Spectrum of musculo-skeletal disorders in sickle cell disease in Lagos, Nigeria

<p>Abstract</p> <p>Background</p> <p>Sickle cell anemia (SCA) is a common genetic disease in Nigeria. Past studies from West Africa focused on isolated aspects of its medical and surgical presentations. To the best of our knowledge, the musculo-skeletal presentations amongst Nigerians with SCA have not been documented in a single all encompassing study. This work aims to prospectively document the musculo-skeletal disease burden among SCA patients.</p> <p>Methods</p> <p>In a prospective study of 318 consecutive patients with genotype-confirmed SCA at the Lagos University Teaching Hospital (LUTH), the musculo-skeletal pathologies, anatomic sites, grade of disease, age at presentation and management outcome were recorded over a one-year period. Data obtained were analyzed using Epi-Info software version 6.0. Data are presented as frequencies (%) and mean values (SD) as appropriate.</p> <p>Results</p> <p>The HbSS genotype occurred in 296 (93.0%), while 22 (7.0%) were HbSC. 100 (31.4%) patients with average presenting haemoglobin concentration of 8.2 g/100 ml in the study group, presented with 131 musculo-skeletal pathologies in 118 anatomic sites. Osteomyelitis 31 (31%) and septic arthritis 19 (19%) were most commonly observed in children less than 10 years. Skin ulcers and avascular necrosis (AVN) occurred predominantly in the older age groups, with frequencies of 13 (13.0%) and 26 (26.0%) respectively. 20 (71.5%) of diagnosed cases of AVN presented with radiological grade 4 disease. The lower limbs were involved in 84 (71.1%) of sites affected. Lesions involving the spine were rare 11 (0.9%). Multiple presentations occurred in 89 (28.0%) of patients; 62 (69.7%) of which were children below 10 years.</p> <p>Conclusions</p> <p>Musculo-skeletal complications are common features of sickle cell anaemia seen in 31.4%. Infectious aetiologies predominate with long bones and joints of lower limbs more commonly affected by osteomyelitis and septic arthritis. Healthcare providers managing SCA should be aware of the potential morbidity and mortality of these conditions to ensure early diagnosis and adequate management.</p

Early outcomes of reconstructing complex distal leg defects in Lagos, Nigeria

Background: Complex defects in the distal third of the leg are often difficult problems for the reconstructive surgeon. Objective: This study aims to identify the early outcomes of reconstruction for complex defects of the distal leg. It explores basic demographics and presentation challenges associated with these defects. It further highlights various methods of reconstruction, complications, and outcomes. Materials and Methods: Between 2008 and 2013, all patients with lower leg and ankle defects that had definitive flap cover were prospectively studied. Age, sex, duration of defect, cause of defect, comorbidity, size of defects, and the reasons for delay in intervention were obtained for each patient. The type of flap used, complications, duration of hospital stay, early outcome, and ambulation status at 6 months were noted. Results: Twenty five patients were studied during the period with a male to female ratio of 3:2. Sixty eight percent (17) of the defects were trauma related. The inability to pay for treatment was the commonest cause of intervention delay. The mean size of the defects was 31 cm2. Diabetes and peripheral vascular disease were the commonest comorbidities. Perforator-based fasciocutaneous flaps were the most commonly used (48%;12), while muscle flaps (24%;6) and adipofascial turnover flaps (20%;5) were less utilized. Two patients died and one underwent a below-knee amputation. Late infection persisted in 16%(4) of the patients seen. Conclusion: Trauma-related defects predominated in this study, and financial issues delayed definitive intervention in many cases. Inspite of this, successful coverage was obtained in 84% of the patients. There was, however, a trend toward increasing infection and mortality among older patients

Management of long bone fractures using SIGN nail: experience from a Nigerian Hospital

Background: Intramedullary nailing with interlocking nails has become the treatment of choice for closed diaphyseal fractures of femur and tibia. When possible locked nailing should be performed as a closed procedure. Fractures fixed by interlocking nailing have comparatively less complications in fracture healing.Methods: A retrospective study of all fractures treated using SIGN nailing system at the Lagos University Teaching Hospital between December 2011 and November 2015 was carried out using information obtained from patient records and SIGN data base. These included biodata, aetiology of fractures, fracture type, injury presentation interval, associated lesions, outcome as well as complications and challenges in treatment.Results: A total of 184 fixations in 169 patients were carried out over a 4years period. The studied patients were aged 17 to 88years with mean of 37.66± 13.98years. One hundred and sixteen (65.2%) were aged below 40 years. There were 121 males and 48 females showing a male to female ratio 2.5:1. Road traffic accident was the most common aetiology (70.8%) The acute (recent) fractures made up about 86% of the cases seen while chronic fractures were 14%, this included malunited fracture 3.8% and non-union 10.2% The surgical approaches were ante grade in 115 cases (62.5%) and retrograde in 69 (37.5%) cases. All the retrograde procedures were performed on the femur. Fifteen patients had multiple fixations The most frequently fixed fracture using SIGN nail were femur 62.5%, tibia 31.5% and humerus 6%. The major challenges included multiple fixations in multiply injured patient as well as Fixation in non- union and malunion of three to four years post injury without image intensifier.Conclusion: Sign interlocking nail system is very effective in treatment of long bone fractures. The major challenges were seen in multiply injured patients with multiple fractures. Also patients that present after several years of injury with malunion and\or non-union may pose some challenges in treatment using SIGN nail.Keywords: Sign, Intramedullary Nail, Image Intensifier, External Jig, Fracture

Presentation and Management Outcomes of Pelvic fractures: A single Institutional Review

Background: Pelvic fractures are orthopaedic emergencies associated with  polytrauma. These fractures have gradually increased in recent times as a result of increasing high speed and complex road traffic accidents.Objective: To describe the presentation and management outcome of patients that were managed in our institution for pelvic fractures over the study periodMethodology: We retrospectively reviewed the hospital records of patients who were admitted and treated in our hospital with pelvic injuries from February 2012 to January 2015.Results: Majority 122 (75.8%) of the patients in this study were aged below 40 years. These fractures were mostly caused by road traffic accidents. Most 116 (71.9%) of our patients had Tile class A and B fractures. Polytrauma seen in 41.6% of the patients was the most common associated injury seen with pelvic fractures. The mean Injury Severity Score (ISS) 31.4 shows that these patients were mostly severely injured patients. The fatality rate in this study was 16.12%. These mortality were higher for patients with Tile class C than B injury and no death was recorded for class A injuries.Conclusion: Majority of the patients were less than 40 years and Road Traffic Accident is the commonest aetiology. Many were successfully  managed conservatively particularly those with stable and partially stable injuries. Functional outcome is generally good.Key words: Pelvic Fractures, Injury Severity Score, Pelvic Fracture

Pattern of surgical procedures performed in the orthopaedic units of a tertiary hospital in South West Nigeria

Background: Lagos University Teaching Hospital (LUTH) is one of the foremost teaching institutions in Nigeria. It is a recognized training institution for residency training in Nigeria. However, a thorough evaluation of the procedures being undertaken by the orthopaedic teams in this centre and the impact on the type of training being passed on to the resident doctors in training is the focus of this paper. Objectives: To determine the pattern of procedures performed by the orthopaedic units of the Department of Surgery, LUTH with a view to import the findings in re-organizing its structure based on service requirement, manpower allocation and to make recommendation. Methods: We retrospectively reviewed data including age, sex, procedures and leading surgeons retrieved from all our operating theatres over a period from 1st January 2010 to 31st December 2011. The data retrieved was analyzed. Results: A total 741 procedures were performed over the 2 year period. More male patients (58.5%) had procedures performed on them than the female patients. The mean age of patients treated was 37.2±15.5 years. Trauma related procedures accounted for 68.8% of the total procedures. Open reduction and internal fixation surgical operations were the most common trauma related procedure while ablative surgical operations following Diabetic Mellitus foot syndrome were the most common non-trauma related procedure performed. Conclusion: Trauma related surgery remains the most common procedures in our teaching hospital. Efforts should be made to increase the number of elective operations like Arthroplasties, Arthroscopic operations and Spinal axis correction operations being performed

Surgical site infection in Nigerian patients: A comparative study of two prophylactic antibiotics

Background: Infection remains an important complication of surgical procedures. It is an important aspect of patient care as it can be a source of distress for the patients, and the healthcare system in terms of finance and psychological impact. The administration of appropriate prophylactic antibiotics is important in the prevention of surgical site infection (SSI). However, resistance to antibiotics by the micro-organisms is a growing concern in the healthcare industry. This study compared the infection rate between Ceftriaxone and Ceftriaxone-Tazobactam combination as surgical prophylaxis in Nigerian population. Method: This was a double blinded randomized study conducted at the Lagos University Teaching Hospital from October 2020 to September2021. Two hundred and forty (240) patients ,who were to have surgical procedures performed on them, were recruited and randomly distributed into two groups (A&B) of 120 patients each. Group A were those who had Ceftriaxone alone ,while group B were those who had combination of Ceftriaxone and Tazobactam. Results: There was no statistical difference in the demographic characteristics of the two groups .The crude infection rate was 3 .8 %. The infection rate in group A was 3 .3 % within the first week but increased to 4 .2 % in the second week. The infection rate in group B was 3 .3 % within the first week and second week. At 30 days, the infection rate within group A was 2 .5 % and 0 % in group B. Regression analysis showed advanced age (P =0 .003), level of education (P =0 .0001),prolonged duration of surgery (P =0 .012) and excessive blood loss (P =0 .0001) as the important factors associated with development of SSI in the patients included in the study. Conclusion: Surgical site infection remains an important complication following surgeries. Certain factors such as advanced age, prolonged surgery and excessive blood loss increase the risk for SSI. Efforts should be geared towards prevention of SSI in patients by modifying risk factors that are modifiable and using antibiotics with better infection rate as prophylaxis