Complications of Fracture and Dislocation Treatment By Traditional Bone Setters: A Private Practice Experience

Background: Traditional bone setting is common in developing nations. The principles of bone setting, although differing slightly among cultures are similar. The practice is not without its shortcomings as patients who have received prior traditional bonesetters (TBS) care usually present with complications to hospitals. This study seeks to document the complications seen as a result of TBS treatment of fractures and dislocations at a private ortho-trauma centre.Methods : A prospective study of consecutive patients with fractures and dislocations who had received treatment from traditional bonesetters and were seen and managed afterwards at Rehoboth Specialist Hospital , Port Harcourt st st from 1 January 2007 to 31 December 2007 .Results: During the study period, 71 patients were seen, consisting of 38 males and 33 females with a male to female ratio of 1.15:1. Their ages ranged from 4 years to 80 years with an average of 33.75 years. The most frequent age brackets were 20-29 years (32.39%) and 30-39 years (22.53%). Those with secondary and tertiary education constituted 81.69% of the total. More patients first consulted the TBS (63.38%) than orthodox practice (36.62%) after the injury. There were 74 fractures (86.05%) and 12 dislocations (13.95%) with more of the injuries occurring in the lower extremity. The most frequent aetiology was road traffic accidents, mostly motor-cycle related, followed by falls and sports injuries. Those who spent 4 months or more with the TBS before presentation constituted 69%. The most frequent complications were nonunion (36.47%) and malunion (24.71%) and both were associated with shortening in 31.76%. Other complications were chronic joint dislocation, ankylosis, joint stiffness, arthrosis/arthritis, chronic osteomyelitis, Volkmann's ischaemic contracture, osteonecrosis, neuropathy, limb gangrene, delayed union and pressure ulcer. The most frequent intervention was open reduction and internal fixation (60.56%) and most of the patients (78.87%) spent 4 weeks or less in the hospital. There was no mortality in this series.Conclusion: Complications following treatment of fractures and dislocations by TBS are common. The common complications include non-union, malunion which were both associated with shortening as well as chronic joint dislocation, although the largely avoidable limb gangrene still occurred. There is a need for basic training of TBS for them to be integrated into the primary care system.Keywords: Traditional bonesetters; Fractures; Dislocations; Complications

Domestic accidental deaths in the Niger Delta region, Nigeria

Background: Domestic accidental deaths constitute a public health burden in the Niger Delta Region of Nigeria. This study is aimed at highlighting this public health burden. Objective: This is study is aimed at highlighting this public health burden. Design: A six year retrospective study using mortuary records. Setting: University of port Harcourt Teaching Hospital, Port Harcout, Nigeria. Patients and Methods: Coroner's forms data were used from University of port HArcout Teaching Hospital anatomical pathology department, which is the foremost health institution in the region serving a core population of about six million people. Results: Eighty three domestic accidental deaths seen at the University of Port Harcourt Teaching Hospital in the Niger Delta Region of Nigeria between January 1995 and December 2001 were analysed. The 83 deaths occurred in 63 males and 20 females, giving a ratio of 3:1, between the ages of six months and 86 years. There was a bimodal age distribution, with 20 cases (24.1%) occurring in preschool age children, and 22 cases (26.5%) occurring in the elderly over 70 years. Fifty one deaths (61.4%) occurred in the urban areas, while 32 cases (36.8%) occurred in the rural areas. Seventeen cases (20.5%) occurred from falls from height or same level, thereby, constituting the commonest mechanism of injuries that lead to death in the elderly. In children, the commonest mechanism of injuries leading to death was poisoning. The yearly incidence of these deaths is decreasing with the peak of 26.5% in 1995, and 6.0% in 1999. Conclusion: Enforceable legislation by government coupled with public education to reduce occurrence should be encouraged. Safety at home must be taken very seriously. East African Medical Journal Vol.80(12) 2003: 622-62

A Report Of Two Cases Of Uncemented Total Hip Replacement In Patients With Sickle Cell Disease

This is a report of two sickle cell patients (HbSS) with advanced osteoarthritis of the right hip. The patients were in Ficat and Arlet\'s stage 3 and 4 respectively. Both were females aged 23 and 46 years and they had uncemented hydroxyapatite coated omnifit (Stryker Howmedica Osteonics) total hip prosthetic replacement. The results so far have been quite encouraging. The procedure is technically demanding, fraught with risks and expensive but very useful. This is the first of such reports in Nigeria. Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 257-25

Prevalence, awareness, treatment, and control of hypertension in Nigeria in 1995 and 2020: A systematic analysis of current evidence

Improved understanding of the current burden of hypertension, including awareness, treatment, and control, is needed to guide relevant preventative measures in Nigeria. A systematic search of studies on the epidemiology of hypertension in Nigeria, published on or after January 1990, was conducted. The authors employed randomeffects meta-analysis on extracted crude hypertension prevalence, and awareness, treatment, and control rates. Using a meta-regression model, overall hypertension cases in Nigeria in 1995 and 2020 were estimated. Fifty-three studies (n = 78 949) met our selection criteria. Estimated crude prevalence of pre-hypertension (120-139/80-89 mmHg) in Nigeria was 30.9% (95% confidence interval [CI]: 22.0%-39.7%), and the crude prevalence of hypertension (≥140/90 mmHg) was 30.6% (95% CI: 27.3%-34.0%). When adjusted for age, study period, and sample, absolute cases of hypertension increased by 540% among individuals aged ≥20 years from approximately 4.3 million individuals in 1995 (age-adjusted prevalence 8.6%, 95% CI: 6.5-10.7) to 27.5 million individuals with hypertension in 2020 (age-adjusted prevalence 32.5%, 95% CI: 29.8-35.3). The age-adjusted prevalence was only significantly higher among men in 1995, with the gap between both sexes considerably narrowed in 2020. Only 29.0% of cases (95% CI: 19.7-38.3) were aware of their hypertension, 12.0% (95% CI: 2.7-21.2) were on treatment, and 2.8% (95% CI: 0.1-5.7) had at-goal blood pressure in 2020. Our study suggests that hypertension prevalence has substantially increased in Nigeria over the last two decades. Although more persons are aware of their hypertension status, clinical treatment and control rates, however, remain low. These estimates are relevant for clinical care, population, and policy response in Nigeria and across Africa

Proposal for lateral malleolar reconstruction in fibula loss proximal to the syndesmosis

No Abstract. Nigerian Journal of Medicine Vol. 14(1) 2005: 100-10

Epidemiology of open tibial fractures in a teaching hospital

Background: Open tibial fracture is a common orthopaedic challenge in Nigeria with adverse economic implications. The aim of study is to investigate the epidemiology of the problem. Methods: This is a prospective observational study of all open tibial fractures seen at the Accident and Emergency department of the University of Port Harcourt Teaching Hospital (UPTH) over a twelve- month period (July 2002- June 2003). Data from a pre-designed proforma for the study was analyzed and descriptive statistics of the epidemiology is presented. Results: Seventy-two open fractures were seen in 70 patients. The male to female ratio was 2.5:1 and the peak age incidence was in the 20-29 years age group (38.6%) followed by the 30-39 years age group (31.4%). The extremes of age were least affected. Road accidents constituted most of the injuries (91.4%), of which 51.5% was motorcycle related. The passenger was the most at risk of injury (56.3%). Gustilo and Anderson type III open injuries were the most frequent followed by the type II injuries. Conclusion: The burden of open tibial fractures in Nigeria is significant. Most fractures of the tibia are open and results from high-energy injuries. They are usually associated with other injuries, which are the major contributors to morbidity and mortality. Poverty and lack of social infra structures are contributory factors. Port Harcourt Medical Journal Vol. 1 (3) 2007: pp. 156-16

A review of the orthopaedic complications of stroke

No Abstract. Nigerian Journal of Orthopaedics and Trauma Vol. 6 (1) 2007: pp. 1-

Characteristics of In-patient Deaths in a Private Health Facility

Background: Death in a private facility is a very traumatic event because of its far reaching economic and social consequences.The aim of the review is to establish the characteristics of deaths amongst admitted patients in a privte facility in Niger Delta , Nigeria. Methods: This was a 7 year retrospective review of deaths amongst admitted patients in a private facility from 2001 to 2007. Demographics and other characteristics were analysed bearing in mind the ortho-trauma bias of the facility. Simple statistical methods were adopted. Results: In the 7 year period 10,431 patients came for treatment, 3285 (31.49%) were admitted and 72 of the patient died with a crude mortality rate of 0.69%. Male to Female ratio was 1.25:1 with the mean age of 43+20. Presenting pathologies included head injury (11.9%), malignancies (10.9%), cervical spine trauma (9.5%), and cardiovascular pathologies (8.2%). A lot of the patients had long bone fractures (22.5%,n=19). Many patients died within 24 hours of admissiom(18.1%) or an intervention (20%). Septicaemia (19.4%), hypovolaemic shock and head trauma (9.7%) each were complications that provided the terminal exits. Conclusion: Standard facilities might reduce some of these deaths which are preventable.We recommend enforceable minimal standards of care.Questionable deaths must be audited by a goverment enabled body with ability to sanction culprits.It might be a step in the right direction. Keywords: admission, deaths, demographics, trauma Nigeria Journal of Orthopaedics and Trauma Vol. 7 (2) 2008: pp. 73-7

Patronage of traditional bone setters for musculoskeletal conditions: A one-year study

Background: Traditional medical practice including bonesetting is a very ancient art.  Patronage of traditional bone setters (TBS) is high in Nigeria.Aim: To document the reasons for patronage of traditional bone setters in a private ortho-trauma centre.Methods: A prospective study of consecutive patients with musculoskeletal conditions who had received treatment from traditional bone setters and were seen and managed afterwards at Rehoboth Specialist Hospital from 1st January 2007 to 31st December 2007.Results: In the study period , 84 patients were seen, 45 males and 39 females with a male to female ratio of 1.2:1. Their ages ranged from 2 years 4 months to 85 years with an average of 32.8 years. Those with secondary and tertiary levels of education constituted over 75%. The most frequent diagnosis/pathology was fractures (70.2%) followed by dislocations (14.3%). More patients (61.9%) consulted the traditional bone setter than orthodox practice (36.9%) as point of first consult after pathology. The duration of TBS treatment before presentation in 65% was 4 months or more. The most frequent reason for choice of TBS treatment was pressure by friends and relatives (58.3%) followed by TBS being better than orthodox (13.1%), cost considerations (10.7%), proximity (9.5%), cultural belief (3.6%), and fear of surgery (3.6%) amongst others.Conclusion: Patronage of traditional bone setters for musculoskeletal conditions is high and the level of educational attainment does not affect this. Keywords: Traditional bone setters, Musculoskeletal conditions, Patronag

Gunshot injuries in the Niger Delta region of Nigeria

Background: Violent trauma especially by gunshot injuries appears to be on the increase worldwide. There is inadequate data from many centres in Nigeria to support this observation. Aim: To determine the pattern of gunshot injuries in the University of Port Harcourt Teaching Hospital (UPTH). Methods: This was a prospective study covering a period of three years (January 2002-December 2004). A standard proforma was used to record all cases of gunshot injuries reporting to the UPTH. Details sought were age, gender, occupation, gun type, anatomic region of the body involved and treatment given. Other information recorded were time of injury, duration of hospital stay, injury time before presentation, assailant and outcome. Information was obtained directly from victims, relations, the police or those accompanying the victim. Where surgical operations were done or patients were admitted to the wards, relevant information or findings were then retrieved from theatre and ward records. Results: There were 135 patients (120 males and 15 females) between the ages of 1½ -67 years. Students and civil servants constituted the largest number. Seventy-one injuries were due to high velocity missiles while 64 were low velocity. Armed robbery and attacks by “unknown assailants” were the commonest modes of attack with 47 and 41 victims respectively. The lower limbs, abdomen and chest were the most frequent anatomic regions involved recording 38, 28 and 27 cases respectively. There were 9 cases in which multiple anatomic sites were affected. The majority of patients (56) presented within 12-18 hours after injury; only 9 cases presented within 6 hours. Twenty-nine patients underwent laparotomy while 14 had thoracostomies. Forty-nine patients were treated and discharged. Minor surgery (like wound debridement) was the commonest treatment in 43 patients. All cases of fracture among these were subsequently referred to the trauma unit for appropriate treatment. Thirty patients died giving a mortality rate of 22.2%. Conclusion: Gunshot injuries constitute a major cause of violent trauma in the Niger Delta Region of Nigeria with a high and disturbing level of morbidity and mortality. Port Harcourt Medical Journal Vol. 1(1) September 2006: 34-3