Skeletal injuries in children presenting in a tertiary health facility in Lagos state, Nigeria

BACKGROUND: Injury remains a major health problem for children worldwide. Traumatic injuries cause substantial mortality and morbidity with temporary or permanent disability in childrenMETHODS: This was a prospective observational hospital based study conducted on all the patients aged 16 years and below who presented in the Accident and Emergency room and at the orthopaedic outpatient clinics in the Lagos University Teaching Hospital (LUTH) with musculoskeletal injuries over a period of fifteen months. All patients who met the inclusion criteria were recruited. Questionnaires were used for data collection. Thorough examination of the injured paediatric patient was done and finding documented in the questionnaire. Fractures of long bones were confirmed in all cases with radiographs. Data obtained was analyzed with Microsoft Excel Starter 2010 by Microsoft Corporation. Redmond, Washington.RESULTS: The age ranged from 4 day (0.01 year) to 16 year with a mean age of6.35± 4.58. Male to Female ratio was 1.9:1. Road traffic accidents were the leading cause of skeletal injuries (49.2%), followed by falls (27.0%). Fractures associated with birth trauma accounted for 12.7%. Younger children were more prone to injuries from falls. The home environment was the second most common environment for children to sustain fractures, the first being the roads. Majority (58.7%) were from families within the lower socioeconomic class. Ninety five percent (95%) of the children who got injured were without adult supervision while crossing the road. Injuries from road traffic accidents peaked between 3pm and 6pm while injuries resulting from falls peaked between 12 noon and 3pm.The femur was the most commonly fractured bone (21.7%). Green stick fractures occurred in 7.9% of the patients seen. Open fractures were seen in 6.3% of the patients. Physeal injuries occurred in 4.8% of paediatric fractures. Some injured paediatric patients (12.3%) were taken to the traditional bone setters prior to presentation at LUTH with 3(4.7%) of them presenting with gangrene of the affected limb.CONCLUSION: Road traffic accident remains the commonest cause of fractures in children. However, injuries sustained at the home environment were quite significant. Emphasis on increase supervision and safety practices at home are strongly recommended.KEY WORDS: Paediatric fracture, limb gangrene, road traffic injuries, mechanism of injury, birth traum

Energy harvesting from household heat sources using a thermoelectric generator module

Inefficiency in energy usage has led to the subject of energy harvesting which simply means recycling dissipated waste energy into another useful form of energy. This paper presents the harvesting of waste thermal energy from household heat sources (kerosene stove and generator exhaust pipe) as an electrical energy. Thermoelectric generator (TEG) modules (TGM-161-1.2-2.0) and aluminium heat sinks were constructed and placed close to the heat sources for waste heat harvesting. The hot and cold side temperatures of the TEG modules were measured along with the corresponding output voltages and currents, while the power and energy harvested were estimated. The harvesting of energy from the stove yielded means of 1.532 ± 0.091 V, 0.388 ± 0.003 A, 0.597 ± 0.039 W and 536.87 ± 34.98 J, subject to an average temperature difference of 84.59 ± 3.64 °C. For the generator exhaust pipe, average values of 1.28 ± 0.074 V, 0.285 ± 0.007 A, 0.367 ± 0.029 W and 330.62 ± 26.15 J with an average temperature difference of 62.31 ± 4.88 °C were achieved. The obtained results agreed with previous studies on energy harvesting using TEG modules. This work revealed the potential of waste heat energy harvesting using TEG technology.Keywords: Waste heat; temperature; thermoelectric generators; heat source; energy harvestin

Validation of mangled extremity severity score in assessing the need for extremity amputation

INTRODUCTION: The decision to either salvage or amputate a mangled extremity poses great challenge to a surgeon.Different scoring systems were therefore developed to aid orthopaedic surgeons in this decision,eitherto contemplate amputation or proceed to salvage a mangled extremity. Of these scoring systems, the mangled extremity severity score (MESS) is mostly used.However,the high predictive accuracy reported by its developers has not been replicated by other authors. This study was carried out to validate the use of this scoring system in Nigeria and by extension, Africa.PATIENTS MATERIALS AND METHOD:The study was a hospital based prospective descriptive one which studied all patients with mangled extremities that were admitted into the Accident and Emergency room of the Lagos University Teaching Hospital (LUTH), Idi- Araba, from April 2014 to March 2015. Injured patients with mangled extremities were resuscitated and relevant investigations conducted. The MESS was calculated at presentation in the emergency room by two senior doctors in orthopaedic and trauma units (not lower than senior registrar cadres) independently and an average score calculated, rounded up to the nearest positive integer and documented.Type of treatment offered was based on the experience of the managing consultants. Patients' progresses were monitored and functional outcomes documented. All data generated during the study were analysed using Statistical Package for the Social Sciences (SPSS inc. Chicago, Illinois. version 21.0.Year of release - 2012).RESULTS: Twenty-nine mangled extremities in 27 patients were studied.The male: female ratio was 3.5:1.Age of patients ranged between 21-70 years with a mean age of 39.9 ±12.3years. Nineteen (65.5%) extremities were salvaged while 10(34.5%) were primarily amputated. Average MESS of all mangled limbs reviewed was 8.1+ 2.6 with scores that ranged from 3 to 13. The mean MESS for limb salvage was 7.0 +2.2while that for primary amputation was 10.1+2.0(P value- 0.01).MESS in this study had a sensitivity of 90%,specificity of 47.4%,positive predictive value of 47.4%, negative predictive value of 90%.AUROC in this study was 0.853.The cost of treatment, number of surgeries, and duration of hospital stay were higher in those with Salvaged limbs.The functional outcome for salvaged upper and lower extremities were better than for those whose limbs were amputated.Level of satisfaction was better in the limbs salvaged group than for those who had ablative surgery with statistical significance (P value- .000).CONCLUSION: This study validated the clinical utility of MESS in predicting the need for amputation in patients with mangled extremity injuries but it had a low predictive accuracy for extremities that would eventually enter the limb salvage pathway.Therefore,when contemplating limb salvage for a patient with mangled extremity,in addition to the result of the MESS score,the surgeons experience cannot be overemphasized.KEY WORDS: Open fracture,mangled limb,amputation,MESS score,classificatio

Mentorship in orthopaedic and trauma residency training programme in Nigeria: the residents' perspective

Background: Mentorship is important in residency training as it is necessary for personal and professional development of the resident traineesObjectives: This study documents mentorship in orthopaedic residency training programme in Nigeria by assessing the awareness of orthopaedic residents on the role of a mentor, willingness to be mentored and their perceived reasons for the possible lack of mentors/ participation of senior colleagues in a mentorship programmeMethod: This was a descriptive cross sectional study of 37 orthopaedic residents attending a revision course of the Faculty of Orthopaedics, National Postgraduate Medical College of Nigeria. Self-administered structured questionnaires were used to collect data. Data obtained was analyzed using SPSS version 21.0.Results: The mean age of the respondent was 34.7 ± 4.7 years. The Male: Female ratio was 19:1. The average number of years already spent in the residency programme by the respondents was 2.8 ± 0.9 years. Only 27% of residents had participated in a mentorship programme since they began residency programme but only half were still being mentored at the time of the study. Sixty-five percent reported no formal mentorship programme in their institutions. However, 73% of the respondents would want a formal mentorship programme in their institution. Ninety percent of the respondents desired to be mentored.Conclusion: Most residents are willing to be mentored. Consultants and trainers should ensure that the trainees are mentored.Keywords: Mentorship, Orthopaedic Residents, Residency Training, Fellowship Training Nigeri

History of Contemporary Orthopaedics in Nigeria: Challenges and Opportunities in Education and Training

Background: Orthopaedic training and practice in Nigeria have come a long way and the number of practitioners and training centres have grown. There is a need to contribute to the debate on the best way to train the next generation of orthopaedic surgeons in Nigeria as well as provide an initial history of orthopaedic practice in Nigeria. Objectives: This paper aim to trace the history of orthopaedic practice and training in Nigeria and suggests ways forward for the practice of orthopaedics and the training of the next generation of orthopaedic surgeons. Method: Key document reviews and consultation with senior orthopaedic surgeons as well as relevant publications. Results: This paper traces the origin of modern orthopaedic practice in Nigeria, including the five generations of Nigerian orthopaedic surgeons. It also itemises some of the current training challenges and their possible solutions. Conclusion: The future direction of orthopaedic growth in Nigeria is interesting and great, especially if the necessary steps are taken

Profile of extremity injuries caused by Motorcycle accidents seen at Lagos University Teaching Hospital, Lagos Nigeria

Background: The increasing use of commercial motorcycle as a mode of transportation in urban cities like Lagos has become an important cause of morbidity and mortality. Injuries of the extremity, especially the lower extremity being the most common nonfatal injury with head injury as thecommon cause of mortality. This has led to several states in the country restricting or banning commercial motorcycle operation. The aim of this study was to determine the trend of motorcycle extremity injuries post restriction of commercial motorcycles in Lagos as seen in LUTH.Materials and Methods: This was a 2-year prospective hospital based study of all patients that presented at the Lagos University Teaching Hospital (LUTH) with motorcycle extremity injury that met the inclusion criteria. It evaluated the pattern of motorcycle extremity injury, determining associated injuries in patients with motorcycle - related extremity injuries and determining the impact of legislation against commercial motorcyclist in Lagos in terms of severity and type of injuries. Also outcome in terms of mortality, duration of hospital stay were assessed.Results: Out of 2670 patients admitted at the accident and emergency during the period of this study, 570 (21.3%) were road traffic accident victims. Of the victims of RTA, 282 (49.5%) patients sustained motorcycle accident. The male: female (M: F) ratio was 2.8:1. The age ranged from less than 1 year to 75 years with a peak at 30-39years. The total number of extremity injuries was 322. Abrasions were the commonest type of injury accounting for 180(55.9%) of all extremity injuries followed by extremity fractures 110(34.2%). 80 patients had isolated extremity injuries and 202 patients had associated injuries. Head injury 190 (94.1%) was the most frequently associated injury followed closely by blunt chest injury 6(3.0%). None of the patients wore protective helmet. 48 mortalities (17.02%) were recorded and all dead patients had head injury.Conclusions: Motorcycle extremity injuries still represent a common cause of morbidity despite its restriction in Lagos. Therefore, strict  enforcement of the law especially those closely associated with subject safety is advocated so as to reduce morbidity and mortality associated with motorcycle accidents .. restriction in Lagos. Therefore strict enforcement of the law especially those closely associated with subject safety is  advocated so as to reduce morbidity associated with motorcycle accident. Keywords: Motorcycle, Fractures, Head Injury, Extremity injury

Prediction of outcome of management of clubfoot using pirani score

Background – Clubfoot can be assessed using Pirani scoring system.Ponseti protocol was used in the management of all the patients. The aims of the study were to evaluate outcome of management of idiopathic clubfoot, to correlate outcome with the initial Pirani score and the value of Pirani score in predicting outcome.Methods- Forty-one children (64 clubfeet) with idiopathic clubfoot were recruited into the study. The children were two years old and less. They were initially assessed using Pirani scoring system and subsequently managed with serial manipulation and cast application weekly with or without tendoachilles tenotomy according to Ponseti protocol. And then followed up for 3 months.Results- Tenotomy was done in 51.56% of feet. There was a statistically significant difference between the midfoot contracture score, hindfoot contracture score and initial scores in the tenotomy and 'non-tenotomy' groups. The initial Pirani score has a strong positive correlation to the number of casts required. The group that required tenotomy required more cast and as such longer duration of treatment than the 'no tenotomy' group. There was a relapse rate of 2% in the feet of the compliant group while the relapse rate was 69% in the group that were not compliant with use of foot abduction brace. The hindfoot score is a better predictor than both the initial total score and midfoot scores for relapse.Conclusion- The Pirani scoring system is reliable, quick, and easy to use. The initial Pirani score correlates with duration of treatment. Hindfoot score is a better predictor of tenotomy than midfoot contracture score

Presentation and Management Outcomes of Pelvic fractures: A single Institutional Review

Background: Pelvic fractures are orthopaedic emergencies associated with  polytrauma. These fractures have gradually increased in recent times as a result of increasing high speed and complex road traffic accidents.Objective: To describe the presentation and management outcome of patients that were managed in our institution for pelvic fractures over the study periodMethodology: We retrospectively reviewed the hospital records of patients who were admitted and treated in our hospital with pelvic injuries from February 2012 to January 2015.Results: Majority 122 (75.8%) of the patients in this study were aged below 40 years. These fractures were mostly caused by road traffic accidents. Most 116 (71.9%) of our patients had Tile class A and B fractures. Polytrauma seen in 41.6% of the patients was the most common associated injury seen with pelvic fractures. The mean Injury Severity Score (ISS) 31.4 shows that these patients were mostly severely injured patients. The fatality rate in this study was 16.12%. These mortality were higher for patients with Tile class C than B injury and no death was recorded for class A injuries.Conclusion: Majority of the patients were less than 40 years and Road Traffic Accident is the commonest aetiology. Many were successfully  managed conservatively particularly those with stable and partially stable injuries. Functional outcome is generally good.Key words: Pelvic Fractures, Injury Severity Score, Pelvic Fracture

Limb deformities: the Lagos, Nigeria experience

Background: Individuals with various forms and degrees of limb deformities are common on the streets of Lagos, Nigeria. State-sponsored screening and surgical correction of the deformities were carried out in Lagos between June 2004 and May 2006. A report on the pattern of limb deformities is presented. Methods: This was a prospective study of all the patients that were seen and treated during the various screening programmes and operating sessions. Data was stored electronically and analysed using Microsoft Excel software. Results: A total number of 1,321 patients were screened, and 344 satisfied the inclusion criteria for enrolment. They were aged between 9 months and 64 years but only 20% were aged 5-years and below. Females constituted 58.2% and males 41.8%. A total of 513 limbs were surgically corrected. The most frequent deformity and disease entity were bilateral genu varum (45.1 %) and Blounts disease (48.7%), respectively. Proximal tibial wedge corrective osteotomy was the most frequent surgical procedure performed. Most beneficiaries presented late and were discharged within 48-hours of hospital admission. Conclusions: Improved public awareness about the availability of hospital based resources to solve the problem of limb deformity is advocated. Keywords: Limb deformity, corrective surgery, public awareness.