Infection risk in Gustilo and Anderson type III tibia and fibular fractures treated with external fixation in a tertiary hospital of a developing country

Background: Open fractures of the tibia and fibula present with multiple management challenges of wound care, bone stabilization, potential risk of infection and its control. Attempt to resolve this problem, stabilization of the fracture with external fixators was introduced. However, this procedure predisposes infection too. This was an overview of the disposition of infection in the course of managing type III fractures in our center.Methods: This was a retrospective study of disposition of infection in Gustilo and Anderson type III open fractures of the tibia and fibula treated with external fixation device over ten years in Jos university teaching hospital. Data extracted from patients records and operation notes included age, sex, nature of open fracture with respect to Gustilo and Anderson classification in theater. Wound culture reports extracted early and weeks after commencement of treatment. The findings were analyzed using Epi info statistical software version 3.5.3.Results: A total of 74 patients, 63 (85.1%) males and 11 (14.9%) females (M:F=5.7:1) with mean age of 37.97±13.57 years. The mean duration of injury-presentation time was 13.48±38.73 days, 41 (55.4%). Patients that present with clinical infection were 40 (54.1%) among which staphylococcus aureus was isolated in 21 (28.3%). While treatment was on, the flora became altered. Motor cycles were responsible for 25 (33.7%), gunshots 20 (27%), motor vehicle injuries 19 (25.6%) while pedestrians accounted for 9 (12.2%).Conclusions: Type III fractures sustained from high energy risk of infections due to late presentation in our setting. Bacterial isolates tend to alter in course of hospitalization

Ipsilateral fibrosarcoma following recurrent post traumatic femoral fracture

The aetio-pathogenesis as with most malignancies is not known. However, trauma has being proposed as a possible theory underlying the development of this malignancy, where it is believed that the reparative cells could undergo malignant transformation. There is however a paucity of data suggestive of this theory in our setting. Hence this case report in the above case report the question is whether the recurrent trauma and subsequent surgery is coincidental with the development of the malignancy. This report highlights the possibility of such occurrences

Management of Orthopedic Injuries Following May 2014 Twin Bomb Blast in Jos, North Central Nigeria

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Clinical profile of diabetic foot ulcers at the Jos University Teaching Hospital

Background: Diabetes mellitus (DM) continues to be a growing health problem worldwide, and diabetic foot complications is one of the most  common causes of nontraumatic foot amputation and hospital admission among patients with DM. The objective of the study was to determine the  clinical profile of patients with Diabetic foot ulcers in Jos University Teaching Hospital. Methods: This was a cross sectional study that evaluated adult patients with DM who presented with foot ulcerations to the Jos University Teaching Hospital over a 6 month period. The patients' socio-demographic characteristics, clinical presentation, grade of ulcer and comorbidities were noted.    Results: Sixty-three patients with Diabetic foot ulcers were studied with a mean age of 57.43±13.76 years (Ranged 39-86 years) and a male: female ratio of 1.26 to 1. The median duration of DM history was 10 (Inter Quartile range IQR 3-14) years (range 1 - 40 years) before manifesting with foot  ulcers. The duration of the ulcers ranged between 2 to 16 weeks with a median of 8 (IQR of 4-8) weeks. The mean glycosylated haemoglobin was  10.74±14.7%. Majority had Neuroischaemic ulcers 19(30.9%). The commonest predisposing factor for DM foot ulcer was wearing of ill-fitting shoes  in 16(24.5%) patients, while in 28 (44.40%) there was no identifiable predisposing factor. Conclusion: The study found that diabetic foot ulcer commonly affected middle age individuals with a slightly higher preponderance among men.  Most had Neuro-ischaemic ulcers, poor glycaemic control and wearing of Ill-fitting shoes a commonly observed predisposing factor.  &nbsp

Subtrochanteric Valgus osteotomy for Coxa Vara stabilized using contoured straight dynamic compression plate

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Outcome of open inter-locking nail for femoral shaft fractures: an effective alternative in a resource restricted environment

Background: Femoralshaft fracture remains one of the commonest fractures in adults arising from high velocity forces. Though closed interlocking nail is the standard of management of closed femoral shaft fractures, however it is not always an obtainable resource in poor settings where ignorance on the part of the patient and absence of required equipment for closed reduction on the part of surgeon makes open interlocking nail popular and the best resort. The aim of the study was to show our experience using open locked intramedullary nail in femoral shaft fracturesMethods: This study is a prospective descriptive study carried out at the Orthopaedic Unit of Barau Dikko Teaching Hospital and Rapha Specialist hospital in Kaduna.Results: In our study, 75% of patients were aged between 21-40 years with mean age of 32.5±5.7 years. The average time of union both radiological and clinically was 13 – 16 weeks in about 34.4% of cases. 23 (71.9%) of our patients had no post up complications, however 2 patients had superficial wound infection, 3 (9.4%) patients had knee stiffness, 2 (6.3%) patients had a <2cm shortening, 1(3.1%) patient had osteomyelitis and 1 (3.1%) patient had an implant failure.Conclusion: Our study showed a favorable outcome for open interlocking nail in the treatment of closed diaphyseal fractures even in a resource -restricted environment

The Mass Casualty from the Jos Crisis of 2008: The Pains and Gains of Lessons from the Past

Background: Following the mass casualty of September 2001, we experienced challenges due to the prolonged nature of the crisis and disaster response. We subsequently made changes to our response protocol which were soon tested in the mass casualty resulting from the violence ofNovember 2008 in our city. We present here the management of the mass casualty situation that resulted from that crisis.Patients and methods: A retrospective analysis of the management of the patients who presented following thecrisis. Data was collected from the Emergency Room, theoperating room records and the crisis register. Informationgathered included patient demographics, cause of injury, mechanism, body part affected, treatment, morbidity and mortality. Data was analyzed using Epi Info statisticalsoftware using simple percentages.Results: One hundred and three patients presented over 2 days. There were 101 males (98.1%) and 2 females (1.9%) patients. The ages ranged from 11-65 (+ SD 10.23) years. Injury was caused by gunshots in 71 (68.9%) patients and machetes in 23 (22.3%) patients. The most frequently affected body parts were the lower limbs in 36 (35.0%) patients, upper limbs in 29 (28.2%) patients, chest in 18 (17.5%) patients and abdomen in 14 (13.6%) patients.Nineteen (18.4%) patients required formal surgicalprocedures, mainly exploratory laparotomy, 10 (9.7%).Complications were seen in 14 (13.6%) patients, 11 (10.7%) of these were infection related. There were 3 (2.9%) hospital mortalities. All had severe head injuries.Conclusion: Majority of the injuries were due to gunshots and only one fifth required urgent life saving interventions. From previous experience, effective and continuous IncidentCommand and Mass Casualty Commander positions , andactivation of unit specific protocols within the hospitalensured a hitch free hospital response and enabled the hospital to return to routine activities within 24hours

Assessing pre-prosthetic rehabilitation outcome of amputees with major limb amputation at the National Orthopaedic Hospital, Dala, Kano

Background: Major limb amputation is the removal of part or a whole of a limb proximal to the wrist or the ankle. It is the last, albeit  valuable option when limb salvage is impossible. It impacts negatively on patients’ participation in valued activities, body image  perception and quality of life, hence multi-disciplinary approach is rewarding.Methods: A hospital based prospective study carried out at the National Orthopaedic Hospital, Kano between August 2014 and July 2015. A proforma was filled which included demographics, clinical history, diagnosis, type of surgery done and clinical outcome. Rehabilitation was assessed using functional independent measure. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 16.0 for windows.Results: Fifty four participants completed the study. Patients' age ranged from 18-82 years. Mean age for females was 33 years±16.51 and males 28.36 years±16.62. Thirty (55.6%) were between the ages of 18-30years. Majority(94.4%) were of the working age group (18-60years). Amputations due to trauma (n=46) had higher Functional Independent Measure (FIM) mean score of 117.50±3.582 with a p-value of 0.00 (not significant).  Upper limb amputations (n- 15) had better FIM score of 118.67±0.62 with a p-value of 0.00. Patients 60 years  and below (n=51) recorded FIM scores of 118.29±1.171 with a P-value of 0.00.(better than the elderly). Females (n=12) had better FIM mean score of 117.67±2.84 with a P-value of 0.00.Conclusion: Pre-prosthetic rehabilitation is better in amputations due to trauma, in females, younger age group and in upper limbs

The duration of response to intra-articular steroid injections in patients with osteoarthritis of the knee: a single centre's experience

Background: The burden of Osteoarthritis (OA) is huge, with a sizable proportion of patients that have failed the analgesic treatment and are not candidates for surgery or have refused surgery. Intraarticular corticosteroid injections (IASI) are considered standard of care for pain relief and control of local inflammation in this category of OA patients. However, there is a wide variation in the duration of response to steroid injections. This study was designed to determine the duration of response to IASI in patients with osteoarthritis of the knee in our environment. Methods: Fifty-four patients aged between 30 and 80 years who have been diagnosed with osteoarthritis using the American College of Rheumatology criteria and have met the inclusion criteria were enrolled in the study and were given intra-articular steroid injections to the knee. Their responses were assessed using visual analogue scale (VAS) score, Western Ontario, and McMaster Universities Osteoarthritis Index (WOMAC) score at 2, 4 and 12 weeks. The patients were classified as responders if there was a fifty percent improvement in the WOMAC scores and a fifty percent reduction in the VAS score and non-responders if there is less than fifty percent improvement in the WOMAC score and less than fifty percent reduction in the VAS score. Results: Fifty-two patients completed the study; 78.4% and 100% of these had good WOMAC and VAS responses respectively at 2 weeks but this proportion gradually reduced to 47.9% and 56.3% for WOMAC and VAS respectively at 3 months. Conclusion: Intra-articular steroid injections provide sustained response in patients with osteoarthritis of the knee who have failed analgesic therapy and are not candidates for total knee replacement for up to three months and the response decreases with advancing age

Jos christmas eve bomb blast: confronting new challenges with old resources

Background: Jos, Nigeria has witnessed several mass casualty incidents from sectarian crises, with mechanisms of injury mainly from blunt forces and use of machetes and less from gunshots. In December 2010, for the first time, twin bomb blasts detonated at a market generating casualties and triggering another crisis. We sought to describe peculiarities of this novel mechanism of mass casualty.Methods: A retrospective descriptive study of patients who presented to our hospital with injuries sustained following the Jos Christmas Eve bombing of 2010.Results: Of the 90 patients that presented over 4 days, 81 were males and 9 females. Age ranged from 2 to 76 years with a mean of 36.2 years, SD=± 16. There were 31 (34.4%) blast injuries and 35 (38.9%) gunshot injuries. Majority of the wounds involved the lower limbs in 39(43.3%) patients, and upper limbs in 24(26.6%). Forty three (47.8%) patients required only debridement and 13(14.4%) needed only wound dressing. Definitive procedures done were open reduction and internal fixation in 7(7.7%) patients, laparotomy in 5(5.5%), amputation and local wound exploration in 3(3.3%) each, and chest tube insertion in 2(2.2%) patients. Duration of hospital stay ranged from 0-84 days. More than half of the 14(15.5%) complications were infective in origin. There were 7(7.7%) mortalities. The hospital cost was 14 times higher than that of previous crisis that did not involve bomb blast.Conclusion: The bomb blasts generated predominantly limb injuries that required a lot of resources and prolonged hospital care..A disaster response protocol that envisages injuries arising from this mechanism is essential