Cobb Angle Changes in Thoracic and Lumbar Spine Fractures Following Road Traffic Injuries in Gwagwalada, Abuja

The annual incidence of spinal column fracture is 350 per million populations. with Motor vehicular accident being the major single cause of spine injuries. The victims are predominantly young and male. The aim of this study to evaluate the clinical outcome of conservative treatment of closed thoracic and lumbar spine fractures following RTI at UATH GwagwaladaAbuja by measuring the progression in kyphotic deformity.In this retrospective study, the age, gender, mechanism of the injury, time of presentation, symptoms, type of fracture, serial Cobb angle of the plainradiology between 1st Jan 2008 and 31 December 2008 were were obtained studied from the case notes. - Sixteen patients with closed thoracic and lumbar fractures were seen during the review period. The male: female ratio was 3:1 with a mean age of 33.7± 11.4 years (males= 32.4 ± 7.9 years; females= 37.3 ± 8.4 years). The peak incidence was in the month of July (18.8%). Ten (62.5%) patients presented within a week of the injury. The predominant symptom was back pain (100%). Commercial bus (56.3%) was the commonest mode of transportation causing RTI with spinal fractures. The first lumbar vertebral (L1) (25.0%) was the most frequently fracture spine and the commonest fracture pattern was compression fracture (56.3%). At the index evaluation, the mean Cobb angle was 28.3º± 7.2º with an average progression of 9.8º± 4.2º at twenty-four weeks of conservative treatment.The thoracolumbar spine was the commonest fracture site and the commonest fracture pattern was compression fracture. The short term clinical outcome of conservative treatment was not satisfactor

Facet joints infiltration: A viable alternative treatment to physiotherapy in patients with low back pain due to facet joint arthropathy

Background: There is a paucity of information on treatment options and outcome of treatment of patients that have MRI findings of FJA presenting with low back pain in the developing country. This prospective cohort study conducted mainly in the University of Abuja Teaching Hospital Gwagwalada, Abuja Nigeria is to compare the short-term clinical outcome between two groups, one having undergone facet joints infiltration (FJI) and the other physiotherapy for facet joint arthropathy (FJA).Materials and Methods: All patients with clinical lower back pain (LBP) and MRI features of FJA were recruited into this prospective study randomly. All the FJI patients had depot methylprednisolone and the physiotherapy patients had McKenzie regimen. Outcome questionnaires comprising Oswentry disability index scores (ODI), visual analogue scores (VAS), and patient satisfaction scores (PSS) were completed at all clinic visits. Follow-up was for 6 months for both groups. The results were analyzed using SPSS 17.0.Result: There were 10 FJI patients and 8 physiotherapy patients (1.25: 1). The outcome scores comprised the following ODI, VAS, and PSS. The FJI group had a better score compared to the physiotherapy group at short-term evaluation and this difference was statistically significant. The female patients in both groups fare better compared to the male counterparts.Conclusions: FJI offered added benefit over physiotherapy in LBPs diagnosed with FJA. Patients with FJI have a significant reduction in pain symptom than the patients in the physiotherapy group. Though majority of the patients reported satisfactory outcome, the FJI patients group had a better outcome

Outcome analysis of surgical treatment of Blount disease in Nigeria

Objective: The objective was to evaluate the results of surgery of Blount diseases using the postoperative metaphysealdiaphyseal angle (MDA) at 2-year follow-up.Background: The goal of surgery in Blount disease is to restore the normal configuration of the articular surface of the proximal end of the tibia in proper relationship to the mechanical axis of the limb. Our hypothesis is that patients will demonstrate significant clinical improvements following surgery and predictive models can be developed.Materials and Methods: All patients who had surgery for Blount disease from January 2002 till December 2007 at the National Orthopaedic Hospital Lagos Nigeria and follow-up for 2 years were included. Data extracted were gender, affected limb, Blount’s type, age when deformity was noted, and age at presentation, preoperative femoral tibial angle (TFA), Langenskiold score, preoperative MDA, and postoperative MDA. Linear regression was used to assess the predictive effect of selected clinical and radiographic measures on post-MDA. The model was adjusted for confounders: age deformity noted, age at presentation, affected limb, Blount’s type, and gender. Variables in the adjusted model achieving significance at P < 0.05 were included in a multiple regression analysis.Results: Eighty-six knees in 57 patients were included. The mean preoperative and postoperative MDA at 2 years was 34.6° ± 8.9° and 10.6° ± 4.3°, respectively. Seventy-three knees (84.9%) have correction of ≤10° with recurrence in 13 (15.1%) knees at 2 years (P < 0.001). The postoperative MDA was graded into good outcome if ≤10°. There was a significant improvement between preoperative MDA and postoperative MDA (P < 0.001). The multilinear analysis demonstrated that the preoperative MDA was a significant predictor of the postoperative MDA. The postoperative MDA was predicted with a standard error of 0.92 with the following formula: post-MDA = ̃1.027 + 0.404 pre-MDA.Conclusion: The mean postoperative MDA of 84.9% of the knees operated at 2 years was 9.4° ± 3.1° with recurrence rate of 15.1%. Postoperative MDA is a good outcome measure for surgical treatment of Blount disease and surgical correction should aim at producing post MDA ≤10°

Ankylosing spondylitis in a 50-year-old man: a case report

Ankylosing spondylitis (AS) is a distinct disease entity characterized by inflammation of multiple articular and paraarticular structures especially of the spine, sacroiliac joints and large peripheral joints such as the hips, shoulders and rarely the knees frequently resulting in bony ankylosis. This is a case report of a 50 year old school teacher with ankylosing spondylitis (AS) that presented at the University of Abuja Teaching Hospital Gwagwalada, Abuja. This case was presented to create further awareness and highlight peculiarity of management in our settings.Key-words: Ankylosing Spondylitis, Bamboo spine, sacroiliac joint, physiotherap

Autologous Bone Grafts Use in Orthopaedic Practice in Abuja

Background: There is widespread use of autologous bone grafts in orthopaedic practice in Nigeria but detailed indications, donor sites and complications following use have not been reported in different regions.Objective: This is to highlight the indications, sources and complications of autologous bone grafts use in Abuja, Nigeria.Materials and Methods: This is a retrospective case series of patients operated on between January 1st, 2005 and December 31st, 2008 for various orthopaedic pathologies at the University of Abuja Teaching Hospital (UATH), Gwagwalada. All patients who received autologous bone grafts were included in this study. Details of indications, donor sites and complications were obtained.Result: A total of 62 patients received autologous bone grafts during the study period. The male: female ratio was 4.2: 1 with mean age of 38.2 ±6.3years. The main indication was nonunion of long bones following fractures. Majority of the grafts were taken from the iliac crest and pain was the commonest complication noted. Majority of the patients were satisfied with the procedure. Conclusion: Autologous bone grafts use is common in orthopaedic practice predominantly in young male adult. Femoral fracture nonunion was the commonest indication for autologous bone grafts use in Abuja. Iliac crest was the site most often employed while pain was the commonest complication following the procedure. The procedure was well tolerated.Key words: autologous bone graft, non-union, iliac crest, pai