Brief communication: Adult limb fractures in Tikur Anbessa Hospital caused by road traffic injuries: Half year plain radiographic pattern

Musculoskeletal road traffic injuries (RTIs) are alarmingly increasing encounters in trauma centers of developing countries and they are public health emergency. Knowledge of commonly presenting radiological pattern helps in planning and getting prepared for managing these injuries. This prospective study done at Addis Ababa University, Medical Faculty, “Tikur Anbessa” Hospital (TAH) was aimed at detailing the radiology of musculoskeletal RTIs in a half- year period from March to August 2007, in Addis Ababa. A total of 202 patients with musculoskeletal road traffic injuries were included in the study. Of the total 422 adult patients who presented to the emergency department of TAH and had musculoskeletal injuries, in nearly half, 49.7% (202 patients) the cause of injury was road traffic accident (RTA). The highest frequency of fractures occurred in the femur 32(15.8%) followed by tibio-fibular 29(14.4%) and humerus 26(12.9%). Incomplete fractures comparatively accounted smaller proportions, 23(11.4%). Transverse fractures stand out the first 125(61.9. %) followed by oblique 38 (18.8%) and comminuted 29 (14.4%) fractures. Road traffic injuries (RTI) were responsible for almost half of the musculoskeletal injuries. Machine injuries and fall injuries were second and third respectively. Most of the fractures were simple transverse and may bemanageable on a day case basis. RTI needs special attention, prevention, intervention and planning of management. [Ethiop. J. Health Dev. 2010;24(1):61-63

Childhood limb fracture at Tikur Anbessa Specialised Hospital (TASH), Addis Ababa, Ethiopia

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Fractures around child’s elbow-radiological patterns

Background: This was a one-year prospective study aimed at evaluating the clinical and radiological patterns of the paediatric elbow fractures and determining the magnitude of the problem. The clinical and radiological pitfalls in managing such fractures were also studied and addressed. The setting was in Addis Ababa University, Medical Faculty, Department of Radiology, Tikur-Anbessa Referral/teaching Hospital.Methods: This was a prospective study of paediatric elbow fractures that were seen at our University Hospital from January 2005 to January 2006. The study population consisted of all children aged less than 16 years who sustained trauma and had a fracture around their elbow. After thorough history and clinical examination routine PA & Lateral plain radiographs were taken. Both Orthopedic Surgeons and Radiologists discussed the findings and these were recorded using the prepared format. More X-ray views, contra lateral elbow X-rays and discussions were conducted on doubtful cases. A total of 223 elbows with fracture were followed up, 72 children with elbow trauma but without fractures were excluded from the study.Results: Males accounted for 168 (75.5 %) of cases. A total of 214 (96%) of the injuries resulted from falls. Only in 7 children reported having been ‘Hit by car’ as cause of fracture and all these were males. The left side was involved in 147 (66%) of instances. The commonest fracture type was supracondylar in 154/223 (69.1%), followed by Capitallar in 31 (13.9%) and medial Epicondylar fracture in 11 (5%). Posterior displacement was the commonest direction of displacement for supracondylar fractures (44.8%). There were no radial neck and isolated medial humeral condyle fractures encountered. Trochlear fracture was of higher incidence than comparable studies. Posterior fat pad radiological sign was present in 77% of elbows. Two children were found evidently abused. Diagnosis of fracture pattern was difficult/ ‘disputable’ in 22 elbows and in four elbows diagnosis was completely missed and later on detected at follow-up clinics.Conclusion: Fractured pediatric elbow is a common clinical encounter and poses a significant diagnostic challenge. Such fractures should be handled cautiously and in doubtful cases discussions between surgeon and radiologist is valuable. Posterior fat pad sign is a reliable radiological diagnostic indicator of pediatric elbow fractures. Additional diagnostic modalities like MRI should be taken to clearly visualize doubtful fractures and cartilaginous secondary new ossification centers at specific ages

X-ray film reject rate analysis at eight selected government hospitals in Addis Ababa, Ethiopia, 2010

Background: Improper practices in radiography that lead to possible repeating of procedures predispose patients for additional cost, more waiting time, and excess dose of ionizing radiation, leading to various dose dependent and dose independent health problems including cancer. In the face of such problems and the scarcity of resources, improvingthe quality and efficiency of radiology services is imperative.Objective: The purpose of this research was to identify the main causes of film faults as well as the pattern and magnitude of film rejection.Methods: Using a prospective cross-sectional hospital based approach; eight public hospitals were selected in Addis Ababa through convenience sampling. Adult and pediatrics radiographs with film faults were reviewed using a standardized checklist of common causes of reject. The collected data were then entered into a database for analysis using descriptive statistics.Results: Reject rate was calculated in eight governmental hospitals across all plain film examinations. The overall reject rate was 374 (3.1 %) in 12,165 x-ray exposures. Total reject rate by hospital showed 10.5% for Zewditu and 1.53% and 1.87% for Tikur Anbessa Specialized Hospital (TASH) and the Police Hospital, respectively.Conclusions: Rejected films were found to have been caused by numerous factors including poor technical judgment, patient motion, and poor supervision of staff. Hence, strategies need to be developed within medical imaging departments to improve the situation.[Ethiop. J. Health Dev. 2012;26(1):54-59

Etiological spectrum and treatment outcome of Obstructive jaundice at a University teaching Hospital in northwestern Tanzania: A diagnostic and therapeutic challenges

Obstructive jaundice poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. This study was undertaken to highlight the etiological spectrum, treatment outcome of obstructive jaundice in our setting and to identify prognostic factors for morbidity and mortality. This was a descriptive prospective study which was conducted at Bugando Medical Centre between July 2006 and June 2010. All patients with a clinical diagnosis of obstructive jaundice were, after informed consent for the study, consecutively enrolled into the study. Data were collected using a pre-tested structured questionnaire and analyzed using SPSS computer software version 11.5. A total of 116 patients were studied. Females outnumbered males by a ratio of 1.3:1. Patients with malignant obstructive jaundice were older than those of benign type. Ca head of pancreas was the commonest malignant cause of jaundice where as choledocholithiasis was the commonest benign cause. Abdominal ultrasound was the only diagnostic imaging done in all patients and revealed dilated intra and extra-hepatic ducts, common bile stones and abdominal masses in 56.2%, 78.9%, 58.1% and 72.4% of the cases respectively. A total of 110 (94.8%) patients underwent surgical treatment and the remaining 6 (5.2%) patients were unfit for surgery. The complication rate was 22.4% mainly surgical site infections. The mean hospital stay and mortality rate were 14.54 days and 15.5% respectively. A low haematocrit and presence of postoperative sepsis were the main predictors of the hospital stay (P < 0.001), whereas age > 60 years, prolonged duration of jaundice, malignant causes and presence of postoperative complications mainly sepsis significantly predicted mortality (P < 0.001). Obstructive jaundice in our setting is more prevalent in females and the cause is mostly malignant. The result of this study suggests that early diagnosis and treatment plays an important role in the prognosis of patients with obstructive jaundice

Guidance for Evidence-Informed Policies about Health Systems: Assessing How Much Confidence to Place in the Research Evidence

In the third paper in a three-part series on health systems guidance, Simon Lewin and colleagues explore the challenge of assessing how much confidence to place in evidence on health systems interventions

Fractures around child&apos;s elbow-Radiological patterns

Background: This was a one-year prospective study aimed at evaluating the clinical and radiological patterns of the paediatric elbow fractures and determining the magnitude of the problem. The clinical and radiological pitfalls in managing such fractures were also studied and addressed. The setting was in Addis Ababa University, Medical Faculty, Department of Radiology, Tikur-Anbessa Referral/teaching Hospital. Methods: This was a prospective study of paediatric elbow fractures that were seen at our University Hospital from January 2005 to January 2006. The study population consisted of all children aged less than 16 years who sustained trauma and had a fracture around their elbow. After thorough history and clinical examination routine PA & Lateral plain radiographs were taken. Both Orthopedic Surgeons and Radiologists discussed the findings and these were recorded using the prepared format. More X-ray views, contra lateral elbow X-rays and discussions were conducted on doubtful cases. A total of 223 elbows with fracture were followed up, 72 children with elbow trauma but without fractures were excluded from the study. Results: Males accounted for 168 (75.5 %) of cases. A total of 214 (96%) of the injuries resulted from falls. Only in 7 children reported having been &apos;Hit by car&apos; as cause of fracture and all these were males. The left side was involved in 147 (66%) of instances. The commonest fracture type was supracondylar in 154/223 (69.1%), followed by Capitallar in 31 (13.9%) and medial Epicondylar fracture in 11 (5%). Posterior displacement was the commonest direction of displacement for supracondylar fractures (44.8%). There were no radial neck and isolated medial humeral condyle fractures encountered. Trochlear fracture was of higher incidence than comparable studies. Posterior fat pad radiological sign was present in 77% of elbows. Two children were found evidently abused. Diagnosis of fracture pattern was difficult/ &apos;disputable&apos; in 22 elbows and in four elbows diagnosis was completely missed and later on detected at follow-up clinics. Conclusion: Fractured pediatric elbow is a common clinical encounter and poses a significant diagnostic challenge. Such fractures should be handled cautiously and in doubtful cases discussions between surgeon and radiologist is valuable. Posterior fat pad sign is a reliable radiological diagnostic indicator of pediatric elbow fractures. Additional diagnostic modalities like MRI should be taken to clearly visualize doubtful fractures and cartilaginous secondary new ossification centers at specific ages