Chronic osteoyelitis in patients with sickle cell disease

Objective: To determine the baseline pattern and audit management modalities of chronic osteomyelitis in patients with sickle cell disease.Design: A retrospective study.Setting: Jos University Teaching Hospital, Jos, Nigeria from August 1993 to July 1997.Patients: Twenty four patients with concomitant chronic sickle cell disease.Interventions: Fifteen patients had operations; eleven had sequestrectomy and curettage while four had incision and drainage. Eight patients were treated with antibiotics alone and one patient refused surgery.Main outcome measures: The demographic data of patients, aetiological agents, culture and sensitivity patterns, aetiopathogenesis, treatment modalities and outcome were analysed.Results: Twenty four (36.9%) out of 65 patients who had chronic osteomyelitis also had sickle cell disease. Male:female ratio was 1.2:1. The peak age incidence (37.5%) was in the first decade of life. Seventy five per cent of infections were haematogenous. The most frequentlyisolated organism was Staphylococcus aureus (58.8%) while the rest were Gram negative organisms. There was no case of Salmonella osteomyelitis. The most sensitive antibiotics were gentamicin and the third generation cephalosporins. Twelve patients (50%) had good results while eight (33.3%) were still undergoing treatment. Complications recorded were persistent discharging sinuses in two cases, recurrence of symptoms in one and pathological fracture with non-union in one patient.Conclusion: Though the incidence of Gram negative organisms in causation of chronic osteomyelitis in patients who have sickle cell disease is high (41.2%), Salmonella osteomyelitis may be related to endemicity of the organism in a given locality

Motorcycle injuries in north-central Nigeria

Background: The increasing use of commercial motorcycle as mode of transportation in urban cities in Nigeria has become important source of morbidity and mortality. This is coupled with poor helmet use, narrow roads, increasing traffic, and poor licensing of the motorcycle riders. The objectives of this study are to determine the pattern of injuries following accident involving motorcycles, the mortality rate, and the immediate causes of mortality.Materials and Methods: This is a combined retrospective and prospective study spanning over 2 years (1 year each). Patient’s records were retrieved to collate data for the retrospective study while all the patients presenting to the casualty unit of Jos University Teaching Hospital following involvement in motorcycle accidents between April 2006 and March 2007 were selected for the study.Results: Out of 485 motorcycle injured patients, 295 and 190 were recruited from the retrospective and prospective study respectively. The male: female (M: F) ratio was 4.8:1. The ages ranged from 2.5 to 84 years with a peak at 21-30 years. The total number of injuries was 559 with 443 patients singly injured and 42 patients multiply traumatized. Head injury (40.1%) was the most frequently occurring injury followed closely by extremity injuries (38.1%). None of the patients wore protective helmet. Thirty-six (36) mortalities (7.4%) were recorded and all dead patients had head injuries. All deaths occurred within 24 h.Conclusions: Head injury represents a common cause of morbidity and mortality following motorcycle injuries in our environment. Therefore, strict enforcement of helmet laws from May 10, 2010 may reduce morbidity and mortality

Management of the mass casualty from the 2001 Jos crisis

Background: We report our experience in the hospital management of mass casualty following the Jos civil crisis of 2001.Materials and Methods: Aretrospective analysis of the records of patients managed in the Jos civil crisis of September 2001, in Plateau State, Nigeria. Information extracted included demographic data of patients, mechanisms of injury, nature and site of injury, treatment modalities and outcome of care.Results: A total of 463 crisis victims presented over a 5 day period. Out of these, the records of 389 (84.0%) were available and analyzed. There were 348 (89.5%) males and 41 females (10.5%) aged between 3 weeks and 70 years, with a median age of 26 years. Most common mechanisms of injury were gunshot in 176 patients (45.2%) and blunt injuries from clubs and sticks in 140 patients (36.0%). Debridement with or without suturing was the most common surgical procedure, performed in 128 patients (33%) followed by exploratory laparotomy in 27 (6.9%) patients.  Complications were documented in 55 patients (14.1%) and there were 16 hospital deaths (4.1% mortality). Challenges included exhaustion of supplies, poor communication and security threats both within the hospital and outside.Conclusion: Most patients reaching the hospital alive had injuries that did not require lifesaving interventions. Institutional preparedness plan would enable the hospital to have an organized approach to care, with better  chances of success. More effective means of containing crises should be employed to reduce the attendant casualty rate.Key words: Challenges, civilian conflicts, crisis, disaster, mass casualty, trauma, violenc

Bone setter's gangrene

Background: Gangrene usually supervenes following prolonged pressure of tight splintage by traditional bone setters (TBS) in the process of treating fractures. However, various complications such as blisters, pressure sores, Volkmann's ischaemia/ contracture, Crush syndrome and pregangrene occur by the same mechanism depending on degree of pressure and duration of splintage of the limb. Method: This is a guest lecture delivered to resident doctors. Literature search was done through the internet and some unlisted journals and texts. Experiences of various institutions in Nigeria and abroad concerning bone setters' gangrene were elucidated. Attempt was made to broaden the concept of bone setters' gangrene to include all complications that arise through the same mechanism. The aetiology, pathophysiology and treatment of the various conditions were highlighted and the solution and way-forward suggested. Result: The various health institutions recorded unacceptably high percentage of amputations secondary to bone setters' gangrene e.g. Zaria - 57% to 63%, Jos - 60-77.8%. Enugu recorded mortality of 26.7% while Banjul had 11.1% mortality in their series. Nearly all the series suggested education of bone setters as a solution. Conclusion: A different approach to limiting bone setters' gangrene is suggested such as condemning bone setters' practice and expanding orthopaedic care. Nigerian Journal of Medicine Vol. 16 (1) 2007: pp. 8-1

Outcome of traditional bone setting in the Middle belt of Nigeria

Background: This hospital based study was designed to elucidate the outcome of Traditional Bone Setting (TBS) practice in four states of the middle belt of Nigeria, via complications presenting in select hospitals.Methods: A combination of retrospective and prospective study of complications arising from traditional bone setting in Plateau and Nasarawa States and southern parts of the Kaduna and Bauchi States was undertaken.Results: Fifteen patients were retrospectively studied in the one year period between December 1999 and November 2000 inclusive, while seventy-six patients were recruited into a 1 year prospective study(January 2001 to December 2001). There were sixty-nine males and twenty-two females giving a male: female ratio of 3.1:1. The mostfrequently encountered patients were children in the first decade of life (34.1%), while the 3rd and 4th decades accounted for 20.9% and 18.7% respectively. 61.5% of the study population were residents inJos, Plateau State, and 19.8% were admitted from Nasarawa State. 12.1% came from Kaduna State while 6.6% were recruited from Bauchi State. The study population cut across all social strata with a preponderance of illiterates, children and primary school certificate holders. The presenting injuries clustered around femur, tibia and fibula, humerus and forearm with 19.61 each. These were followed by dislocations of hip, elbow and shoulders (15.2%). The presentation of complications included non union (13.1%), mal union (21.5%), volkman’s ischaemic contractures and compartment syndrome (8.4%), infections (24.4%), stiffness/ankylosis (15.9%) and gangrene (8.4%) among others. Eight two orthopaedic interventions were carried out ranging from minor procedures to open reduction and internal fixations (15.9%), amputations (7.3%) and arthroplasties (4.9%). Five  portalities were recorded giving a mortality rate of (5.5%).Conclusion: 91 complications with 5 mortalities, largely avoidable in two years calls for a serious look at traditional bone setting practice in the Middle Belt of Nigeria. We recommend that other zones undertake similar studies so that a national picture would emerge and policy dialogue initiated

Imperative of Precision Diagnosis in Management of Gluteal Mycetoma

BODY: A 48 year old civil servant who had four year copious discharge from multiple left gluteal sinuses is presented. He had had traditional herbal treatment self medication and empirical antituberculous treatment. Plain X-ray of pelvis, sinogram and detailed mycotic studies enabled diagnosis of actinomyces isreali. A course of co-trimoxazole was efficacious in drying up the discharge, healing of the sinuses and reversal of the patients early depressive overlay. Precise etiologic diagnosis in Mycetoma located at unusual site would enable direct efficacious antimicrobiol treatment since the lesions are caused by different organisms. BACKGROUND: Mycetoma lesions can constitute a major challenge in diagnosis and treatment. Key Words: Mycetoma gluteal region, actinomyces Isreali, mycotic Studies, Sinuses. Nigerian Journal of Orthopaedics and Trauma Vol.3(2) 2004: 196-20

Orthopaedic Injuries in Patients with Polytrauma: The Jos Experience and a Review of Literature

Background: Orthopaedic injuries constitute a major part of polytrauma. Treatment trends are evolving. In order to determine what is best for our environment, there is a need to define the magnitude of the problem.Aims and objectives: To describe the frequency of occurrence and pattern of distribution of orthopaedic injuries those occur in patients with polytrauma as well as carry out a review of relevant literature.Patients and Methods. This is a one-year prospective study of patients with polytrauma from which an analysis of orthopaedic injuries was performed. Patients were recruited at the point of presentation in the accident and emergency department and followed up to the point of discharge.Results: One hundred and twenty eight patients were recruited out of which orthopaedic injuries constituted 84 (64.1%). Lower limb injuries predominated in 63 (77%), with tibial fractures being the most common in 40 (49.6%) patients. Head injuries were the most frequent associated injuries in 57 (67.9%). Only three (3.6%) patients had operative treatment and all were delayed procedures. Eighty one (96.7%) were either managed non-operatively, or refused hospital treatment. Complications rate was 11.9%, mainly wound infection in compound fractures. Mortality rate was 7.1%, all had associated severe head injury. 33% of the patients discharged themselves against medical advice and opted for traditional bone setting.Conclusion: Orthopaedic injuries constitute a major part of polytrauma. Lower limb injuries predominate. Head injuries are the most common associated injuries and account for most of the early mortality. Increased operative management is advocated because of established advantages in literature.Key words: Orthopaedic injuries, polytrauma, trauma

Prognostic Indices Of Diabetic Foot Disease

OBJECTIVE: To determine the prognostic indices and outline objective factors to be considered in management of diabetic foot disease. METHOD: Forty-six diabetic feet in 38 patients were studied using a predetermined protocol of clinical and management indices. There were 24 males and 14 females giving a male:female ratio of 1.7:1. The ages ranged from 26 years to 74 years with a mean age of 52.8 years. RESULTS: The venous filling time, Meggit-Wagner grading status, associated medical condition, eye signs, duration and type of diabetes mellitus were found to correlate with prognosis. Aggressive antibiotic treatment following aerobic and anaerobic culture, radical serial debridement, and frequent dressings after hypertonic saline soaks of the limbs resulted in healing of 31 out of 46 feet (67.4%) at a mean haling time of 2.4 months. Eight limbs had major amputation giving amputation rates of 17.4%. We recorded six mortalities out of the 38 patients (15.8%). CONCLUSION: We conclude that diligent clinical assessment, prompt and aggressive antibiotic treatment, radical sequential debridement, and meticulous attention to wound dressing in a multidisciplinary setting would reduce rate of amputation and mortality in diabetic foot diseases. Where limb salvage is not possible, above knee amputation is the best option. Nig Jnl Orthopaedics & Trauma Vol.2(2) 2003: 84-8

The burden of morbidity in polytrauma

Background: Trauma is a leading cause of death, hospitalization and disability for all ages under 45years. The development of complications in the clinical course could make management more complex and worsen the outcome. We evaluated our polytrauma patients with a view to elucidating the pattern of morbidity and mortality in our practice.Methods: We prospectively studied the patients presenting to our institution with polytrauma over a one year period. Those who incurred any complications or died in the course of their management were extracted and studied. Survivors were followed up to the point of discharge and for two or three subsequent outpatient follow up visits.Results: 131 patients presented over the study period out of which there were complications in 27 patients (20.6%). The most common complications were wound infections particularly in patients with compound extremity fractures. 80% of the deaths occurred in patients with severe head injury. Mortality was 10(7.6%) ;al l had associated severe head injury.Conclusion: In fectious complications predominate in patients with polytrauma while head injury accounts for most of the mortality among patients presenting to the hospital. A more energetic management of these injuries is advocated as a way of reducing the morbidity and mortality associated with polytrauma.Keywords: injuries, morbidity, mortality, polytrauma, trauma