Outcome of the Treatment of Gunshot Open Fractures of the Lower Extremities with ‘SIGN’ Interlocking Nails

Background: Gunshot injuries are gradually on the increase in civilian populations in developing countries due to increasing violence in our society. The treatment of fractures from these injuries is changing with the use of locked intramedullary nailing becoming an acceptable and effective method of fixation. Surgical Implant Generation Network interlocking nails are gaining universal acceptability in these countries due to ease of use without the need for image intensifier. The purpose of this study was to evaluate the outcome of the use ‘SIGN’ interlocking nailing in gunshot open fractures of the lower limbs. Methods: This is a prospective study of all patients in three tertiary centres in developing countries who had gunshot fractures of lower limbs fixed with SIGN nails from 1st January to 31st December 2009 and followed up for a period of 2 years. Results: Twenty eight patients with 31 fractures with average age of 32.5years±12.6SD. All the patients were males except one female. Fractures occurred in femur in 20(71.4%) and tibia in 11(29.6%) SIGN nail was used to fix all fractures and union was achieved in all the patients. The most common complication was wound in infection in 5 (15.2%). Conclusion: SIGN intramedullary locked nail provided an effective method of fixation for gunshot fractures of the lower extremity with minimal complication

Incidental hand injuries in assault: a report of two cases

Background: Hand injuries are common occurrences in domestic settings. However, unintentional injuries to a third party who mediates a brawl between two individuals is unusual. Two patients who sustained hand injuries in this circumstance are presented. Method: The patients had initial wound debridement, antibiotic therapy and daily wound dressing till infection was controlled and re-exploration performed. Extensor pollicis longus was found to be severed with a gap of 4 centimeter after mobilization and traction. Palmaris longus tendon graft from the same hand was used to bridge the gap. Case 2 had wound exploration evacuation of Hematoma and ligation of feeding dorsal arch arteries. Results: Both patients made an uneventful postoperative functional recovery of the hands. Second case was lost to follow up. Conclusion: Unintended injuries to the hand can result from arbitration in physical fight which could be life threatening and disabling. Prompt attention from appropriate specialist will curtail the morbidity from such injuries.Keywords: hand injuries, incidental, assaultNigerian Journal of Plastic Surgery Vol. 9, No 2, September 201

Over and under exposures of radiotherapy patients at the A.B.U. teaching hospital, Zaria, Nigeria: case reports

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Locked Intramedullary Nailing of Femur and Tibia in a Semi Urban Area

Background: Long bone fractures of the extremities are increasingly becoming a common clinical presentation of the trauma patients to the emergency unit of most urban hospital in Nigeria due to increasing vehicular traffic on our roads. Locked intramedullary nailing is the gold standard for operative treatment of these injuries.Patients and Methods: 104 consecutive patients with 108 fractures of femur and tibia who had Surgical Implant Generation Network (SIGN) locked intramedullary nailing over a period of two years from September 2004 to August 2006 was evaluated for its effectiveness.Results: There were 72 males and 32 females giving a ratio of 2.3:1.The mean age was 36.6years SD±15.2 and 88 (81.5%) femoral and 20 (18.5%) tibia fractures. Fractures was closed and open in 86 (79.6%) and 22 (20.4%) patients respectively. Gustillo and Andersen grades of open fractures was I 7 (31.8%), II 8 (36.4%), IIIA 4 (18.2%) and IIIB 3 (13.6%. The open method of reduction was used. Indications for fixation were: Recent factures in 73 (67.6%) and non union in 35(32.4%). Average time to union was 4.5 SD±1.92 with a range of 3 to 9 months. The mean duration of follow up was 36 months. Mean duration of hospital stay was 36.8 days SD±39.2.Conclusion: We concluded that locked intramedullary nailing using SIGN nail was safe and achieved satisfactory union of fracture of Femur and Tibia.Key words: Intramedullary nail, SIGN

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

The Financial Implication of Treating Motorcycle Limb Trauma in a Developing Country - The Patient's Perspective

Background: The total cost of care of injuries is usually much more than the cost of hospitalization. This study was designed to determine the total cost to the patient, of limb injuries sustained from motorcycle crashes.Method: The study design was based on the cost-of illness method. Only patients who were employed and could estimate their daily income; and who completed their course of treatment, and were followed up for two years were included in the study. Results: 60 patients satisfied the criteria for inclusion. The total cost of treatment ranged from N4,715.00 to N141,655.00 with a mean of N37,615.15 ± N30,908.00 SD. It represented between 4.09% and 310.48% of patients' annual income. The medical costwas 48.4% of the total while the balance was made of lost productivity (39.0%) and cost of vehicle repair/replacement (12.6%). Lower limb injuries were significantly more expensive to treat than upper limb injuries.Conclusion: The cost of treating injuries from trauma remains a large burden to patients especially in a country where health insurance coverage is poor.Key words: Cost analysis, motorcycle, trauma, injury, limb

A Three-Year Review of Birth Weight Pattern Among Term Deliveries in Bowen University Teaching Hospital, Ogbomoso, Nigeria

Background: Birth weight is a commonly used indicator of newborn maturity and health and a reliable predictor of postnatal survival. There is a need to determine the birth weight pattern and maternal factors that influence the birth weight in babies delivered at term. Objective: To determine the birth weight pattern and maternal factors influencing the birth weight of babies delivered at term. Methods: In this retrospective, descriptive study, the hospital records of all pregnant women who had childbirth at term in Bowen University Teaching Hospital (BUTH), Ogbomoso, Nigeria, from 01 January 2018 to 31 December 2020, were retrieved. Data on birth weight and maternal obstetric factors were retrieved for analysis. Results: The mean age of the mothers was 30.52 ± 5.23 years. A total of 1072 deliveries were recorded during the study period. These consisted of 580 (54.1%) males and 492 (45.9%) females, with a male-to-female ratio of 1.18:1. The caesarean section rate was 37.7%. The mean birth weight was 3.15±0.56 kg, and male babies had a higher mean weight (3.186±0.535kg vs 3.14±0.493kg). Normal birth weight (NBW) was recorded among 90.3%, while low birth weight (LBW) and high birth weight (HBW) were 6.7% and 3.0%, respectively. Only maternal comorbidities (p = 0.0001) and number of gestation (p = 0.0001) were significantly associated with birth weight. Conclusion: Maternal and foetal factors influenced the birth weights of the babies. Implementing measures to minimise the risk of delivering babies with abnormal birth weights is essential to improve newborn survival

Mortality among orthopaedic and traumatology admissions: a ten year review

Objective: Mortality in orthopaedic admissions is not a common event. This study sets out to review the incidence and causes of mortality in orthopaedic and trauma admissions in a tertiary centre in a developing country. Methods: Medical records of patients admitted to the Orthopaedic wards of the Obafemi Awolowo University Teaching Hospital, Ile-Ife over a ten year period (January 1999-December 2008) were retrospectively reviewed. The death certificates and postmortem examination findings were used in conjunction with the medical records to arrive at the possible cause of death in the deceased patients. Frequency analysis was done using SPSS version 13. Results: Over this period, 2418 patients were admitted for orthopaedic and trauma with 84 deaths giving an overrall crude mortality rate of 3.47% ( 1.27% for paediatrics and 4.39% for the adults). Fourty nine patients (58.4%) died from trauma (fracture) related diagnoses followed by tumour (21(25%) and infection (14(16.7%). Males were more affected 73.8% and the average age at death was 45.7years. Co-morbid conditions were found in 39.3% of the deceased patients. Conclusion: Trauma related deaths were the leading cause of mortality in our ward admissions and male patients at the prime of their lives were more often involved. Accident prevention and provision of facilities for appropriate management of trauma victims will help reduce substantially these untimely deaths in our world. The high incidence of comorbid conditions emphasizes the role of multidisciplinary care in orthopaedic and trauma patients.Key words: Mortality, orthopaedic and Trauma, In-patients