Effectiveness and complications of SIGN intramedullary interlocking nailing in the management of femoral and tibial fractures at Moi Teaching and Referral Hospital, Eldoret- Kenya: A retrospective study

Background: Interlocking intramedullary nailing is the current state-of-the-art management of the shaft fractures of long bones. Objective: To assess the functional outcome of SIGN nailing of femoral and tibial fractures at Moi Teaching and Referral Hospital. Design: Retrospective analytical, study over a three year period from February 2005 to April 2008. Setting: Orthopaedic Department, Moi Teaching and Referral Hospital, Eldoret. Subjects: All patients with closed or Gustillo Grade I or II open tibial and/or femoral shaft fractures presenting at Moi Teaching and Referral Hospital, Eldoret. Results: Three hundred and eleven patients with tibial and/or femoral shaft fractures were treated at Moi Teaching and Referral Hospital of whom 245(78.8%) were males while 66(21.2%) were females. Total nails fixed were 329 and the oldest patient aged 100 years while the youngest was 13 years.Twelve (3.9%) of the total number of patients presented with ipsilateral fractures, 4(1.3%) had bilateral fractures, 4 (1.3%) had fractures of both the femur and tibia while 1(0.3%) patient had fractures of the femur and humerus. There were 300 closed fractures and 29 open fractures treated with intramedullary nailing. Road traffic accidents were the leading cause of injury. Other causes included falls, assault, gunshot, sports injuries, pathological fractures among others. Prophylactic antibiotics were used in 288 patients. One hundred and thirty four (43.1%) patients turned up for follow up during the same period. There were 23 cases of wound infection, 4(1.2%) broken nails, 6(1.8%) failed distal locking and 2(0.6%) fractures above the nail. Conclusion: Males were found to be more affected than females. Road traffic accidents are the leading causes of trauma. Loss of follow up is one of the major problems still encountered. SIGN intramedullary nailing was found to be the most effective method of fracture management with minimum complications

The management of bone and joint infections at Moi Teaching and Referral Hospital

Background: Bone (cortex and marrow) and joint infection are not uncommon in this health institution. The management of patients with the lesion has posed a challenge yet the institution is in top gear training the surgeons in the field of orthopaedic and trauma surgery. This study aims to lay foundation for development of the management protocol, and further research. Objective: To evaluate the management of Bone and Joint infection in children. Design: Retrospective descriptive study. Setting: Moi Teaching and Refferal Hospital, Eldoret, Kenya. Methods: The relevant data of 85 consecutive patients on aspects of demography and the management in the period 2001- 2006 were recorded into the data sheet (proforma), then analyzed and presented in statistical patterns. Results: Eighty five consecutive patients (47 males, 38 females), ratio M: F =1.24:1. Admission rated at least 14±2SD patients per year. Age: 2weeks-13 years, mean= 7.53 ±3.98SD. Major risk/predisposing factor-trauma. Duration of symptoms: 1 day-2 years, mean=16.44± 11.28SD. Commonest symptomatology included pain, swelling and loss of function more so in the joints than in bones. Of investigations- Laboratory: anaemia, bacterial isolates(33 and 14 patients respectively), while radiological/ imaging: lesions identified in patients’ radiographs, CT- scans and ultrasound scans (49, 3 and 3 respectively). Fifty six patients were diagnosed with arthritis and 39 with osteomyelitis. Treatment of 26 patients was non- operative and 59 were operated. All the patients survived. Hospital stay ranged from 2- 159 days, mean=14.16 ±9.46SD. Follow-up in clinic- 12 patients defaulted, 26 inconsistent while 47 consistent. Conclusion: Bone and joint infections were associated with significant morbidity as shown by high operative intervention and long hospital stay. Delayed presentation as noted could be responsible for the high morbidity