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

Primary and Revision Amputation Surgery in a Tertiary Institution in South West Nigeria

Background: Amputation is a common elective or emergency surgical procedure. We set out to study the cases undergoing amputation surgery with special interest of determining the prevalence rate of revisionamputation surgery; its indication and trend among patients who had amputation surgery at a tertiary health facility.Method: Study was cross sectional in design and retrospective in nature, conducted in a tertiary health facility selected purposively in a state, South West, Nigeria. Data collection was by reviewing the records of amputation surgery done at a tertiary health facility over a 15-year period (1996- 2010). Data collected were analyzed using the SPSS version 17, and statistical inferences made at p-value .0.05.Results: A total of 124 amputations were done with 9 cases of revision amputation giving a prevalence rate of 7.25%. The commonest indication found for amputation surgery was trauma while it was ascending gangrene for revision amputation. Among those who had revision amputation done, 75% were diabetic while 22% had earlier refused consent for amputation at an appropriate site. An increasing trend in the prevalence of revision amputation was found. There was a statistically significant associationbetween diabetic amputees and their having a revision amputation done with p =0.002.Conclusion: Diabetic amputees are at a higher risk of a revision amputation. Counseling and appropriate diagnostic procedures is essential for prevention

Use Of Continuous Axillary Brachial Plexus Block Facilitates Assessment Of Motor Functions During Tendon Repair

Objective: To report the successful use of continuous axillary brachial plexus block in the assessment of muscle functions during tendon repair. Methods: A prospective observational study carried out at Obafemi Awolowo University Teaching Hospital, Ile-Ife between November 2006 and December 2007. The study included patients scheduled for repair of upper limb tendon secondary to trauma. American Society of Anaesthesiologist (ASA) health status 1 and 2 were included. 24 healthy patients who presented with laceration of upper limb tendon had continuous axillary block for the repair of the tendon using a catheter infusion technique. 0.5% Ropivacaine hydrochloride was the local anaesthestic solution. Monitoring of motor and sensory functions was done both intraoperatively and postoperatively. Results:The awake patients were able to carry out basic motor functions which facilitated assessment of tendon repair in all the 24 patients. Anaesthesia was adequate in 21 (87.5%) of the patients. 3 patients requested for supplementary analgesia. Only one patient developed features suggestive of local anaesthetic toxicity. Conclusion: Insertion of axillary catheters for the purpose of continuous brachial plexus block can facilitate assessment of functions following tendon repair when appropriate local anaesthestic agents with motor sparing effects are selected. Keywords: Axillary block, assessment, motor functions, Nigeria Journal of Orthopaedics and Trauma Vol. 7 (2) 2008: pp. 60-6

External jig in the placement of distal interlocking screws

Background: Placement of distal locking screws is a challenge to many surgeons involved in interlocking nails. Objectives: The aim of this study is to evaluate the accuracy of external jig as a target arm for distal locking screw insertion. Methods: 85 consecutive patients with 90 fractures treated with SIGN interlocking nails were prospectively studied. We report the assessment of the accuracy of insertion of distal locking screws with the use of SIGN external jigs. The patient's demographic data and fracture characteristics were documented. Two distal screws are usually inserted. However, in very difficult cases, one distal screw may be inserted. In all cases there was no access to intra operative radiograph. Results: There were 85 patients and 90 fractures. There were 57 males and 28 females giving a ratio of M:F 2:1. The mean±SD age of the patients was 41.19±16.28 years and the range was 18-85 years. The two bones studied were femur 62.3% and tibia 37.8%. Retrograde (52.2%) was the commonest surgical approach used for femur. The main indication for SIGN interlocking surgery was recent fracture 77.8%. Open reduction 97.8% was the commonest method of reduction used. The mean±SD bone union time was 3.58±0.56 months and range 3-5 months. Distal screw insertion was successful (2 screws) in 93.3% and partial success (1 screw) in 6.7%. At first attempt 96.7% of distal screws were inserted while 3.3% distal screws were inserted at 2nd attempt (2nd visit to theatre). The main complication was screw loosing seen in 3.3%. Conclusion: External jig as a target arm is effective for the placement of distal locking screw.Keywords: External jig; Target arm; Distal screws; Interlocking nails

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

Prognostic factors in Adult Tetanus in a Tertiary referral Centre.

Background: Tetanus is a cause of painful and avoidable deaths in Nigeria. The aim of this study is to identify the factors that significantly contribute to the outcome of adult tetanus at Obafemi Awolowo University Teaching Hospitals' Complex.Method: Medical records of adult patients (≥ 16years) admitted for tetanus at the Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife was retrospectively reviewed over a 10year period (1998-2007).Results: Tetanus mostly results from minor wounds. Males were more affected (4:1) and the median age of affected adult was 28years (interquartile range 20-40years). The mortality rate was 46.9%. Multivariate logistic regression analysis revealed that the onset period (odds ratio 0.94, 95% CI 0.91-0.98), the duration between symptom and admission (odds ratio 0.6, 95% CI 0.38- 0.94), and temperature of the patient (odds ratio 2.66, 95% CI 1.02- 6.97) were important prognostic factors in this study. Conclusion: Mortality rate from adult tetanus is still very high in our environment. The presence of factors indicating an adverse outcome in patients on admission will help identify the patients that will require more intensive management. Immunization prophylaxis is recommended for all individuals and patients.Key Words: tetanus, adult, prognostic factors.

Pattern of Congenital Musculoskeletal Abnormalities in South West, Nigeria: A Hospital Based Study

Background: Published data on congenital musculoskeletal anomaly in subsaharan Africa are few.Aim: To review the pattern of congenital musculoskeletal abnormalities seen at the Obafemi Awolowo University Teaching Hospitals' Complex (O.A.U.T.H.C) Ile-Ife.Materials and Methods: The clinical records of patients who presented to the O.A.U.T.H.C, Ile-Ife, with congenital musculoskeletal abnormalities over 7 years (July 2000 to June 2007) were reviewed. Comprising patients delivered in the hospital, referred patients seen in the Orthopaedic clinics and those admitted to the hospital Orthopaedic, Paediatric and Postnatal wards. The following data were extracted; age, gender, diagnoses, description of the abnormality and the presence of associated congenital deformities. The side of the body involved and bilaterality were noted.Result: Over this period, 123 patients met the criteria. Eighty one were males while 42 were females with a M:F= 2:1 Congenital talipes equinovarus(CTEV) deformity was the most common congenital musculoskeletal anomaly in 64(52.0%) patients. Others were Polydactyly 16 (13.0%) and syndactyly 11(8.9%). Other common congenital orthopaedic anomalies encountered include: Arthrogryposis multiplex congenital 7(5.7%), congenital knee dislocation 6(4.9%), Calcaneovalgus deformity 5(4.1%) and absent radius 5(4.1%). Among the patients with clubfoot, there was a predominance of bilateral involvement of both foot with 63.4% of the idiopathic variety showing bilaterality and 60.9% of the non-idiopathic variety having bilateral involvement. The idiopathic Variety constituted 64.1% of the club foot deformities. Spina bifida cystica was the most common associated deformity among the patients with nonidiopathic clubfoot.Conclusion: Congenital talipes equinovarus was the most common congenital Musculoskeletal anomaly seen at the Obafemi Awolowo University Teaching Hospital Ile-Ife, with a high incidence of bilaterality. Spina bifida cystica was the most associated anomaly in the non-idiopathic club foot in this centre.Keywords: Congenital, Musculoskeletal, anomaly, Tertiary, Referral, Centre

Mortality among orthopaedic and traumatology admissions: A ten year review.

Objective: Mortality in orthopaedic patients 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 co-morbid conditions emphasizes the role of multidisciplinary care in orthopaedic and trauma patients