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

Gunshot fractures of tibia and femur - excellent results with reamed bone marrow graft and interlocking nailing

Objective: To document the outcome of treatment of femur and tibia diaphyseal fractures due to gunshot injury grafted with reamed bone marrow and immobilised with Surgical Implant Generation Network (SIGN) interlocking nail.Design: A prospective study.Setting: Three referral centres in two developing countriesSubjects: Thirty-three patients with 36 fractures due to gunshot injury were studied.Interventions: Stabilised patients were commenced on prophylactic parenteral antibiotic; X-rays done to classify fractures by Gustillo-Anderson classification. Documented were entry, exit wounds and neurovascular status of the limb. Bone marrow was reamed manually and collected oozing reamed marrow was used as graft. Drain was used minimally and when used, was placed where the reamed marrow would not be drained.Patients were followed-up between one to three years.Mean outcome measure: Clinical and radiological evidences of healing of the fracture at six weeks.Results: Patients age ranged between 15-70 years with mean of 32.2±12.2 years. M : F 32:1. Thirty-one (86.1 %) were femoral fractures and 15 (41.7%) of studied long bone fractures were around the knees. The fractures were mainly Gustillo- Anderson type I (41.7%) and II (41.7%). At six weeks there was massive callus formation in 86.1 % of the fractures sites. All other fractures healed within three to four months except one fracture.                                                              Conclusion: Fractures of femur and tibia fractures due to gunshot injury fixed with SIGN intramedullary interlocking nails and grafted with reamed bone marrow give excellent result. This may be due to the use of harvested osteogenic and osteoinductive bone marrow

Motorcycle Trauma in a St Lucian Hospital

Objective: A motorcycle is a single-track, two-wheeled motor vehicle that is used worldwide for transportation. The use of the motorcycle has resulted in trauma that is associated with significant morbidity and mortality. The aim of this study is to document the pattern of motorcycle accidents and the demographics of the cyclists in St Lucia. Method: This is a 15-month prospective study on all patients with motorcycle injuries that reported to the emergency room at the Victoria Hospital. Information on patients: age, gender, helmet use, intake of alcohol/drugs before the motorcycling and mechanism of injury were obtained and filled into a prepared proforma by the attending physician. Those admitted were followed-up to know the outcome and complications of treatment. Results: Total number of patients studied was 136 in 115 accidents, males (M) were 127 while females (F) were 9, with M:F ratio of 14.1:1.0. There were 105, 28 and 3 riders, passengers and pedestrians respectively; 87.5 % of the patients were below the age of 35 years. Fifty-three per cent of the accidents occurred over the weekend. The limbs were mostly injured, constituting 81.9% of the parts of the body injured. Conclusion: The study revealed that young and productive males were mainly injured in motorcycle accidents and the injuries were more in the limbs. More than fifty per cent of the accidents were found to occur during the weekends and more than fifty per cent of the motorcyclists were not wearing crash helmets. Keywords: Motorcycle, St Lucia, trauma "Traumas por Motocicletas en un Hospital de Santa Lucía" RESUMEN Objetivo: La motocicleta es un vehículo motor dos ruedas y vía única, usado mundialmente como medio de transporte. El uso de la motocicleta ha traído consigo traumas asociados con una morbilidad y una mortalidad significativas. El objetivo de este estudio es documentar el patrón de accidentes de motocicletas así como la demografía de los ciclistas en Santa Lucía. Método: Se trata de un estudio prospectivo de 15 meses en torno a pacientes con lesiones de motocicleta. Los heridos acudieron a la sala de emergencias del Hospital Victoria. Se obtuvo información sobre los pacientes – edad, género, uso del casco, consumo de alcohol/drogas antes de montar la moto, y el mecanismo de la lesión. Con la información obtenida una pro forma fue preparada por el médico asistente. A los ingresados se les hizo un seguimiento a fin de conocer la evolución clínica y las complicaciones del tratamiento. Resultados: El número total de pacientes estudiados fue 136 en 115 accidentes. Los varones (M) fueron 127 mientras que las hembras (F) fueron 9, para una proporción M:F de 14.1: 1.0. Hubo 105, 28 y 3 motoristas, pasajeros y peatones respectivamente. El 87.5% de los pacientes estaban por debajo de los 35 años de edad. Cincuenta y tres por ciento de los accidentes ocurrieron durante el fin de semana. Las extremidades fueron principalmente dañadas, constituyendo el 81.9% de las partes del cuerpo lesionadas. Conclusión: El estudio reveló que los lesionados en accidentes de motocicletas eran principalmente varones jóvenes y productivos, y que las lesiones eran mayormente en las extremidades. Se halló que más del cincuenta por ciento de los accidentes ocurrieron durante los fines de semana, y más del cincuenta por ciento de los motociclistas no llevaban el casco de protección. Palabras claves: Motocicleta, Santa Lucia, traum

Playing Into Injuries: Paediatric Trauma in a Nigerian Hospital

Background: Childhood trauma is a common problem worldwide and a leading cause of death in developed countries. High number of paediatric traumas encountered in emergency department and orthopaedic clinic stimulated this study to find why many children are traumatized and to document the pattern of injury in Ado- Ekiti, NigeriaStudy design: This is a six-month prospective study in a secondary hospital. Seventy- seven consecutive paediatric trauma patients seen at the emergency department were studied. Interviews were conducted with injured children, their relatives or guardians to obtain data. Obtained information included biodata, site and type of injury, part of the body injured and the presence of adult supervision during peer playing. Forty-one patients were treated as out-patients and thirty six patients were admitted and followed up while on admission. Both groups of patients were followed up in the out-patient clinics.Result: The 77 patients formed 14.7% of trauma patients seen inthe Emergency department during the study period. The femaleswere 23 and males 54 with female: male ratio of 1: 2.4. The ageranged between 7 months and 14 years. The mean age was 7.8±4.0 years. Of the 77 paediatric trauma patients, 61 (79.3%)sustained injuries during unsupervised peer playing.Conclusion: Unsupervised peer playing accounted for high proportion of paediatric injury in our environment and these injuries could be prevented if the parents at home, teachers at school and available adults would carefully monitor the playing children

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

Traditional medical removal of gunshot pellets: traditional medical treatment or traditional deceit?

No Abstract. Nigerian Journal of Orthopaedics and Trauma Vol. 6 (1) 2007: pp. 11-1

Absolute compartment pressure versus differential pressure for the diagnosis of compartment syndrome in tibial fractures

We studied 39 patients with 42 diaphyseal tibial fractures in whom we suspected a high risk for the development of a compartment syndrome. We measured the anterior absolute compartment pressure (ACP) every 12 h for 72 h and also recorded the differential pressure (ΔP=diastolic blood pressure−ACP). Fasciotomy of the extremity was only performed when the differential pressure was less than 30 mmHg for more than 30 min. The highest values of the ACP were recorded between 24 h and 36 h after admission. Three fractures had a differential pressure less than 30 mmHg and all were treated by fasciotomy. In three fractures the ACP was equal to or higher than 50 mmHg, of which two had a differential pressure less than 30 mmHg. The patients were followed up for a mean of 36 months (29–45). All fractures healed, and none of our patients showed any sequelae of compartment syndrome at their last review