Predictive factors for primary amputation in trauma patients in a Nigerian university teaching hospital

No Abstract.The East African Medical Journal Vol. 83 (10) 2006: pp. 539-54

Femoral bifurcation with ipsilateral tibia hemimelia: Early outcome of ablation and prosthetic fitting

Femoral bifurcation and tibia hemimelia are rare anomalies. Hereby, we present a case report of a 2-year-old boy who first presented in our orthopedic clinic as a 12-day-old neonate, with a grossly deformed right lower limb from a combination of complete tibia hemimelia and ipsilateral femoral bifurcation. Excision of femoral exostosis, knee disarticulation and prosthetic fitting gives satisfactory early outcome

Reasons Why Trauma Patients Request for Discharge against Medical Advice in Wesley Guild Hospital Ilesha

Background:The aim of this study was to find out the reasons why trauma victims with Orthopaedic injuries take their discharge against medical  advice.Methods: This was a prospective study conducted on Trauma victims  presenting to the Wesley Guild Hospital Ilesha who took their discharge against medical advice (DAMA) over a 2 year period. A questionnaire was designed that was used to retrieve information on the patients biodata, their injuries and the reasons why they DAMA.Results: A total of 49 patients were interviewed over this period. The mean age of the patients was 36.7 years. Students (22.4%), traders (20.4%) and artisans (24.5%) were commonly involved in this practice. Eighteen (36.7%) of the respondents claimed to have taken DAMA due to hospital cost, 18 (36.7%) also DAMA because of their believe in Traditional Bone Setters. Eleven patients (22.4%) simply said they want treatment near home while one patient each gave the fear of amputation and hospital protocol as their reasons for DAMA.Conclusion: Cost of treatment and believe in traditional bone setters were the 2 main reasons why most patients with fracture DAMA. Measures to reduce the cost of treatment and patient’s education about the dangers with unorthodox treatment of fractures and dislocations should help to reduce this behaviour

The aetiology of rickets-like lower limb deformities in Malawian children

Summary: Debilitating rickets-like lower limb deformities are common in children throughout the world, particularly in Malawi, Africa where the causes are unknown. We have identified that Blount disease and calcium deficiency rickets are the likely causes of these deformities and propose calcium supplementation as a potential treatment of Malawian rickets. Introduction: Surgical correction of rickets-like lower limb deformities is the most common paediatric operation performed at Beit Cure Orthopaedic Hospital, Malawi. The aim of this study was to investigate the aetiology of these deformities. Methods: Children with a tibio-femoral angle of deformity >20° were enrolled (n = 42, 3.0–15.0 years). Anthropometric and early life and well-being data were collected. Early morning serum and urine samples were collected on the morning of the operation for markers of calcium and phosphate homeostasis. Knee radiographs were obtained, and the children were diagnosed with either Blount (BD, n = 22) or evidence of rickets disease (RD, n = 20). As BD is a mechanical rather than metabolic disease, BD were assumed to be biochemically representative of the local population and thus used as a local reference for RD. Results: There were no differences in anthropometry or early life experiences between BD and RD. Parathyroid hormone (PTH), 1,25-dihydroxyvitamin D, total alkaline phosphatase and urinary phosphate were significantly higher and serum phosphate, 25-hydroxyvitamin D (25OHD) and tubular maximal reabsorption of phosphate significantly lower in RD than BD. There was no difference in serum calcium, fibroblast growth factor 23 or markers of iron status between groups. All children had 25OHD > 25 nmol/L. Conclusions: Vitamin D deficiency is not implicated in the aetiology of RD or BD in Malawian children. The cause of RD in Malawi is likely to be dietary calcium deficiency leading to elevated PTH resulting in increased losses of phosphate from the bone and glomerular filtrate. The causes of BD remain unclear; there was no evidence in support of previously suggested risk factors such as being overweight or starting to walk early. Prior to surgical intervention, supplementation with calcium should be considered for children with RD

Effect of wearing a helmet on the occurrence of head injuries in motorcycle riders in Benin: a case-control study

BACKGROUND: In Benin, motorcycles are the main means of transport for road users and are involved in more than half of crashes. This study aims to determine the effect of wearing a helmet on reducing head injuries in road crashes in Benin. METHODS: This case-control study took place in 2020 and focused on road trauma victims. The sample, consisting of 242 cases (trauma victims with head injuries) for 484 controls (without head injuries), was drawn from a database of traffic crash victims recruited from five hospitals across the country from July 2019 to January 2020. Four groups of independent variables were studied: socio-demographic and economic variables, history, behavioural variables including helmet use and road-related and environmental variables. To assess the shape of the association between the independent variables and the dependent variable, a descending step-by-step binary logistic regression model was performed using an explanatory approach. RESULTS: Fewer of the subjects with a head injury were wearing a helmet at the time of the crash 69.8% (95% CI = 63.6-75.6) compared to those without a head injury 90.3% (95% CI = 87.3-92.8). Adjusting for the other variables, subjects not wearing helmets were at greater risk of head injuries (OR = 3.8, 95% CI (2.5-5.7)); the head injury rating was 1.9 (95% CI = 1.2-3.3) times higher in subjects who were fatigued during the crash than among those who were not and 2.0 (95% CI = 1.2-3.3) times higher in subjects with no medical history. CONCLUSION: Failure to wear a helmet exposes motorcyclists to the risk of head injuries during crashes. It is important to increase awareness and better target such initiatives at the subjects most at risk

Vitamin D Deficiency and Its Health Consequences in Africa

Africa is heterogeneous in latitude, geography, climate, food availability, religious and cultural practices, and skin pigmentation. It is expected, therefore, that prevalence of vitamin D deficiency varies widely, in line with influences on skin exposure to UVB sunshine. Furthermore, low calcium intakes and heavy burden of infectious disease common in many countries may increase vitamin D utilization and turnover. Studies of plasma 25OHD concentration indicate a spectrum from clinical deficiency to values at the high end of the physiological range; however, data are limited. Representative studies of status in different countries, using comparable analytical techniques, and of relationships between vitamin D status and risk of infectious and chronic diseases relevant to the African context are needed. Public health measures to secure vitamin D adequacy cannot encompass the whole continent and need to be developed locally

Determinants of management outcome in open tibia fractures in ile-ife

Background:Fracture of a normal tibia shaft constitutes a major trauma mostly sustained by young adults during high-energy injuries. Its superficial location and the subcutaneous characteristics of its anteromedial aspect easily causes open fracture. The objectives of this study were to determine the pattern of presentation, and determinants of management outcome in open fractures of the tibia.Methods: This is a prospective hospital based study. A total of 89 patients aged 4 to 80 years with open fractures of the tibia with or without fibula involvement were studied. All the patients received anti tetanus prophylaxis and intravenous antibiotics as well as wound irrigation, debridement and skeletal stabilisation.Results: Students and traders accounted for the majority of the cases (57.3%). Most of the open tibia fractures 69 (77.5%) had above knee Plaster of Paris cast. The majority of the cases were Gustilo and Anderson type II 32 (36.0%) cases and type I 22(24.7%) cases. There was Correlation between the presence of wound infection and (i) Gustilo and Anderson grading (F -.352, P .001); (ii) Injury to Debridement time in hours (F -.304, P .004); (iii) Osteomyelitis (F .397, P .001); (iv) Delayed union (F .253, P .017); and (v) Union time in weeks (F -.350, P .001). There was also correlation between the following: (i) Injury to Debridement time in hours and the distance from the accident scene to the hospital (F .464, P .001); (ii) The fracture pattern and the union time in weeks (F .353, P .001); and (iii) The presence of osteomyelities and delayed union (F .382, P .001). The commonest complications observed were wound infection 35(39.3%) patients and delayed union 30(33.7%) patients.Conclusion:This study shows that the higher the Gustilo and Anderson grading of the open fractures of the tibia, the more severe the wound and bone infection that occurred. The interval between injury time and wound débridement time affected the treatment outcome

Bacterial cultures from sinus track and bone in Nigerians with chronic osteomyelitis

Chronic osteomyelitis of the long bones is common in the tropics, despite advances in antimicrobial therapy and surgical treatment. Attempts to isolate the causative pathogen are often done by surface swabs from the discharging sinuses and findings may differ from bone sampling isolates. This study aimed to establish the correlation between sinus and bone culture. A 2-year prospective study was under taken at Federal Medical Centre Owo, Nigeria, from May 2002 to April 2004. Of 25 patients, bacteria were cultured from 11(44%) sinus tracks and 7(28%) bone samples with only 45% concordance between the cultures. The isolation of a single organism especially Staphylococcus aureus from the bone correlated well with that of sinus track culture. Malawi Medical Journal Vol. 17(2) 2005: 47-4

Pelvic fractures management in a teaching hospital in Nigeria

BACKGROUND: Significant external forces are required to fracture a normal pelvis. The forces usually result from rapid deceleration or crushing injuries. Associated injuries are common as the energy is delivered to multiple anatomical sites. AIMS/OBJECTIVE: The aim of this study was to highlight the pattern of presentation of pelvic injuries, causes, types of the pelvic fracture and outcome of the treatment of these injuries in a teaching hospital in a developing country. SETTING: Department of Orthopaedic Surgery and Traumatology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria. DESIGN: A seven-year retrospective study was done from January 1995 to December 2001. RESULTS: The mean age of the patients at presentation was 35.0+14.8 (SD) with 42 males and 11 females. The mean injury severity score was 20.1. Motor vehicular accident remains the most common cause of pelvic fractures in 37(69.8%) patients, fall from height in 8(15.1%) patients, collapsed walls of dilapidated building in 4(7.6%) patients, motor vehicle pedestrian accident and motorbike pedestrian accidents in 2(3.8%) patients each. The type of pelvic fracture was classified according to Tile. Types A, B, and C were found in 24(45.3%), 17(32.1%), and 12(22.6%) patients respectively. In three patients, the fractures were open. Directly associated injury was diagnosed in 9 patients, these were mainly urogenital system, 2 had bladder injuries, 4 had urethral injuries and 3 had vagina laceration. All the patients were managed without recourse to open operative reduction. The outcome was adjudged excellent, good, fair and poor in 18(34%), 20(37.4%), 9(17%), and 6(11.3%) patients respectively. CONCLUSION: It was concluded that most types of pelvic fractures could be managed with satisfactory results in this environment using the facilities available. KEY WORDS: Pelvis fracture, motor vehicle accidents, falls. Nigerian Journal of Orthopaedics and Trauma Vol.3(1) 2004: 10-1