Estimating road traffic accidents and injuries in Enugu Nigeria

Background: Road traffic injuries are a growing public health and development problem1. In this paper, we examined the trend and impact of road traffic injuries using evidence from our hospital records. This evidence shows how serious the problem of road traffic injuries is at present and indicates that it will become worse if no appropriate action is taken.Methods: Case notes of patients with Road Traffic Accident (RTA) admitted at National Orthopaedic Hospital Enugu, (NOHE) which is a regional Trauma Centre in Nigeria between Jan 1 2011 and January 1 2015 were retrieved and analyzed.Result: There were a total of One Thousand Nine Hundred and Six (1906) victims with a total of One Thousand Six Hundred and Seventy Seven (1677) admissions. There were One Thousand Four Hundred and Nine (1409) males and Four Hundred and Ninety Seven (497) females with a male: female ratio of 2.8:2. One Thousand Six Hundred and Eighty Six (1686) victim's accident occurred within the city while two Hundred and Twenty (220) victims had their accident intercity. 9 An analysis of the occupation of the victims showed students to be the most vulnerable group with motorcycle as the victims' mode of transport. Most of these accidents occurred in months of May and June with a second peak occurring within March and April and these periods correspond with the period of students' end of session exams and Easter festivities. Most of our patients had no pre-Hospital treatment before arriving as a result of our inadequate health system and victims were rescued by passers-by using commercial vehicles as a mode of transport.Conclusion: We therefore recommend the following: development of infrastructure in academic institutions in this country to reduce the incidence of students travelling from various areas of abode in busy city centers to places of lectures, consideration of regulation such as speed limit, protective gear, road signs, training and retraining of Federal road safety corps members as first respondersKeywords: Developing Country, Magnitude, Mitigation ,Road Traffic Injuries, Public Healt

Major limb amputations: a 5year retrospective study in a regional trauma centre

Objective: The aim of this study is to establish the pattern of amputation in our environment, analyze the procedures done and outcome, compare our findings with various reports coming out from developing countries namely, indication, level of amputation, rehabilitation and outcome and recommend ways of mitigation and improved outcome.Methodology: This is a retrospective study in whichcase histories of patients that had undergone amputations at National Orthopaedic Hospital Enugu (NOHE), Nigeria over 5 year period (Jan 1 2011 – Dec 31 2015) were reviewed.Results: Results showed: There were forty – six (46) patients with forty seven (47) amputations, thirty-eight (38) (82.61%) were males and eight (8) (17.39%) Females with M.F ratio of 4:75:1. The Mean Age (in years) was 36.6 ± 17.08 with a of Range 1 – 90 (yrs) Eight (8) (17.39%) of the patients were diabetic and the remaining thirty eight (38) (82.6%) were non diabetic patients. Thirty three (33) (70.21%) of these amputations were in the lower limb while fourteen (14) (29.79%) were in the upper Limb. There was a re-amputation in five (50 (10.87%) patients. Twenty four (24)(52.17%) patients had complications.Discussion: Six of the patients died representing a mortality rate of 13.04%. Seventeen (17) (36.96%) patients were rehabilitated with prosthesis. The highest indication in our series is due to gangrene secondary to diabetic foot followed closely by mismanaged tibia fractures by the Traditional Bone Setters (TBS) and poor wound management by doctors.Conclusion: Most of our amputations are above knee with phantom limb as the most noted complications. Out rate of rehabilitation is quite low. We therefore recommend the following: continued education for doctors on wound management and management of diabetic foot, regulation and education of practice of Traditional Bone Setters to enable them recognize and not exceed their limits, development, equipping and capacity building for prosthetic units to enable them meet with the challenges facing the amputee, further studies to establish the real cause of low rate of rehabilitation.Keywords -Amputation, Complications, Developing Country, Indications, and Rehabilitatio

Slipped capital femoral epiphysis: a review of 40 consecutive cases at the National Orthopaedic Hospital Enugu

Introduction: Slipped capital femoral epiphysis (SCFE) is not a life threatening condition. However, untreated and complicated slipped capital femoral epiphysis can lead to deformity and early osteoarthrosis of the hip. This can lead to considerable morbidity. Recent studies1,2,3 from other centers have described diagnosis, treatment and outcome. The aim of this study therefore, is to: establish the pattern of presentation of Slipped Capital Femoral Epiphysis in our environment, analyze the treatment given and its outcome, observe the complication arising from this condition and recommend ways of improved management.Patients and Methods: The case notes of patients who had Slipped Capital Femoral Epiphysis seen at National Orthopedic Hospital between January 1 2006 –December 2015(10years) were retrieved and analyzedResult: There were Forty (40) Patients, Eighteen (18), Males and Twenty Two (22) Females with a Male Female ratio of 1:1.3 .The Range (in years) was 9 -16yrs (See Figure 1) with a Mean Age (M &F) of 12.9. The Mean Age for Females (F) is 12.55 years while that of Males (M) is 13.33. Eight (8) (20%) of our patients had Associated Conditions. The Average number of days before presentation was 134.2 days with a Range of 3 to 365 days .The Sides affected showed Fourteen (14)(35%) patients had the Left side affected while eighteen 18(45%) had it on the Right. Eight (8) (20%) patients had bilateral conditions. Thirteen (13)(32.5%) patients had Revision Surgery. Eleven (11)(27.5%)had Complications of the condition .Discussion: Our patients did not show any sex preference. This is in contrast to with the findings of Kelsey4 which revealed a propensity of the left hip to be involved in boys as against the right in our review. Majority (20%) of our patients had bilateral condition which is in keeping with most reports in the literature.5Conclusion: A retrospective review of Slipped Upper Femoral Epiphysis managed at the National Orthopaedic Hospital Enugu has been examined. Most of our patients presented late and avascular necrosis the major complication of the series. We will therefore recommend a high index of suspicion for physicians who see these patients primarily as the diagnosis is often subtle, and symptoms, such as groin or knee pain, can be misleading and also to create awareness as most of our patients presented to the Traditional Bone Setters at the early stages of the condition. We believe like Alvin6 postulated that early presentation will enable the surgeon intervene early and mitigate these complications.Keywords: Slipped Capital Femoral Epiphysis, Pattern of presentation, Treatment and Outcom

Bilateral Symmetrical Humeral Fracture on a Background of Multiple Myeloma and Humeral Capillary Hemangioma

A 59-year-old female who was managed for multiple myeloma presented with spontaneous bilateral pathologic fracture of the distal third of both humeri. She had associated renal impairment and background diabetes mellitus. Biopsy of her bone specimen from surgery shows features in keeping with capillary hemangioma. The patient was properly optimized for surgery; she was reviewed by a nephrologist and endocrinologist before surgery. Her blood investigations showed that she was anemic. She was transfused with fresh whole blood and also had renal dialysis. She subsequently was offered bilateral retrograde locked intramedullary nailing of both humeri, which was done 2 weeks apart under regional anesthesia (brachial plexus block). There was profuse intraoperative bleeding, which was controlled with bone wax and electrocautery. Biopsy of her bone specimen from surgery shows that she also has osseous capillary hemangioma rather than the provisional diagnosis of bilateral pathological fracture of the humerus following extramedullary manifestation of multiple myeloma. There have been suggestions in the literature that extra manifestations of multiple myeloma simulating hemangioma may be due to neoangiogenesis propagated by myeloma cells secreting vascular endothelial growth factor. We present a case of multiple myeloma with renal failure that presented to us with bilateral humeral fracture with a histological report of capillary hemangioma. We suggest that tumor‑neoangiogenesis may be responsible for this type of manifestation. This case is a rare coincidental finding which has not been reported in literature, hence the objective of this presentation. Keywords: Bilateral humeral fracture, capillary hemangioma, multiple myeloma, neoangiogenesis, vascular endothelial growth facto