The doctrine of informed consent in surgical practice

Physicians and other professionals in the field of medicine have to perform invasive and non-invasive procedures on patients as part of their duties. There is a legal basis upon which these procedures are done; this is called \u2032informed consent.\u2032 Sociocultural factors have strong influence on the sick role. These factors influence the application of informed consent in Nigeria

Trauma intensive care in a terror-ravaged, resource-constrained setting: Are we prepared for the emerging challenge?

Introduction: Trauma in developing countries has been on the increase, a situation perpetuated by rising road traffic collisions, terrorism and firearms proliferation. Some of the victims of trauma are left with life threatening conditions requiring urgent surgical intervention and/or intensive care. The objectives of this study were to determine the pattern of major trauma needing intensive care in the region, and to determine the outcome of major trauma admitted to intensive care unit. Methods: A six-year retrospective cohort study of trauma patients needing intensive care, set in the Intensive Care Unit of Ahmadu Bello University Teaching Hospital, Zaria, North-West Nigeria. Subjects were major trauma patients admitted into the intensive care unit of the institution, identified via an admission register kept in the unit. The main outcomes measured were length of stay and mortality. Results: Trauma admissions represented 25.1% of the all intensive care admissions. Severe traumatic brain injury accounted for 32.1% of the trauma admissions, while burns accounted for 23.2%. Of the injuries, 15.5% were sustained in bomb blasts, and 8.3% were firearm injuries. The majority of the patients stayed for no more than seven days from admission. Burns patients had the worst outcomes, with 82.1% mortality. Conclusion: Major trauma contributes significantly to local intensive care admissions, with terrorism- related trauma now an emerging challenging cause of major trauma in our region. The observed poor outcomes in this study are a reflection of the quality of available intensive care, and lends credence to the concept of appropriately resourced, specialised intensive care units for optimisation of care. Keywords: Trauma admissions, Intensive care, Terrorism, Outcom

Use of non-vascularized autologous fibula strut graft in the treatment of segmental bone loss

Background : Fractures resulting in segmental bone loss challenge the orthopedic surgeon. Orthopedic surgeons in developed countries have the option of choosing vascularized bone transfers, bone transport, allogenic bone grafts, bone graft substitutes and several other means to treat such conditions. In developing countries where such facilities or expertise may not be readily available, the surgeon has to rely on other techniques of treatment. Non-vascularized fibula strut graft and cancellous bone grafting provides a reliable means of treating such conditions in developing countries. Materials and Methods : Over a period of six years all patients with segmental bone loss either from trauma or oncologic resection were included in the study. Data concerning the type of wound, size of gap and skin loss at tumor or fracture were obtained from clinical examination and radiographs. Result : Ten patients satisfied the inclusion criteria for the study. The average length of the fibula strut is 7 cm, the longest being 15 cm and the shortest 3 cm long. The average defect length was 6.5 cm. Five patients had Gustillo III B open tibial fractures. One patient had recurrent giant cell tumor of the distal radius and another had a polyostotic bone cyst of the femur, which was later confirmed to be osteosarcoma. Another had non-union of distal tibial fracture with shortening. One other patient had gunshot injury to the femur and was initially managed by skeletal traction. The tenth patient had a comminuted femoral fracture. All trauma patients had measurement of missing segment, tissue envelope assessment, neurological examination, and debridement under general anesthesia with fracture stabilization with external fixators or casts. Graft incorporation was 80% in all treated patients. Conclusion : Autologous free, non-vascularized fibula and cancellous graft is a useful addition to the armamentarium of orthopedic surgeon in developing countries attempting to manage segmental bone loss, whether created by trauma or excision of tumors

Use of non-vascularized autologous fibula strut graft in the treatment of segmental bone loss

Background : Fractures resulting in segmental bone loss challenge the orthopedic surgeon. Orthopedic surgeons in developed countries have the option of choosing vascularized bone transfers, bone transport, allogenic bone grafts, bone graft substitutes and several other means to treat such conditions. In developing countries where such facilities or expertise may not be readily available, the surgeon has to rely on other techniques of treatment. Non-vascularized fibula strut graft and cancellous bone grafting provides a reliable means of treating such conditions in developing countries. Materials and Methods : Over a period of six years all patients with segmental bone loss either from trauma or oncologic resection were included in the study. Data concerning the type of wound, size of gap and skin loss at tumor or fracture were obtained from clinical examination and radiographs. Result : Ten patients satisfied the inclusion criteria for the study. The average length of the fibula strut is 7 cm, the longest being 15 cm and the shortest 3 cm long. The average defect length was 6.5 cm. Five patients had Gustillo III B open tibial fractures. One patient had recurrent giant cell tumor of the distal radius and another had a polyostotic bone cyst of the femur, which was later confirmed to be osteosarcoma. Another had non-union of distal tibial fracture with shortening. One other patient had gunshot injury to the femur and was initially managed by skeletal traction. The tenth patient had a comminuted femoral fracture. All trauma patients had measurement of missing segment, tissue envelope assessment, neurological examination, and debridement under general anesthesia with fracture stabilization with external fixators or casts. Graft incorporation was 80% in all treated patients. Conclusion : Autologous free, non-vascularized fibula and cancellous graft is a useful addition to the armamentarium of orthopedic surgeon in developing countries attempting to manage segmental bone loss, whether created by trauma or excision of tumors

Primary Total Knee Replacement in a Patient with failed High Tibial Corrective Osteotomy: A Case Report

Background: Cases of elderly patients presenting with nonunion following high tibial osteotomy for genu vaum are now very rare. This is because corrective osteotomy around the knee in middle age and elderly has lost its importance over the years due to successes of total knee replacement.For the very few that present, several options of treatment, such as revision plating, intramedullary nailing or illizarov compression osteosynthesis exist. These are however not without limitations such as the need for prolong immobilization, development of joint stiffness, soft tissue contractures, recurrent nonunion and subsequent worsening of osteoarthritis of the adjacent joint (knee). We report primary total knee arthroplasty in a patient presenting with nonunion following failed high tibial osteotomy, using diaphyseal engaging stem (DES) in form of tibia extension rod. To the best of our knowledge we have not come across similar report in the country.Method: K.S is sixty two year old woman who presented with inability to walk. Prior to her presentation, she underwent high tibial corrective osteotomy for medial unicompartmental osteoarthritis of the right knee 3 years ago. She developed nonunion necessitating revision surgery (replating) a year and 7 month after first operation (2016), which resulted in nonunion again. Diagnosis of Post Osteotomy High Tibial Nonunion with bone loss was made. She was optimized and underwent total knee replacement with tibia extension rod.Result: She was able to mobilize on the 7th day post operative with the aid of walking frame and was discharged on the 14th day. At 11 month follow up, she mobilises comfortably and pain-free without aid with radiological union at fracture site.Conclusion: Semi constrained Total Knee Replacement with extension rod may be an option for treating failed high tibial corrective osteotomy coexisting with moderate to severe ipsilateral knee osteoarthritis. Keywords: Total Knee Arthroplasty, Tibial Extension Rod, Failed High Tibial Osteotomy