Treatment outcomes of congenital pseudarthrosis of the tibia at Beit Cure International Hospital in Blantyre, Malawi

Background: Congenital pseudarthrosis of the tibia (CPT) is a rare condition. The natural history of CPT includes persistent instability and progressive deformity. Several CPT treatment methods have been practiced, however, in Africa where there is scarce information on the modalities of treatment available and their outcomes. Methods: A retrospective cross-sectional study which was conducted among patients with CPT at Beit Cure International Hospital (BCIH), Malawi. Forty-four patients were recruited in this study and their treatment modalities and outcomes were analyzed. Results: Out of 44 patients recruited in this study, majority (63.6%) were male. The majority of cases were stage 4 congenital tibia pseudarthrosis by Crawford classification. Most patients were treated by more than one surgical modality; however, surgical excision and intramedullary rodding was commonly used (54.7%). The outcomes of treatment were good in 5%, fair in 30%, with amputation in 45% and poor outcomes in 20% of the patients. Complications developed in 60% of patients, predominated by limb length discrepancy. The foot and ankle status were rated by Oxford Foot and Ankle scoring system (OxFAQ). Conclusions: Congenital pseudarthrosis of the tibia is a complex congenital disorder with multiple modalities of treatment. Majority of the patients were treated by more than one operation. Some patients ended up with amputation or poor outcome. Limb length discrepancy, deep infection and pin tract infection are among the common complications. Keywords: congenital pseudarthrosis; tibia; treatment outcomes; Malaw

Clinicopathological guide to malignant bone tumours: A retrospective analysis of the cancer registry at Kilimanjaro Christian Medical Centre in northern Tanzania

Background: Primary neoplasms of the skeleton are rare. This study aimed at determining the spectrum of different malignant bone tumours at a tertiary hospital cancer registry in the Northern Zone of Tanzania, along with related symptoms, clinical presentations, and clinical diagnosis accuracy (using histology as the standard).Methods: This retrospective study reviewed bone specimen records in the cancer registry at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania, for the period from 1 January 1998-31 December 2012. Patient information for corresponding cancer registry records was traced from hospital files and x-ray reports. Data were analysed using a mixed quantitative and qualitative approach.Results: Two hundred twenty-five malignant bone tumours were recorded at KCMC Cancer Registry over a period of 14 years. Seventy-five with adequate records were analysed. Forty-seven patients (62.7%) were male. Mean age was 34.1 (standard deviation 20) years. The femur was affected in 26 cases (34.7%). Osteosarcoma (22 cases; 29.3%) was the most common malignant bone tumour. Clinicians correctly preliminarily diagnosed multiple myeloma, osteosarcoma, and ameloblastoma, but had inexperience with carcinomas and other types of sarcomas. Chronic osteomyelitis and metastatic lesions were mentioned frequently by radiologists as the diagnosis of some malignant bone tumours that turned out to be carcinomas or sarcomas on histology.Conclusions: Clinician and radiologist training of other types of malignant bone tumours other than multiple myeloma, osteosarcoma, and ameloblastoma is required. An Orthopaedic Biopsy Form (OBF) was developed to address high loss to follow-up (66.7%). Keywords: malignant bone tumours; cancer registry; KCM