Stabilisation of Posterior Sternoclavicular Joint Dislocation using Palmaris Longus Tendon Autograft: A Case Report

Posterior sternoclavicular joint dislocation is a rare injury. It is usually sustained acutely in activities such as contact sports eg. rugby and motorcycle accidents. Plain radiography of the chest will often miss the diagnosis and confirmation is by CT scans. However CT scans are often reported to miss epiphyseal injuries. Management is by closed reduction and if the injury is unstable, by open reduction and stabilisation. A case is reported where palmaris longus tendon was used to stabilise the joint following open reduction

Patterns of injuries in children who fall from a Height as seen at Kenyatta National Hospital

Objective: To describe injuries and outcomes among children who fall from a height Design: Prospective, convenience hospital based study. Setting: Paediatric surgical wards of Kenyatta National Hospital, Nairobi, from November 2006 to February 2007. Subjects: Children aged 1-13 years who sustained injuries after failing from any height. Results: Eighty children were recruited. There were 61 male (76%) and 19 female (24%), with an age range 1-13 years. Most injuries occurred at home (78.75%) after falling from buildings (33.75%), and were of mild-to-moderate severity. 13.4% sustained external haemorrhage, 16.5% sustained facial injuries, 25.2% sustained CNS injuries, 43.3% sustained various fractures, and 1.6% sustained abdominal trauma. The head and musculoskeletal systems were the most likely regions to be injured. The most common diagnoses were supracondylar fracture of humerus and mild head injury. No thoracic or pelvic fractures were recorded. Recovery was good in most instances. Conclusion: Most children who sustain injuries after a fall from height do so after falling from a building. The most common types of injuries sustained were to the head and distal limbs, especially fractures. They were mostly of mild-moderate severity and recovery usually complete.East African Medical Journal Vol. 87 No. 8 August 201

Patterns of poisoning among patients aged 0-13 years at a paediatric hospital in Nairobi

Objectives: To determine the pattern of poisoning amongst patients admitted at a paediatric hospital in Nairobi and compare it with that of other hospitals around the worldDesign: A retrospective hospital based multivariate study.Setting: Gertrude’s Garden Children’s Hospital, Nairobi, Kenya.Subjects: Medical records of all children admitted with a diagnosis of poisoning between January 2003 and December 2007Results: The age range of the study population was birth to 13 years. The mean age was 3.57 years with a standard deviation of ±1.57 with a peak incidence in the one to three years old age group (56.7%). Males comprised 61.7% of the cases. The most common cause of poisoning was ingestion of a drug ( 46.7%). Petroleum products caused 30.0%, detergents 8.3% and organophosphates 6.7%. Ninety six point seven percent of poisonings were unintentional and 93.3% of injuries took place at home. There were no mortalities.Conclusion: The majority of these incidents were preventable. Measures need to be instituted to reduce the number of incidents of poisoning in children. This can take the form of health and safety education particularly in relation to storage of common household poisons

Prevalence of low back pain amongst workers at a paediatric Hospital in Nairobi

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Delays in hospital admissions in patients with fractures across 18 low-income and middle-income countries (INORMUS): a prospective observational study

Background: The Lancet Commission on Global Surgery established the Three Delays framework, categorising delays in accessing timely surgical care into delays in seeking care (First Delay), reaching care (Second Delay), and receiving care (Third Delay). Globally, knowledge gaps regarding delays for fracture care, and the lack of large prospective studies informed the rationale for our international observational study. We investigated delays in hospital admission as a surrogate for accessing timely fracture care and explored factors associated with delayed hospital admission. Methods: In this prospective observational substudy of the ongoing International Orthopaedic Multicenter Study in Fracture Care (INORMUS), we enrolled patients with fracture across 49 hospitals in 18 low-income and middle-income countries, categorised into the regions of China, Africa, India, south and east Asia, and Latin America. Eligible patients were aged 18 years or older and had been admitted to a hospital within 3 months of sustaining an orthopaedic trauma. We collected demographic injury data and time to hospital admission. Our primary outcome was the number of patients with open and closed fractures who were delayed in their admission to a treating hospital. Delays for patients with open fractures were defined as being more than 2 h from the time of injury (in accordance with the Lancet Commission on Global Surgery) and for those with closed fractures as being a delay of more than 24 h. Secondary outcomes were reasons for delay for all patients with either open or closed fractures who were delayed for more than 24 h. We did logistic regression analyses to identify risk factors of delays of more than 2 h in patients with open fractures and delays of more than 24 h in patients with closed fractures. Logistic regressions were adjusted for region, age, employment, urban living, health insurance, interfacility referral, method of transportation, number of fractures, mechanism of injury, and fracture location. We further calculated adjusted relative risk (RR) from adjusted odds ratios, adjusted for the same variables. This study was registered with ClinicalTrials.gov, NCT02150980, and is ongoing. Findings: Between April 3, 2014, and May 10, 2019, we enrolled 31 255 patients with fractures, with a median age of 45 years (IQR 31–62), of whom 19 937 (63·8%) were men, and 14 524 (46·5%) had lower limb fractures, making them the most common fractures. Of 5256 patients with open fractures, 3778 (71·9%) were not admitted to hospital within 2 h. Of 25 999 patients with closed fractures, 7141 (27·5%) were delayed by more than 24 h. Of all regions, Latin America had the greatest proportions of patients with delays (173 [88·7%] of 195 patients with open fractures; 426 [44·7%] of 952 with closed fractures). Among patients delayed by more than 24 h, the most common reason for delays were interfacility referrals (3755 [47·7%] of 7875) and Third Delays (cumulatively interfacility referral and delay in emergency department: 3974 [50·5%]), while Second Delays (delays in reaching care) were the least common (423 [5·4%]). Compared with other methods of transportation (eg, walking, rickshaw), ambulances led to delay in transporting patients with open fractures to a treating hospital (adjusted RR 0·66, 99% CI 0·46–0·93). Compared with patients with closed lower limb fractures, patients with closed spine (adjusted RR 2·47, 99% CI 2·17–2·81) and pelvic (1·35, 1·10–1·66) fractures were most likely to have delays of more than 24 h before admission to hospital. Interpretation: In low-income and middle-income countries, timely hospital admission remains largely inaccessible, especially among patients with open fractures. Reducing hospital-based delays in receiving care, and, in particular, improving interfacility referral systems are the most substantial tools for reducing delays in admissions to hospital. Funding: National Health and Medical Research Council of Australia, Canadian Institutes of Health Research, McMaster Surgical Associates, and Hamilton Health Sciences