cervical cord injured patients. 93.6% of the patients with incomplete cord injury were mobilizing with walking aids at the point of discharge. 60% and 75% of the patients were lost to fellowup at one and two years respectively.Conclusion: Lower cervical spine fracture subluxation is the commonest site of cervical spine injury in our environment. Complete cord injury is commoner than incomplete cord injury. The commonest complications in our environment are pressure sores and urinary tract infection. Prevention of these injuries remains the best  management option.Key Words: cervical spine injury, pattern, outcome, Nigeria

Orthopaedic Complications of Sickle Cell Disease: A Review

Sickle cell disease (SCD) is a genetic disorder of mutant haemoglobin. It is inherited as an autosomal recessive disorder and is common in the West Africa subregion. Many of its orthopaedic complications require surgical intervention and many of its diverse manifestations need to be differentiated from some surgical conditions. The surgical/anaesthetic risks due to the pathophysiology of the disease process require that the patients should be properly assessed, optimized, monitored and followed up well after definitive care. Acute care, anaesthetic preparations and immediate post operative period are critical in the care of these patients.Keywords: sickle cell disease, orthopaedic complications, anaesthesia , Surgery

Perioperative care of children with sickle cell disease: a systematic review and clinical recommendations.

Children with sickle cell disease (SCD) require specific perioperative care, and clinical practice in this area remains poorly defined. We aimed to a) conduct a systematic, PRISMA-based review of the literature and any available clinical guidelines, practice recommendations, and extract any valuable information for the "best of available-evidence"-based prevention of perioperative adverse events in children with SCD, b) highlight the most urgent priorities in clinical research. As data sources, US National Library of Medicine, Medline, National Guideline Clearinghouse, International Guideline Network, TRIP databases were searched for any content until January 2019. We also included institutional, consortia and expert group guidelines. Included were reports/guidelines in English, French, German, Italian. Excluded were reports on obstetrical and fetal management. We identified 202 reports/guidelines fulfilling the criteria outlined above. A majority focused on visceral, cardiovascular and orthopedic surgery procedures, and only five were multicenter randomized controlled trials and two prospective randomized studies. After grading of quality of evidence, the extracted data was summarized into clinical recommendations for daily practice. Additionally, we designed a risk-grading algorithm to identify contexts likely to be associated with adverse outcomes. In conclusion, we provide a systematic PRISMA-based review of the existing literature and any ancillary practice and delineate a set of clinical recommendations and priorities for research. This article is protected by copyright. All rights reserved