Avascular necrosis of the femoral head in HIV positive patients-an assessment of risk factors and early response to surgical treatment

26 consecutive patients (37 hips) with avascular necrosis (AVN) of the femoral head treated surgically at our institution from 1999 to 2008 were reviewed . The aims of the study were to evaluate the risk factors associated with AVN in HIV positive and HIV negative individuals, and assess early response to total hip replacement (THR) surgery in HIV positive and negative patients. There were 15 male and 11 female  patients in total. The mean age for all patients was 47.1± 8.0 years  (range, 33 to 66 years). 12 patients were HIV positive, 11 patients were HIV negative and 3 patients had unknown HIV status. Excessive alcohol intake was the most common risk factor for developing AVN .15 patients (58%) had more than one risk factor for AVN and only 2/12 (17%) HIV positive patients had no other risk factor apart from HIV infection. There were no early postoperative complications in 34 arthroplasties in both HIV positive and negative patients. The aetiology of AVN seems often to be multifactorial, even in the presence of HIV infection. Early response to arthroplasty surgery in AVN of the femoral head is equally good irrespective of the HIV serostatus of the patients

Geographical Differences in the Forefoot Morphology – A Comparative Radiological Study of Feet in Malawi and UK

Background: Many skeletal morphological differences between populations have been reported with possible but unproven clinical importance. This study was aimed at identifying the normal radiographic findings and measurements seen in patients from Southern Africa and compares them to a European population’s values.Methods: AP foot radiographs of 40 adults from Blantyre, Malawi were compared with those of 40 adults from London, UK. For each patient, measurements were taken of: 1st and 2nd metatarsal lengths, the 1st/2nd intermetatarsal angle, the 1st metatarso- phalangeal angle (the ‘bunion’ angle), and the 2nd metatarsal mortice joint medial and lateral depths.Results: Our results show an increased 1st/2nd metatarsal angle in Malawian feet, but a reduced ‘bunion’ angle. We also found the second metatarsal length to be longer relative to the first in the Malawian foot, and the 2nd metatarsal base to be significantly more covered by its mortice than in UK feet.Conclusion: This racial anatomical variation may convey more stability and less risk of a Lisfranc dislocation. It is also important to be aware of the normal range of these values when considering the need for forefoot arthroplasty procedures

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

Geographical Differences in the Forefoot Morphology – A Comparative Radiological Study of Feet in Malawi and UK

Background: Many skeletal morphological differences between populations have been reported with possible but unproven clinical importance. This study was aimed at identifying the normal radiographic findings and measurements seen in patients from Southern Africa and compares them to a European population’s values. Methods: AP foot radiographs of 40 adults from Blantyre, Malawi were compared with those of 40 adults from London, UK. For each patient, measurements were taken of: 1st and 2nd metatarsal lengths, the 1st/2nd intermetatarsal angle, the 1st metatarso-phalangeal angle (the ‘bunion’ angle), and the 2nd metatarsal mortice joint medial and lateral depths. Results : Our results show an increased 1st/2nd metatarsal angle in Malawian feet, but a reduced 'bunion' angle. We also found the second metatarsal length to be longer relative to the first in the Malawian foot, and the 2nd metatarsal base to be significantly more covered by its mortice than in UK feet. Conclusion: This racial anatomical variation may convey more stability and less risk of a Lisfranc dislocation. It is also important to be aware of the normal range of these values when considering the need for forefoot arthroplasty procedures

Prioritisation of surgery in the national health strategic plans of Africa: A systematic review.

Disease amenable to surgical intervention accounts for 11-15 % of world disability and there is increasing interest in surgery as a global public health issue. National Health Strategic Plans (NHSPs) reflect countries' long-term health priorities, plans and targets. These plans were analysed to assess the prioritisation of surgery as a public health issue in Africa.NHSPs of 43 independent Sub-Saharan African countries available in the public domain in March 2014 in French or English were searched electronically for key terms: surg*, ortho*, trauma, cancer, appendic*, laparotomy, HIV, tuberculosis, malaria. They were then searched manually for disease prevalence, targets, and human resources.19 % of NHSPs had no mention of surgery or surgical conditions. 63 % had five or less mentions of surgery. HIV and malaria had 3772 mentions across all the policies, compared to surgery with only 376 mentions. Trauma had 239 mentions, while the common surgical conditions of appendicitis, laparotomy and hernia had no mentions at all. Over 95 % of NHSPs specifically mentioned the prevalence of HIV, tuberculosis, malaria, infant mortality and maternal mortality. Whereas, the most commonly mentioned surgical condition for which a prevalence was given was trauma, in only 47 % of policies. All NHSPs had plans and measurable targets for the reduction of HIV and tuberculosis. Of the total 4064 health targets, only 2 % were related to surgical conditions or surgical care. 33 % of policies had no surgical targets.NHSPs are the best available measure of health service and planning priorities. It is clear from our findings that surgery is poorly represented and that surgical conditions and surgical treatment are not widely recognised as a public health priority. Greater prioritisation of surgery in national health strategic policies is required to build resilient surgical systems