Tibial Diaphyseal Fractures: Aetiology, morphology and treatment in adult patients at Moi Teaching And Referral Hospital, Eldoret, Kenya

Background: Tibial Diaphyseal Fractures (TDFs) arise from various forms of trauma and assume different patterns. They are responsible for high morbidity and mortality.Objective: To describe the mechanism of injury, morphology and treatment methods of tibial diaphyseal fractures in adult patients at Moi Teaching and Referral Hospital, Eldoret, Kenya.Methods: A descriptive prospective study on 89 adult patients with tibia shaft fractures. An interviewer administered questionnaire was used to collect data. Association between categorical variables was assessed using Pearson’s Chi Square test.Results: The median age was 28.0 years (IQR: 24.0-40.0) with a male to female ratio of 3.2:1. Most of the TDF (67.4%) were due to Road Traffic  Accidents (RTAs); fall 16 (18.0%) and the least, gunshot 3 (3.4%). Up to 40.9% of the fractures were open type while (59.1%) were closed. Middle 1/3 tibia shaft was the commonest site of fracture at 52.7%. Fibula fracture was the most associated injury at 62.9%. Operative management was donein 61.6%.Conclusion: Road Traffic Accidents were the major cause of TDF with motorcycles injuries leading. Most TDF were closed type; mainly at mid third level. Fibular fractures were the most associated injuries. Treatment of TDF was mainly surgical using locked intramedullary nail. Key words: Tibia Diaphyseal Fractures (TDFs), Road Traffic Accidents (RTAs), Motor Vehicular Accident (MVA

Gerdy’s safe zone in the Kenyan population: a cadaveric study

Background: The Common Peroneal Nerve (CPN) is a branch of the sciatic nerve, which is almost subcutaneous in its course around the fibula. This means it is a structure that is at risk when performing procedures around the proximal fibula and tibia. This study was done to determine a safe zone in which procedures can be performed without injuring it.Objective: To determine the extent of Gerdy’s safe zone in the Kenyan population.Design: This was an anatomical descriptive cross- sectional study.Methods: The study was carried out at the human anatomy laboratory, Moi University. Dissection was done on forty three right sided formalin fixed limbs. Right sided lower limbs were chosen because they were more in number than the left sided lower limbs thus satisfying requirements of study population.Results: Forty three right sided lower limbs (32 male, 11 female) were dissected. The nerve was seen to define an arc like trajectory around Gerdy’s tubercle, with a mean radius of 57.6±5mm.Conclusion: In this population, Gerdy’s safe zone (radius of 57.6±5mm) is most likely to be free of the common peroneal nerve and its branches and thus can be marked preoperatively before carrying out procedures in the proximal tibia.Keywords: Gerdy’s tubercle, Gerdy’s safe zone, Tibi

Use of sign intramedullary nailing in open tibia and femur fractures at Moi Teaching and Referral Hospital, Eldoret, Kenya

Background: Interlocking intramedullary nailing is the current method of choice for fixation of both open and closed tibia and femur fractures. This has been associated with excellent results. Objective: To assess the functional outcome of SIGN intramedullary nailing in the management of open tibia and femur fractures managed at Moi Teaching and Referral Hospital. Design: A retrospective analytical study between February 2005 and December, 2008. Setting: Moi Teaching and Referral Hospital, Eldoret. Subjects: All patients with open tibia and femur fractures who presented at the Moi Teaching and Referral Hospital and had fracture stabilized by SIGN intramedullary nailing during the study period. Results: Forty three open fractures in forty one patients were treated using SIGN intramedullary nailing in the fracture stabilization. Thirty seven (90.2%) of the patients were males while 4 (9.8%)were females. Two (4.9%) patients had bilateral tibial fractures. The average age of the patients was 37 with a range of 14 to 61 years. Road traffic accidents were the leading cause of injury followed by gunshot injuries. Other causes included falls and assault. All patients received surgical antibiotic and tetanus prophylaxis. Antibiotic therapy was maintained post operatively up to a period of two weeks. Patients were discharged with evident satisfactory wound healing and ability to walk on crutches. Irrespective of the fracture configuration, patients were advised to remain non weight bearing for the first 6 weeks. Thirty seven (90.2%) patients turned up for follow up. Sixteen per cent had superficial infections which responded to antibiotic treatment and dressings. Four (11%) had deep infection (3 femur and 1 tibia), 1 in Gustillo IIIB, 2 Gustillo IIIA and 1 Gustillo II. Exchange nailing was done in three patients and one patient had the nail removed and fracture fixed with an external fixator. Conclusion: This study shows good results of intramedullary nailing for grade I, II and IIIA-fractures. We recommend treatment of these injuries by adequate debridement followed by immediate or delayed intramedullary nailing

Effectiveness and complications of SIGN intramedullary interlocking nailing in the management of femoral and tibial fractures at Moi Teaching and Referral Hospital, Eldoret- Kenya: A retrospective study

Background: Interlocking intramedullary nailing is the current state-of-the-art management of the shaft fractures of long bones. Objective: To assess the functional outcome of SIGN nailing of femoral and tibial fractures at Moi Teaching and Referral Hospital. Design: Retrospective analytical, study over a three year period from February 2005 to April 2008. Setting: Orthopaedic Department, Moi Teaching and Referral Hospital, Eldoret. Subjects: All patients with closed or Gustillo Grade I or II open tibial and/or femoral shaft fractures presenting at Moi Teaching and Referral Hospital, Eldoret. Results: Three hundred and eleven patients with tibial and/or femoral shaft fractures were treated at Moi Teaching and Referral Hospital of whom 245(78.8%) were males while 66(21.2%) were females. Total nails fixed were 329 and the oldest patient aged 100 years while the youngest was 13 years.Twelve (3.9%) of the total number of patients presented with ipsilateral fractures, 4(1.3%) had bilateral fractures, 4 (1.3%) had fractures of both the femur and tibia while 1(0.3%) patient had fractures of the femur and humerus. There were 300 closed fractures and 29 open fractures treated with intramedullary nailing. Road traffic accidents were the leading cause of injury. Other causes included falls, assault, gunshot, sports injuries, pathological fractures among others. Prophylactic antibiotics were used in 288 patients. One hundred and thirty four (43.1%) patients turned up for follow up during the same period. There were 23 cases of wound infection, 4(1.2%) broken nails, 6(1.8%) failed distal locking and 2(0.6%) fractures above the nail. Conclusion: Males were found to be more affected than females. Road traffic accidents are the leading causes of trauma. Loss of follow up is one of the major problems still encountered. SIGN intramedullary nailing was found to be the most effective method of fracture management with minimum complications

The management of bone and joint infections at Moi Teaching and Referral Hospital

Background: Bone (cortex and marrow) and joint infection are not uncommon in this health institution. The management of patients with the lesion has posed a challenge yet the institution is in top gear training the surgeons in the field of orthopaedic and trauma surgery. This study aims to lay foundation for development of the management protocol, and further research. Objective: To evaluate the management of Bone and Joint infection in children. Design: Retrospective descriptive study. Setting: Moi Teaching and Refferal Hospital, Eldoret, Kenya. Methods: The relevant data of 85 consecutive patients on aspects of demography and the management in the period 2001- 2006 were recorded into the data sheet (proforma), then analyzed and presented in statistical patterns. Results: Eighty five consecutive patients (47 males, 38 females), ratio M: F =1.24:1. Admission rated at least 14±2SD patients per year. Age: 2weeks-13 years, mean= 7.53 ±3.98SD. Major risk/predisposing factor-trauma. Duration of symptoms: 1 day-2 years, mean=16.44± 11.28SD. Commonest symptomatology included pain, swelling and loss of function more so in the joints than in bones. Of investigations- Laboratory: anaemia, bacterial isolates(33 and 14 patients respectively), while radiological/ imaging: lesions identified in patients’ radiographs, CT- scans and ultrasound scans (49, 3 and 3 respectively). Fifty six patients were diagnosed with arthritis and 39 with osteomyelitis. Treatment of 26 patients was non- operative and 59 were operated. All the patients survived. Hospital stay ranged from 2- 159 days, mean=14.16 ±9.46SD. Follow-up in clinic- 12 patients defaulted, 26 inconsistent while 47 consistent. Conclusion: Bone and joint infections were associated with significant morbidity as shown by high operative intervention and long hospital stay. Delayed presentation as noted could be responsible for the high morbidity