Sideswipes Injuries of Upper Limbs: A Case Series Report and Review of Literature

BACKGROUND: Sideswipe injuries are consequent to object striking an elbow on the window edge of a moving vehicle. It often results in severe soft tissue and bony injuries or partial amputation of the upper limb.Functional outcome in most patients is poor. The aim is to highlight the occurrence and functional outcome of these injuries.METHOD: In our series we report three cases which presented to us in succession within four weeks.RESULTS: Two of the patients were passengers of commercial buses while one patient is the driver of a private car. Two were males. All were protruding their arm from the open vehicle window at the time of impact.All presented within five hours of injury. All sustained open fracture-dislocations. All were managed with external fixation and soft tissue cover. They all had poor outcome as evidenced by joint stiffness.CONCLUSION: The functional outcome of such injuries is usually poor especially if the dominant limb is involved. Therefore the need for prevention cannot be overemphasized. Simple measures like ensuring that no part of the limb is sticking outside a moving vehicle, winding up glass up to mid window level etc will greatly reduce the occurrence of these injuries

Pattern of Bone Tumours Seen In A Regional Orthopaedic Hospital In Nigeria

Background: Primary bone tumour is a challenge to Orthopaedic surgeons working in developing countries due to late presentation as a result of ignorance and poverty. This is further compounded by limited number of specialist personnel, diagnostic and therapeutic centres. Consequently, they are associated with high rate of morbidity and mortality, which can be reduced with early presentation.Materials and methods: This is a retrospective review of all histologically proven primary bone tumours seen at National Orthopaedic hospital Enugu,South east Nigeria, over a 6 year period.Results: Sixty eight (68) cases met the study criteria and were reviewed. Male:Female ratio was 1.35:1, with a mean age of 22.8years and peak frequency in the 11-20years age range. A total of 28(41.1%) were benign, 21(30.9%) were malignant while 19(27.9%) were tumour-like conditions. The commonest benign tumour was osteochondroma, accounting for 44.7% of non-malignant lesions, while fibrous dysplasia was the commonest tumour-like condition(23.4%). Primary malignant bone tumours accounted for 30.9% of all pathologies, with osteosarcoma(17) accounting for 80.1% of all malignant lesions. The commonest region affected is the leg i.e proximal tibia. Duration of symptoms before presentation ranged from 1month to 12years, with the commonest presenting complaint being apainless lump.Conclusion: Primary bone tumours is commonest in young males, usually benign and affecting the Tibia. Associated late presentation results in increased morbidity and mortality. Hence, efforts need to be geared towards public enlightenment in developing countries, to ensure early presentation, thereby reducing morbidity and mortality

Pattern of femoral fractures and associated injuries in a Nigerian tertiary trauma centre

Background: The femur is the strongest and largest bone in the human body. It therefore requires high-energy trauma for it to fracture unless there is an ongoing pathology that weakens the bone. Femoral fractures are thus associated with significant pain, deformities, bleeding and varying degrees of injuries. The aim of this study is to determine the pattern of femoral fractures and the associated injuries in our region while recommending possible means of averting these injuries.Materials and Methods: A 10-year retrospective study was done in National Orthopedic Hospital Enugu from 1994 to 2003. The demographic data, etiology, the part of femur affected and associated injuries were collated from the hospital records/folders. The analysis was performed using descriptive statistics in Microsoft Excel 2007.Results: A total of 562 cases were reviewed, 63.7% of all the patients were males and the most common etiological factor was road traffic accidents. The site of fracture varied with age and etiology with 26.5% occurring at the mid-shaft with an average age of 27.2 years and 16% occurring at the neck of femur, more in the elderly, with 55.6% following minor falls and trips. The most common associated injury was soft tissue injuries requiring secondary wound closure.Conclusion: Femoral fractures are common and the pattern varies with age and the mechanism of injury. They are associated with other injuries that may be life-threatening.Keywords: Associated injuries, femoral fractures, Nigeria, patter

Talectomy For Recurrent And Resistant Talipes Equinovarus

OBJECTIVE: To report the results of talectomy in the treatment of recurrent/resistant talipes equinovarus deformity during the last twenty years at the National Orthopaedic Hospital Enugu. Nigeria. METHOD: Seventeen Patients (31 Feet) treated by talectomy for rigid non-bracable equinovarus deformities were reviewed. There were 9 males and 8 females. The average age at talectomy was 4 years. RESULTS: The primary diagnoses were Arthrogryposis multiplex congenital (AMC) in 12 patients, myelomeningocele in 3 patients, recurrent congenital talipes equinovarus (CTEV) in 2 patients. Twenty-seven feet had talectomy as a salvage procedure after repeated failed posterior medial release (PMR). The average follow up was 6.5years (1-14). As at last follow up 26 feet were plantigrade and pain-free and were considered satisfactory. CONCLUSION: Talectomy will not correct associated forefoot adduction Nig Jnl Orthopaedics & Trauma Vol.2(2) 2003: 94-9

Unwholesome trauma care: A cautionary note

No Abstract. Nigerian Journal of Medicine Vol. 14(2) 2005: 218-22

Paradigm Shift in the Treatment of Distal Radial Fractures

Key words: Distal, radial fractures, treatment, and paradigm shift Nigerian Journal of Orthopaedics and Trauma Vol.3(2) 2004: 100-11

Management of Penetrating Spinal Cord Injuries in a Non Spinal Centre: Experience at Enugu, Nigeria

Background: Penetrating injuries of the spinal cord are among the most dangerous of injuries. They are often associated with injuries to other vital organs of the body, which may demand priority attention. The objectives of this study were to determine the pattern of the penetrating spinal cord injuries and to evaluate outcome of treatment in our setting. Methods: This is a retrospective study of all penetrating spinal cord injuries seen at the National Orthopaedic Hospital, Enugu over a fifteen-year period (April 1990 March 2005). Information about the demographics aetiology, level of injury, associated injuries, time of presentation, duration of hospitalization and outcome of treatment were retrieved from patients case notes. Data were analyzed using SPSS for windows version11. Result: There were 22 patients, 13 males and 9 females, giving a M:F ratio of 1.7:1. Gunshot injury was the most common aetiological factor. The thoracic spine{9(41%)}was most often involved. Chest and abdominal injuries were common associated injuries in 5 cases. The circumstances of the injury were mostly armed robbery attack {13(59%)}. On admission the neurological status was Frankel grade A in 20(91%) cases. Period of hospitalization ranged from 1 week to 36 weeks with a mean of 11 weeks. Pressure sore was the most common complication that delayed rehabilitation. Five (23%) patients with injury at cervical level died from respiratory failure. Conclusion: Penetrating spinal cord injuries are relatively rare and demand extra care. Early recognition of associated injuries, minimal wound excision and antibiotic therapy give good result. Keywords: Penetrating spinal cord injuries, pattern, outcome of treatment, Enugu, Nigeria.Nigerian Journal of Medicine Vol. 17 (2) 2008: pp. 207-21

Anaesthetic Requirement in Spinal Cord Injured Patients undergoing Operation below the Level of Cord Injury

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Pattern of Pressure Sores in Spinal Injured Patients with in the First Six Months of Injury

Background: Before 2006, all our spinal injured patients were nursed on conventional form mattress without pressure redistributing support surface. Pressure sore was a common complication and was a major contributing factor to prolonged hospitalizationAim: The aim of this study is to determine the pattern of pressure sores within the first six months of injury in spinal cord injured (SCI) treated on conventional foam in our setting.Methods: This was a retrospective study of one hundred and ninety-three spinal patients admitted between January 1997 and December 2005 at National Orthopaedic Hospital Enugu.Results: There were one hundred and ninety-three patients. One hundred and seventy-six of these patients were males and seventeen were females; giving an overall male female ratio of 10:1. The mean age was 34±4.8 years. Out of 193 patients, ninety-four (49%) developed pressure sore and a total of one hundred and twenty-one pressure sores were documented due to multiplicity of sites. The common sites were sacrum (42%), and greater trochanter (39%). The peak time for developing pressure sore was between 3rd and 4th weeks of admission. The average duration of hospitalisation was 12 weeks (range 8-28weeks) The treatment sores varied from dressing (37%), debridement (21%), to flap cover (37%).Conclusion: The sacral and the trochanteric pressure sores are very common and they tend to develop around the 3rd and the 4th weeks of admission. It is therefore important for health care providers to be aware of this temporal pattern and take adequate preventive measures.Key words: Pressure sores, Time, Distribution, Spinal injured patients, Enugu, Nigeri

Above-Elbow Amputation and Death Following Human Bite Mismanaged by Quacks: A Case Report and Review of Literature

No Abstract