Is the femoral neck-shaft angle an independent risk factor for hip fractures? An observational study

Background: The femoral neck-shaft angle (FNSA) has been implicated in the aetiology of hip fractures. The longer moment arm of a higher FNSA has been theorized to impart a greater deforming force to the greater trochanter, which may cause a hip fracture.Methods: A prospective study that involves adults with hip fractures and a control group matched for age and sex. The FNSA of both groups were measured on an anteroposterior X-ray of the pelvis. The mean FNSA were compared with a paired samples t-test, and a binary logistic regression analysis was run with the FNSA as a predictor variable and the presence of hip fracture as an outcome variable.Results: A total of 150 patients were recruited for the study, 75 per group. The mean age of patients with hip fractures was 71.30 years (S.D.=14.34), and that of the control group was 73.94 years (S.D.=12.55), p=0.264. The mean FNSA of the study group was 133.96o (S.D.=3.77) while that of the control group was 131.05o (S.D.=3.86), p<0.001. Increasing FNSA imparts a higher risk of having a hip fracture, O.R.=1.24 (95% C.I, 1.12-1.37).Conclusions: Individuals with higher FNSA demonstrated a significantly increased risk of developing hip fractures. However, the exact cut-off point of the FNSA, which predisposes to the risk of these fractures, remains to be elucidated.

Common Errors in Proposals and Dissertations and How to Avoid them: A Resident’s Guide

Background: The dissertation is now a necessary part of the fellowship examinations of both the West African college of surgeons and physiciansand the national postgraduate medical college of Nigeria. Many resident doctors are confused about how to get on with their proposals and thedissertations. This confusion often leads to frustrations, and in extreme cases to unnecessary delay in attempting the examinations when due. Aim: This study aims to identify the common errors made by resident doctors in the proposal and dissertations and to recommend the solutionsto such problems. Methods: This survey is based on a direct interview with experienced examiners in both colleges. The examiners were asked to list what they observed as the common problems they identified concerning the proposal and dissertation of residents. The answers were collated and categorized according to the frequencies of problems identified. Based on the response of the examiners, a questionnaire was designed and administered to the senior residents who are at various stages of writing their dissertations. Results: Some of the findings include starting the proposal too late, difficulty in choosing a topic, mediocre and tedious literature search, difficulty in finding appropriate supervisors, poor appreciation of basic research design and necessary statistical tests, improper presentation of results and  wrong referencing. Others are editorial mistakes, pagination errors, and the lack of knowledge on proper attitude and skill during the defense.  Conclusion: Starting too late is the most common error made by the resident doctor in the dissertation. Residents should choose a topic within 6  months of passing the membership examination. Keywords: Dissertations, errors, proposals, resident doctor

Epidemiology of lumbar disc herniations in adults with low back pain in Enugu, Nigeria

Background: Lumbar intervertebral disc herniation is used to describe a spectrum of anatomical abnormalities involving disc extension beyond the interspace. It follows a tear in the annulus fibrosus of the intervertebral disc. It is one of the most common causes of low back pain among adults. The study aims to assess the epidemiological pattern of lumbar disc herniations among adults with low back pain in Enugu urban.Methods: The study was a prospective study at National Orthopedic Hospital Enugu and Annunciation Specialist Hospital Enugu. Following ethical approval and written informed consent, patients who met the inclusion criteria were consecutively recruited. The MRI scans of the participants were viewed using DICOM® (Digital Imaging and Communications in Medicine) software on laptop computer. The data included the patients’ demographics, functional disability index for back pain, weight, height, the anatomical level(s) and site(s) of the herniated disc among other parameters.Results: A total of 81 subjects who met the inclusion criteria were included and analyzed using SPSS version 20.0. The mean age of the subjects is 52.99±13.13 years. The most common affected age group is 51-60 years (27.2%). Majority of the subjects (68; 84%) had multiple level herniations which usually includes L4 level(74; 91.4%).Conclusions: That multilevel lumbar disc herniation is far more common than single level herniation with a prevalence of 84% among adults with low back pain in Enugu urban. That, there is statistically significant association of lumbar disc herniation and increasing age

Assessment of complications following use of pneumatic tourniquet for elective orthopedic procedures at National Orthopedic Hospital, Enugu

Background: A pneumatic tourniquet is a constricting or compressing device with an inflatable cuff used to control venous or arterial circulation to an extremity for a period of time. Tourniquet safety is related to the cuff pressure and duration of application. The objective of this study was to determine the common complications that follow the use of pneumatic tourniquet in elective orthopaedic surgical procedures at National Orthopaedic Hospital Enugu.Methods: This was a prospective study over 18 month period (June 2014 – November 2015) at National Orthopaedic Hospital, Enugu. Following ethical approval and written informed consent, patients who met the inclusion criteria were consecutively recruited. The study was conducted using the ‘intelligent pneumatic tourniquet’ with single bladder reusable cylindrical cuff. The cuff pressure was determined in each case by addition of 100mmHg to the baseline systolic BP for the upper limbs and 150 mmHg to the baseline systolic BP for the lower limbs. The data collected included patients’ demographics, cuff pressure, cuff location, tourniquet duration and complication encountered among other parameters.Results: A total of 160 procedures in 152 patients were included and analyzed using SPSS version 20.0. The prevalence rate of 1.9% for nerve palsy, 1.3% for tourniquet pain, 1.9% for surgical site infection and 5.6% for pressure sore were found in the study. No other complication was encountered.Conclusions: From the results of this study, it is concluded that the use of pneumatic tourniquet under the prescribed conditions is associated with low prevalence of complications

Operative management of congenital talipes equinovarus deformity: experience and reason

Background: Congenital talipes equinovarus is the most common congenital anomaly of the foot and ankle. The prevalence of this condition in our environment is not known due to dearth of medical literature on the subject. The aim of this study was to determine the outcome of our operative management of resistant talipes equinovarus by elongation of tendo-Achilles and posteromedial soft tissue release. Methods: We present a retrospective review of congenital talipes equinovarus treated by Elongation of tendo Achilles (ETA) and Posterior Medial Release(PMR) at National Orthopaedic Hospital Enugu over a 6- year period (January1995- December 2000). Results: There were 63(68%) males and 30(32%) females with mean age of 2.06 years at presentation (range 1/12-18years). There was positive family history in 6(7%) patients. More than half of the patients 63(68%) came without any formal referral. The mode of delivery was spontaneous vaginal delivery in 81(87%) and the first child appears to be more affected 22(24%). The deformities on presentation varied from talipes equinovarus 50(54%) to frank equinus in 3(3%) and fifty-four (58%) were bilateral. Sixty- three (68%) had initial treatment ranging from serial casting in 46(50%) to massage by traditional bonesetter in 2(2%) and the average duration of this initial treatment was 20weeks (range 2-106weeks). The average age at surgery was 2.5years (range 3/12-24 years). All patients received postoperative cast for an average of 13 weeks. The commonest post- operative complication was medial wound breakdown. The average duration of follow-up was 30 weeks (range3weeks-3years). Some patients were lost to follow-up immediately the cast was removed. As at last visit 90% were walking pain-free and do not require special shoe. The commonest residual deformity as at last visit was forefoot adduction in 17(18%) patients. Conclusion: Elongation of tendo-Achilles and posteromedial soft tissue release are common operative procedures for CTEV. The short-term result of these procedures appears very good in our environment. However, the long-term result cannot be effectively analyzed due to high rate of loss to follow-up Orient Journal of Medicine Vol. 18(1&2) 2006: 24-2

Psychological distress and its associated socio-demographic factors among amputees in an orthopaedic hospital in south-eastern Nigeria

Early detection and treatment of psychological morbidity have been associated with reduction in long-term disability and increase in total well-being of amputees. However, much attention have been focused on the management of the physical disability with little interest on differences in distress on account of socio-demographic factors such as gender. This cross-sectional study examined psychological distress in 86 orthopaedic patients with limb amputation participated in the study. They were assessed with the Symptom Distress Checklist-90 (SCL-90) and socio-demographic questionnaire. Results showed that about sixty-four percent (64.4%) of the participants manifested distress in at least one domain of the Symptom Distress Checklist. None of the socio-demographic variables (e.g., gender) differentiated the participants in their self-reported psychological distress. Considering the high prevalence of psychological distress among amputees, mental health professionals should be involved in the management of these patients prior to and after amputation in order to enhance and promote prevention, early detection and treatment of psychological morbidity among amputees.Keywords: Amputation, Gender, Mental Health, Psychological distress, Psychotherap

Early outcome after the use of the triceps fascia flap in interposition elbow arthroplasty: a novel method in the treatment of post-traumatic elbow stiffness

Background: Post-traumatic elbow stiffness (PTES) results in severe interference with the activities of daily living (ADL), affecting mainly young people. Total elbow arthroplasty (TEA) is relatively contraindicated in the young patient and arthrodesis is poorly tolerated. Interposition elbow arthroplasty (IEA) improves the range of motion (ROM) buying time for future reconstructive surgery. While the fascia lata remains the most common material used in IEA, the triceps fascia is a native vascularized tissue, and it does not require a separate incision to harvest. To our knowledge, there are no published studies on the use of this technique of IEA. Method: Sixteen patients with post-traumatic elbow stiffness had IEA with the triceps fascia between January 2009 and January 2017. The ROM was assessed pre-operatively and post-operatively at the 6th and the 24th week. The researchers also evaluated the functional outcome with the Mayo Elbow Performance Score (MEPS) at the 24th week. The data were analysed with the software IBM SPSS Version 20. Results: Nine males and seven females had IEA with the triceps fascia. The mean age of the subjects was 22.8 years (SD = 6.39). The median duration of the stiffness was eight months (range: 2–168 months). Fall was the most frequent cause of post-traumatic elbow stiffness, and the non-dominant side was more frequently involved. Fourteen patients had an intervention at the native bone setters before presentation to the hospital. The mean elbow ROM increased from 16.4° pre-operatively to 97.2° at the 24th week (p < 0.001), while the mean MEPS improved from 42.5° pre-operatively to 81.2° post-operatively (p < 0.001). Conclusion: The triceps fascia flap provides an excellent alternative to the fascia lata for IEA without the complications of the donor site morbidity

Gynaecomastia, erectile dysfunction and subfertility from tramadol abuse in a protracted case of left tilbiofibula nonunion: A case report

Introduction: The abuse of tramadol is on the increase and has attained epidemic proportion globally. Tramadol, a synthetic opioid is frequently prescribed to manage moderate to severe pain. The aim of this case report is to highlight the possible rare side effects of tramadol abuse in an orthopaedic surgical patient.Case report: A 37 year old married school teacher who had left Tibiofibular nonunion resulting from a poorly managed Gustillo-Anderson IIIc tibio-fibular fracture in a road traffic crash about 7 years earlier with associated chronic pain, deformity and limb length inequality for which he started selfmedication with tramadol, escalating to 1.5grams per day over the 7 year period. He had two children but his wife had not conceived in the past six years and there was associated poor erection. Examination findings of dysfunctional and insensate foot, tanner stage IV bilateral gynaecomastia and a score of 10 out of 30 on assessment of erectile dysfunction using international index of erectile function (IIEF) questionnaire. Ultrasound report showed normal breast tissues and loss of normal testicular echotexture, high luteinising hormone level and low testosterone level. His rehabilitation included tramadol withdrawal therapy, below knee amputation and prosthetic fitting . At his six months follow up visit, he had improved IIEF score of 20, his hormonal levels had normalized, and his wife was pregnant.Conclusion: Prolonged use of high doses of tramadol is an uncommon cause of gynaecomastia, erectile dysfunction and subfertility essentially due to testicular atrophy and testosterone suppression. Clinicians should prescribe this medication with caution and adopt multimodal analgesia therapy in management of chronic pain