Transforaminal epidural steroid injections for the treatment of lumbosacral radicular pain in a Nigeria tertiary hospital: observational study

Background: Lumbosacral radicular pain is a common cause of chronic low back pain. Despite published reports of effectiveness of transforaminal epidural steroid for lumbosacral radicular pain, it is underutilised in many tertiary hospitals in sub-Saharan Africa. This study assessed the clinical effects of transforaminal epidural steroid injections in patients with lumbosacral radicular pain at a major tertiary health facility in Nigeria.Methods: This is a prospective observational study carried out between March 2012 and February 2016. Under fluoroscopy, the epidural space was accessed through the neuroforamen using 22G spinal needles in 47 adult patients with lumbosacral radicular pain; and a mixture of 10 mg triamcinolone acetonide and 0.25% plain bupivacaine (2 mLs per level) was injected. Pain intensity and functional impairment were assessed with the Numeric Pain Rating Scale (NPRS) and the Oswestry Disability Index (ODI) scores respectively at three and six months.Results: The pain and ODI scores at baseline and at six months’ follow-up improved significantly; 8.49 ± 1.28 vs. 3.6 ± 1.5 (p = 0.002) and 45.1 ± 11.5 vs. 32.4 ± 11.5 (p = 0.001) respectively.Conclusion: Transforaminal epidural steroid injections provided significant pain relief and improved function in patients with lumbar radicular pain due to intervertebral disc herniations.Keywords: herniated intervertebral disc, lumbosacral radicular pain, Nigeria, pain relief, transforaminal epidural steroid injectio

Evaluation of an accelerated Ponseti protocol for the treatment of talipesequinovarus in Nigeria

Background: The commonest congenital musculoskeletal deformity worldwide is talipes equino varus (CTEV). Of the various treatment methods available, the most acceptable treatment currently for CTEV worldwide is serial manipulation and casting using the Ponseti technique. The Ponseti technique consists of weekly manipulation and casting for an average of six to eight weeks followed by bracing of the feet till school age. Some studies have shown evidence that more frequent casts may have similar outcomes with weekly casts using the Ponseti method. This study compared the efficacy of management of idiopathic CTEV using an accelerated protocol of twice weekly casts, with the standard weekly Ponseti protocol.Methods: The study was a randomized case control study with a group of patients undergoing an accelerated casting protocol involving twice weekly casts compared with another group who went through the normal weekly Ponseti protocol.Results: A total of 45 feet in 28 patients were studied. The study showed a significantly shorter treatment period in the accelerated protocol (39 days) compared with the standard protocol (52 days); with no significant increase in the number of casts needed for treatment.Conclusions: A twice weekly Ponseti casting protocol enables completion of the casting period earlier than the standard Ponseti method.Keywords: Talipes equinovarus; Ponseti treatment; Accelerated Ponseti Protocol; Serial Castin

A Survey of Pre-clerkship Medical Students' Perspectives on their Educational Exposure to Operating Theatre in Two Nigerian Universities.

Surgery is an essential part of undergraduate pre-clerkship medical student training. Quality training and exposure will boost the future surgical manpower especially in developing country when there is dearth of manpower and infrastructure. This study is an audit of the impact of traditional theatre sessions as done in two Nigeria university medical schools. The result shows that there is a need to re-evaluate and re-invigorate the traditional theatre sessions by the undergraduate students with simulations and audiovisuals to have more impact in their training.Keywords: Survey, pre-clerkship, medical students, perspectives, operating theatre, universities

Chronic osteomyelitis: Comparison of outcome following the use of antibiotic impregnated beads and gentamycinsaline solution after sequestrectomy

Background: Chronic osteomyelitis (COSM) is a common disease in developing countries. Complete cure of the disease is difficult due to its high  recurrent rate. Sequestrectomy and debridement in addition to parenteral antibiotics is essential in the treatment of the disease. Local deposition of antibiotics has been shown to be effective in eradicating residual bacteria. The aim of this study was to compare the outcome of treatment following the use of antibiotic beads vs gentamycin-saline solution as local antibiotic delivery after sequestrectomy.Method: A prospective study carried out between April 2014 and March 2016. Each patient was followed up for a year.Results: Sixty-seven patients were recruited during the study period, 46 males and 21 females (M:F=2.2:1). The mean age was 22 ± 8.2 years, (range = 4 to 72 years). COSM was most common in the age group 11-20 years, n=37 (55.2%), the disease was commonest among patient with genotype SS, n=25 (37.3%). The commonest aetiology was acute haematogenous osteomyelitis, n=43 (64.2%). Tibia was the commonest bone involved, n=34 (50.7%). The commonest organism isolated from the sinus tract and sequestrum was Staphylococcus aureus, n=32 (56.2%), and n=34(56.7) respectively. Antibiotic beads were used in 27 (40.3%) patients after sequestrectomy with one recurrence, while 40 (59.7%) patients had gentamycin-saline instillation after sequestrectomy with two recurrences.Conclusion: Chronic osteomyelitis is still common in Nigeria, the organism cultured from sinus tract and the sequestrum is the same in most cases. Instillation of gentamycin-saline solution after sequestrectomy is as good as using antibiotic beads after sequestrectomy

Clinical outcomes after open locked intramedullary nailing of closed femoral shaft fractures for adult patients in a Nigerian hospital

Background: Femoral shaft fractures are common injuries in adults. Closed locked intramedullary nailing is the recommended treatment for femoral shaft fractures due to its high union rate. Objective: The objective of this study is to determine the outcome of management of closed femoral shaft fractures in adult patients, using open locked intramedullary nailing. Patients and Methods: This is a  prospective study which was carried out on all adult patients aged 16 years and above who presented within 2 weeks of sustaining closed femoral shaft fractures to the accident and emergency unit of a University  Teaching Hospital in Nigeria from January 2013 to December 2013. Pathological fractures were excluded from the study. The procedure was carried out using standard techniques, and each patient was followed up for a minimum of 1 year. Results: Forty‑three patients were recruited into the study. They had a mean age of 36.9 ± 11.7 years, with a male to female ratio of 2.9:1. The most common cause of closed femoral shaft fractures was road traffic crashes (95.3%), with   motorcycle‑related injuries found to be the highest type (56.1%). The rate of union in the study was 95.3%. The average time to radiological union was 14.0 ± 1.2 weeks while the mean time to painless full weight bearing was 14.2 ± 1.2 weeks. Among the complications encountered were broken nails (4.7%), infection, loosening of the distal screw, and limb length discrepancy (2.3% each). Using Thoresen’s criteria, excellent results were obtained in 93% and poor results in 4.7% of patients. Conclusion: Open locked intramedullary nailing gives excellent clinical outcomes with high union and low complication rates in the management of closed femoral shaft fractures in adult patients.Keywords: Clinical union, femoral shaft fracture, open locked intramedullary nail, radiological union, Thoresen’s criteri