Comparing the random blood glucose level in patients with single and multiple long bone fractures

Background: Long bone fractures either single or multiple present frequently to the emergency. The metabolic response to trauma elicits various markers amongst which is hyperglycaemia. Determination of hyperglycaemia in these two sets of patients is however yet to be fully evaluated.Objective: To compare the random blood glucose levels in patients with single and multiple long bone fractures.Design: Prospective comparative cross-sectional studySetting: Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun state Nigeria.Patients and Methods: Ninety cases of patients with traumatic single and multiple long bone fractures had their random blood glucose levels evaluated at three different times and were all treated.Main Outcome Measure: Random blood glucose level before,during and after resuscitation.Results: Ninety patients were recruited into the study with 65 and 25 of them having single and multiple long bone fractures respectively. Young males with closed Tibia fractures following road traffic accidents accounted for majority (30%) of the single fractures while those with floating knee accounted for the majority (8.8%) of multiple long bone fractures. The mean Random blood glucose at presentation, 12 hours and 24 hours after presentation were 7.7,7.1 and 5.9 (mmol/l) respectively. There was a statistically significant difference in the random blood glucose levels between patients with single and those with multiple long bone fractures.Conclusion: Patients with multiple long bone fractures appear to mount a higher metabolic response to trauma. Hyperglycaemia can be reduced with prompt and adequate resuscitation. Thus routine random glucose checks for all trauma patients should be done and serve as marker for injury severity and adequacy of resuscitation.Keywords: Random Blood Glucose, Single and Multiple Long Bone Fracture

Comparing the effects of haematoma block and conscious sedation in adults with distal radius fractures

Background: Distal radius fractures present frequently to the orthopaedic surgeon following high velocity injuries in the young or low velocity injuries in the elderly. Haematoma block or conscious sedation can be applied to provide anaesthesia during reduction. Comparing the effects of both anaesthetic methods is yet to be fully evaluated.Objective: To compare the pain level and quality of reduction using haematoma block and conscious sedation following reduction of distal radius fractures.Design: Prospective comparative cross-sectional study.Patients and Methods: Seventy patients with distal radius fractures were grouped for closed reduction; in one group conscious sedation was used and the other, haematoma block. All patients had pain measured with Visual Analogue Scale and quality of reduction by measuring palmar tilt on plain radiograph.Main Outcome Measures: Severity of pain and palmar tilt on radiograph measured before and after reduction.Results: The modal age group was 60 years (40%) with a slightly higher female preponderance (57.1%). Majority, 54.3% had injuries following fall on outstretched hand. The mean Visual Analogue Score for pain following conscious sedation and haematoma block post reduction was 3.5 and 2.4 respectively. The mean palmar tilt of radius for conscious sedation and haematoma groups were 10.1 and 10.9 degrees respectively. There was no statistically significant difference in the efficacy of both anaesthetic methods.Conclusion: The choice anaesthesia for reduction of distal radius fracture on should be based on surgeon’s preference, patient’s wish and history of drug reactions.Keywords: Distal Radius Fractures, Haematoma Block, Conscious Sedatio

Quadriceps strength and anterior knee pain following tibia intramedullary nailing: Any clinical relationship?

Introduction: Anterior knee pain can be chronic sequelae of intramedullary nailing of the tibia. Several causes have been identified; no single reason can fully explain the occurrence. We, therefore, set out to find the rate of anterior knee pain in our practice and if any relationship exists between the anterior knee pain and extensor muscle strength.Methodology: A total of 72 knees in 36 patients with no prior history of knee pain, but had unilateral tibiofibular fracture, who had internal fixation with interlocking intramedullary nailing done and were followed up for at least 1 year were recruited into the study. The tension generated on extension of the knee against a resistance using tensiometer was measured in Newton. The ranges of motion of the knees were documented, as well as Lysholm score which measures activities and document the presence and limitation caused by anterior knee pain.Results: A total of 36 patients with 72 knees were studied. Anterior knee pain occurred in 7 (19.4%) patients in this study. There was no statistically significant relationship between the force of tension (N) generated in the extensor in patients with anterior knee pain compared with those without knee pain (158.43 ± 49.35, 189.54 ± 74.63, P = 0.304). There was, however, a significant statistical relationship between the mean Lysholm score of the operated and unoperated knee (P = 0.042).Conclusion: Anterior knee pain rate was 19.4% in our series and no statistical association exists between the extensor strength and occurrence of anterior knee pain.Keywords: Anterior knee pain, intramedullary nailing, quadricep

Determinants of management outcome in open tibia fractures in ile-ife

Background:Fracture of a normal tibia shaft constitutes a major trauma mostly sustained by young adults during high-energy injuries. Its superficial location and the subcutaneous characteristics of its anteromedial aspect easily causes open fracture. The objectives of this study were to determine the pattern of presentation, and determinants of management outcome in open fractures of the tibia. Methods: This is a prospective hospital based study. A total of 89 patients aged 4 to 80 years with open fractures of the tibia with or without fibula involvement were studied. All the patients received anti tetanus prophylaxis and intravenous antibiotics as well as wound irrigation, debridement and skeletal stabilisation. Results: Students and traders accounted for the majority of the cases (57.3%). Most of the open tibia fractures 69 (77.5%) had above knee Plaster of Paris cast. The majority of the cases were Gustilo and Anderson type II 32 (36.0%) cases and type I 22(24.7%) cases. There was Correlation between the presence of wound infection and (i) Gustilo and Anderson grading (F -.352, P .001); (ii) Injury to Debridement time in hours (F -.304, P .004); (iii) Osteomyelitis (F .397, P .001); (iv) Delayed union (F .253, P .017); and (v) Union time in weeks (F -.350, P .001). There was also correlation between the following: (i) Injury to Debridement time in hours and the distance from the accident scene to the hospital (F .464, P .001); (ii) The fracture pattern and the union time in weeks (F .353, P .001); and (iii) The presence of osteomyelities and delayed union (F .382, P .001). The commonest complications observed were wound infection 35(39.3%) patients and delayed union 30(33.7%) patients. Conclusion: This study shows that the higher the Gustilo and Anderson grading of the open fractures of the tibia, the more severe the wound and bone infection that occurred. The interval between injury time and wound débridement time affected the treatment outcome

Outcome of the Treatment of Gunshot Open Fractures of the Lower Extremities with 'SIGN' Interlocking Nails

Background: Gunshot injuries are gradually on the increase in civilian populations in developing countries due to increasing violence in our society. The treatment of fractures from these injuries is changing with the use of locked intramedullary nailing becoming an acceptable and effective method of fixation. Surgical Implant Generation Network interlocking nails are gaining universal acceptability in these countries due to ease of use without the need for image intensifier. The purpose of this study was to evaluate the outcome of the use 'SIGN' interlocking nailing in gunshot open fractures of the lower limbs. Methods: This is a prospective study of all patients in three tertiary centres in developing countries who had gunshot fractures of lower limbs fixed with SIGN nails from 1st January to 31st December 2009 and followed up for a period of 2 years. Results: Twenty eight patients with 31 fractures with average age of 32.5years±12.6SD. All the patients were males except one female. Fractures occurred in femur in 20(71.4%) and tibia in 11(29.6%) SIGN nail was used to fix all fractures and union was achieved in all the patients. The most common complication was wound in infection in 5 (15.2%). Conclusion: SIGN intramedullary locked nail provided an effective method of fixation for gunshot fractures of the lower extremity with minimal complication