Traumatic separation of the upper femoral epiphysis in a neonate

Background: Traumatic separation of the upper femoral epiphyses at birth is a rare event. Other terminologies that have been used to describe the injury include traumatic proximal femoral epiphysiolysis and apparent dislocation of the hip. This injury is associated with difficult deliveries.Aim: To report a case of traumatic separation of the upper femoral epiphysis in a neonate following a caesarean section.Case Report: A full term infant female was delivered by breech extraction through a caesarean section in 2007. She weighed 4.2kg at birth and her mother was not a known diabetic. Her mother noticed she had reduced movement in her right lower extremity five days after delivery and this necessitated an orthopaedic consultation. After a clinical review a diagnosis of congenital dislocation of the right hip was made.An initial pelvic radiograph was taken and a repeat radiograph taken 3 weeks after delivery showed callus around the neck of the right femur. This indicated a healing traumatic separation of the right upper femoral epiphysis.Conclusion: Traumatic separation of the upper femoral epiphysis in the newborn is an uncommon injury. A high index of suspicion is required as the condition is easily misdiagnosed.Keywords: Trauma; Epihysiolysis; Proximal femur; Neonate; Caesarean sectio

Hereditary multiple exostoses in a 15-year-old boy: A case report and review of literature

Background: Hereditary Multiple Exostoses (HME) is a rare bone disease, usually associated with deformity and pressure symptoms. It is an autosomal dominant disorder characterized by the development of benign tumours growing outward from the metaphyses of long bones and can lead to considerable psychosocial problems. This paper aims at reporting a case of HME with some peculiar features.Methods: A case report of a 15- year-old Nigerian male with Hereditary Multiple Exostoses is presented to highlight the clinical, radiological features and management challenges of the condition.Results: The patient presented with multiple hard, bony and ridge-like growth along the spine, scapula and para-vertebral region which gradually increased in size. These swellings were non-tender, not attached to the overlying skin and immobile, had no differential warmth and appeared to be continuous with the underlying bony structures. A striking feature was exostoses that extended from the lumbar spine towards the left scapula. He also had brachymetatarsia of the first ray of both feet. Skeletal survey confirmed the diagnosis.Conclusion: Though rare, HME do occur in our environment. The treatment is individualized, with small asymptomatic or minimally symptomatic lesions followed up and only supportive care provided. Larger symptomatic lesions may cause major physical handicap and may be resected.Keywords: Hereditary, Multiple, Exostoses, Deformit

Infant femoral fracture from babysitter fall

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Orthopaedic injuries in children: Federal Medical Centre, Umuahia experience

Background: Worldwide, trauma is a recognized leading cause of childhood morbidity, mortality and disability. Aim: To review the causes and consequences of orthopaedic injuries in children. Methods: A retrospective study of all injuries in children 14 years and below seen at the Federal Medical Centre Umuahia from 1st July 1996 to 30th June 1999 utilizing data  from patients' case notes, casualty and ward registers and the theatre records. Data extracted was analyzed using descriptive statistics. Results: Of the 125 patients seen, only 81 records were retrievable. There were 54 males and 27 females (M: F = 2:1). Their average age was 6.1 years, most (50.6%) being in the 6-10 years age group. Most of the injuries resulted from motor vehicle accidents (37.0%), followed by falls (21.0%). Majority (80.2%) of the injuries occurred in an urban setting. Complications noted at presentation include severe anaemia, chronic osteomyelitis, soft tissue infection, limb gangrene and septicaemia. Less than 50% presented within the first six hours following injury. Most (56.7%) of the fractures seen were closed. The commonest body region involved was the lower limb (49.4%), followed by the head and neck (32.1%). The duration of hospital stay was more than 2 weeks in 25.9%. Most (95.1%) of the patients recovered without residual disability and there was one mortality (1.2%). Conclusion: The problem of orthopaedic injuries in children in a developing setting like Nigeria is significant. Road traffic crashes constitute a significant cause of orthopaedic injuries and the practice of quacks complicate these injuries.   Keywords:  Orthopaedic injuries, Children, Causes, Consequencie

Total knee arthroplasty in the Niger Delta, Nigeria: Preliminary report and lessons learnt

Background: Total knee arthroplasty is the treatment of choice for patients with debilitating knee pain secondary to severe osteoarthritis. The procedure is yet to be commonplace in Nigeria due to socio-cultural and financial constraints.Aim: To review the pattern of presentation and our experience in total knee arthroplasties in a private hospital in Port Harcourt, Nigeria.Methods: A retrospective review of all patients who had total knee replacement (TKR) from February, 2013 to June, 2017 at a private health facility in Port Harcourt, Rivers State. The INDUS knee was utilized in all the patients. Data was analysed by descriptive statistics.Results: Forty-five total knee replacements (TKR) were done on thirty-eight patients , seven patients had bilateral TKR's. Male to female ratio was 1: 2.45. Mean patient age was 60 years. Majority presented with bilateral knee pain (55.3%). Fourteen had angular deformity while four had bonedefects. Kellgren-Lawrence radiologic grade was 4 for almost all the patients. Average duration of surgery was 107 mins. Mean post-operative  hospital stay was 58 days. Twenty-nine patients had significant improvement in functional knee indices. There were three deaths. Total  postoperative complication rate was 31.1%. Most were followed up for between six and 36 months.Conclusion: There is a gradual but definite increase in total knee arthroplasty surgeries in Nigeria. Regular audit and changes in government policy concerning health insurance and medical tourism will enhance our practice. Keywords: knee, arthroplasty, osteoarthriti

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran