Multiple dorsal carpometacarpal joint dislocation: case report

Carpometacarpal joint dislocation extending from the second to fifth metacarpal is a rare injury. It usually follows high energy trauma but may be seen in low energy trauma. The diagnosis can easily be missed because of severe swelling of the hand at presentation and overlapping of the bones on radiograph of the wrist and hand. The dorsal dislocation is the commonest pattern of injury. We present a case of right dorsal carpometacarpal joint dislocation. The diagnosis was made with radiograph of the right wrist. It was managed with closed reduction and percutaneous K-wire fixation under image intensifier control. He had intensive physiotherapy and functional assessment was done using quick DASH score at regular interval on follow up. On the last follow up, 2 years later, the quick DASH score was 9.1%. The right hand was pain-free. A high index of suspicion and meticulous hand examination is important to avoid missed diagnosis of a carpometacarpal joint dislocation. Prompt reduction and fixation followed by intensive physiotherapy are necessary to achieve excellent hand function

Geriatric trauma - epidemiology and outcome at Cedarcrest Hospitals, Abuja, Nigeria

Background: Trauma is a major public health problem with huge economic and social implications. Old age and co-morbidities generally affect the outcome of traumatic injuries in elderly patients, and the impact of trauma on elderly patients has generally been overlooked. Objective: To describe the epidemiology and outcome of trauma on elderly patients. Design: This was a retrospective study that was conducted at Cedarcrest Hospitals, Abuja, Nigeria. Method: Data were collected from the electronic medical records for all patients aged 65 years and above who visited the emergency department as a result of traumatic injuries. Results: A total of 82 patients were recruited for the study. The prevalence of geriatric trauma was 4.9%, and fall was the commonest mechanism of injury (67.1%). Ninety eight point eight percent had a revised trauma score of 12 while the injury severity score ranged from 1 to 15. Conclusion: Geriatric trauma is relatively common in our environment and efforts should be made to prevent falls in the elderly

Prevalence and pattern of osteoarthritis of the knee at National Orthopaedic Hospital Enugu

Objectives: To determine the prevalence of osteoarthritis of the knee and the risk factors associated with its development at National Orthopaedic Hospital Enugu.Design: Cross sectional descriptive study.Setting: A regional orthopeadic centre in NigeriaSubjects: Two thousand three hundred and ten adults aged 30 years and above.Results: One hundred and fifty one patients were diagnosed as having symptomatic osteoarthritis of the knee with a male to female ratio of 1:2.6. The prevalence of osteoarthritis increased with advancing age. It peaked at 70-79 years age group. The prevalence of osteoarthritis of the knee was noted to be higher in the female sex, house wives and farmers. The overall prevalence of knee osteoarthritis was 6.5%. Multiple risk factors played roles in the aetiology of osteoarthritis of the knee. The majority of the patients were obese. Obesity was noted in 49.7% of the patients while 24.5% of the patients reported having previous knee injuries. A positive family history of osteoarthritis of the knee was noted in 17.2% of the patients while it was noted to be idiopathic in 4.6% of the patients.Conclusion: The prevalence of osteoarthritis of the knee at National Orthopaedic Hospital Enugu is 6.5%. Prevalence was higher in the female sex, house wives and farmers. Obesity was the major risk factor while valgus knee was the commonest presentation.Keywords: Osteoarthritis of the knee, prevalence, risk factors, Enugu

The practice of hepatocellular cancer surveillance in Nigeria

Background: Hepatocellular cancer is a disease of global and public health importance due to the widespread distribution of risk factors and associated high case fatality. Hepatocellular Cancer (HCC) in Sub-Saharan Africa is commonly seen among the younger age groups (<45 years) who present mostly in the terminal stage, when the disease is not amenable to any curative therapy. Hepatocellular Carcinoma surveillance employs the use of simple, cheap and readily available investigations, to detect early curable cancer in individuals with risk factors for HCC.Objectives:The aim of this study is to assess the practice of hepatocellular cancer screening among physicians.Methodolgy:This is a nationwide online survey carried out among physicians who care for patients with HCC. A questionnaire was sent out via a web link to all consenting doctors in Nigeria. The responses were collated in a cloud-based application and data was analysed using Epi-info version 20.Results:Atotal of 218 respondents, 142 were males (65.1 %) with a mean age of 37.6 ± 5.7 years. The modal age group was 31-40 years 153 (69.5%). The main factors considered as a hindrance to surveillance were; the cost of the tests (57.7%), failure of return of patients (50.5%) and not being aware of a surveillance program (45.2 %). The majority of the respondents were Gastroenterologists and Family Physicians. 54% of the gastroenterologists and 64% of the family physicians have never offered HCC surveillance to their patients.Conclusion:This survey highlights a knowledge gap in HCC surveillance among physicians. There is a need to make HCCsurveillance a daily routine among patients at risk by all physicians. Keywords: Surveillance, Hepatocellular Carcinoma, HBV, HCV, Cancer screening

Paediatric Hip Fracture - Dislocation: a case report.

We present a case of posterior fracture- dislocation of the left hip in a 6 year old child who was a passenger of a car that was involved in vehicular accident. The child presented with painful left hip and widening of the medial joint space on radiograph of the hip. The possibility of a spontaneousreduction in a traumatic hip dislocation adds to the diagnostic confusion. In this patient, a loose osteochondral fragment was visible on CT-scan, there was an obvious increase in the medial joint space. Open reduction of the hip was done via a posterior approach, the hip joint was explored and the loose fragment fixed using polydioxanone(PDS) screws and anchor sutures. A stable concentric reduction was obtained and maintained post operatively using a hip spica. At follow up 6 months later, the hip was noted to be painless with full range of motion. A repeat MRI at 7 months showed that the previously widened medial joint space is reduced with slight uncovering of the hip