Gangrene of the limb complicating Salmonella typhi Septicaemia in a Nigerian child

We report an unusual case of lower limb gangrene in a pubertal boy following a typical clinical presentation of septicaemia due to Salmonella typhi. After an initial response to presumed appropriate antibiotic and supportive therapy, the patient developed tissue ischaemia in both feet. There were no clinical or laboratory evidence suggestive of DIC or coagulopathy. Following conservative management which included oral administration of vitamin C, there was gradual regression of ischaemic changes, progressive healing and recovery of function of the left foot while the condition of the right foot deteriorated with extensive tissue necrosis and dry gangrene that extended to the distal one third of the foot. This necessitated surgical disarticulation of the metatarsophalangeal joints two months after admission. This report is to alert clinicians about this rare complication of a common curable disease with a view to anticipating the possibility of it occurring as well as considering appropriate preventive measures.Keywords: Gangrene, foot, Salmonella typhi, septicaemi

Diabetic Extremities in Kaduna

A 5-year retrospective review of 35 patients, suffering from diabetes mellitus with complication of the disease affecting the hands and feet is made between November 1994 and October 1999. The age range was 35-70 years with mean age of 48.5 years. M:F ratio was 2:1. The mean blood sugar at presentation was 12.9 mmol/L. There were 4 diabetic hands and 31 diabetic feet. There were 17 amputations, 12 serial wound dressing and 6 debridments. Mean duration of hospitalisation was 47.3 days. Early presentation and aggressive surgical approach to these patients is recommended (Nig J Surg Res 2000; 2:57-61) KEY WORDS: Diabetes, Extremitie

Management of civilian gunshot injuries to the extremities in Nigeria-an overview

There is an increasing incidence of missile injury attributable to improved technology, and increased crime and conflict rates in both developing and developed nations of the world. We undertook a review of civilian gunshot injuries to the extremities in Nigeria. The pathology of these injuries aswell as their implications for management are presented. The peculiar challenges they present to the orthopaedic surgeons in the management of gunshot injuries in a resource depleted country are highlighted. Community based socially and culturally acceptable conflict resolution mechanisms,control of fire arms and revision of the treatment guidelines are recommended as preventive and management strategies of gunshot injuries in Nigeria

The doctrine of informed consent in surgical practice

Physicians and other professionals in the field of medicine have to perform invasive and non-invasive procedures on patients as part of their duties. There is a legal basis upon which these procedures are done; this is called \u2032informed consent.\u2032 Sociocultural factors have strong influence on the sick role. These factors influence the application of informed consent in Nigeria

Primary Total Knee Replacement in a Patient with failed High Tibial Corrective Osteotomy: A Case Report

Background: Cases of elderly patients presenting with nonunion following high tibial osteotomy for genu vaum are now very rare. This is because corrective osteotomy around the knee in middle age and elderly has lost its importance over the years due to successes of total knee replacement.For the very few that present, several options of treatment, such as revision plating, intramedullary nailing or illizarov compression osteosynthesis exist. These are however not without limitations such as the need for prolong immobilization, development of joint stiffness, soft tissue contractures, recurrent nonunion and subsequent worsening of osteoarthritis of the adjacent joint (knee). We report primary total knee arthroplasty in a patient presenting with nonunion following failed high tibial osteotomy, using diaphyseal engaging stem (DES) in form of tibia extension rod. To the best of our knowledge we have not come across similar report in the country.Method: K.S is sixty two year old woman who presented with inability to walk. Prior to her presentation, she underwent high tibial corrective osteotomy for medial unicompartmental osteoarthritis of the right knee 3 years ago. She developed nonunion necessitating revision surgery (replating) a year and 7 month after first operation (2016), which resulted in nonunion again. Diagnosis of Post Osteotomy High Tibial Nonunion with bone loss was made. She was optimized and underwent total knee replacement with tibia extension rod.Result: She was able to mobilize on the 7th day post operative with the aid of walking frame and was discharged on the 14th day. At 11 month follow up, she mobilises comfortably and pain-free without aid with radiological union at fracture site.Conclusion: Semi constrained Total Knee Replacement with extension rod may be an option for treating failed high tibial corrective osteotomy coexisting with moderate to severe ipsilateral knee osteoarthritis. Keywords: Total Knee Arthroplasty, Tibial Extension Rod, Failed High Tibial Osteotomy

Use of non-vascularized autologous fibula strut graft in the treatment of segmental bone loss

Background : Fractures resulting in segmental bone loss challenge the orthopedic surgeon. Orthopedic surgeons in developed countries have the option of choosing vascularized bone transfers, bone transport, allogenic bone grafts, bone graft substitutes and several other means to treat such conditions. In developing countries where such facilities or expertise may not be readily available, the surgeon has to rely on other techniques of treatment. Non-vascularized fibula strut graft and cancellous bone grafting provides a reliable means of treating such conditions in developing countries. Materials and Methods : Over a period of six years all patients with segmental bone loss either from trauma or oncologic resection were included in the study. Data concerning the type of wound, size of gap and skin loss at tumor or fracture were obtained from clinical examination and radiographs. Result : Ten patients satisfied the inclusion criteria for the study. The average length of the fibula strut is 7 cm, the longest being 15 cm and the shortest 3 cm long. The average defect length was 6.5 cm. Five patients had Gustillo III B open tibial fractures. One patient had recurrent giant cell tumor of the distal radius and another had a polyostotic bone cyst of the femur, which was later confirmed to be osteosarcoma. Another had non-union of distal tibial fracture with shortening. One other patient had gunshot injury to the femur and was initially managed by skeletal traction. The tenth patient had a comminuted femoral fracture. All trauma patients had measurement of missing segment, tissue envelope assessment, neurological examination, and debridement under general anesthesia with fracture stabilization with external fixators or casts. Graft incorporation was 80% in all treated patients. Conclusion : Autologous free, non-vascularized fibula and cancellous graft is a useful addition to the armamentarium of orthopedic surgeon in developing countries attempting to manage segmental bone loss, whether created by trauma or excision of tumors

Use of non-vascularized autologous fibula strut graft in the treatment of segmental bone loss

Background : Fractures resulting in segmental bone loss challenge the orthopedic surgeon. Orthopedic surgeons in developed countries have the option of choosing vascularized bone transfers, bone transport, allogenic bone grafts, bone graft substitutes and several other means to treat such conditions. In developing countries where such facilities or expertise may not be readily available, the surgeon has to rely on other techniques of treatment. Non-vascularized fibula strut graft and cancellous bone grafting provides a reliable means of treating such conditions in developing countries. Materials and Methods : Over a period of six years all patients with segmental bone loss either from trauma or oncologic resection were included in the study. Data concerning the type of wound, size of gap and skin loss at tumor or fracture were obtained from clinical examination and radiographs. Result : Ten patients satisfied the inclusion criteria for the study. The average length of the fibula strut is 7 cm, the longest being 15 cm and the shortest 3 cm long. The average defect length was 6.5 cm. Five patients had Gustillo III B open tibial fractures. One patient had recurrent giant cell tumor of the distal radius and another had a polyostotic bone cyst of the femur, which was later confirmed to be osteosarcoma. Another had non-union of distal tibial fracture with shortening. One other patient had gunshot injury to the femur and was initially managed by skeletal traction. The tenth patient had a comminuted femoral fracture. All trauma patients had measurement of missing segment, tissue envelope assessment, neurological examination, and debridement under general anesthesia with fracture stabilization with external fixators or casts. Graft incorporation was 80% in all treated patients. Conclusion : Autologous free, non-vascularized fibula and cancellous graft is a useful addition to the armamentarium of orthopedic surgeon in developing countries attempting to manage segmental bone loss, whether created by trauma or excision of tumors