Pigmented villonodular synovitis of the knee: a case report

This case study is a report of a 21 year old female with one year history of non-traumatic left knee pain and swelling. Radiography and histology were in keeping with Pigmented Villonodular Synovitis (PVNS). This case highlights the clinical presentation of this rare disorder and emphasizes its consideration as a differential diagnosis in our set up when dealing with non-traumatic persistent knee pain and swelling. East African Orthopaedic Journal, Vol. 4: March 201

Operative management of ankle fractures during pregnancy: case series

Trauma affects approximately 5% of pregnancies and is the leading non-obstetric cause of maternal death. Ankle fractures occurring in pregnancy although minor, can nonetheless create diagnostic and therapeutic challenges for the patient and the surgeon. There is limited information on the operative management of ankle fractures during pregnancy in literature. We retrospectively reviewed hospital records of pregnant patients with ankle fractures who underwent surgery over a six month period from January to June 2013 in a private hospital in Nairobi. We present four cases of displaced ankle fractures in pregnancy that were fixed with good pregnancy outcomes. These case series highlight the management considerations of ankle fractures in pregnant women whose time to delivery is more than six weeks

Outcome of management of humerus diaphysis non-union

Background: The majority of diaphyseal humerus fractures heal uneventfully when treated nonoperatively, however, nonunion is not a rare event. Nonunion after conservative treatment can be successfully treated by open reduction and internal fixation. A nonunion of a diaphyseal fracture of the humerus can present a major functional problem. The main of our study was to document the outcome of management of non united diaphyseal humerus fractures with plate or plate and rush pin fixation.Methods: A 4 year retrospective study was undertaken at Presbyterian Church of East Africa (PCEA) Kikuyu Hospital, Orthopedic Unit in Kenya from April 2004 to April 2008. Records of consecutive patients with nonunion of the humeral diaphysis were reviewed. Four cases were lost to follow up. The rest were treated with a single posterior, anterior or anterolateral plate while four with a plate and rush pin construct. Autogenous iliac crest bone graft was utilised in most of the cases. A clinical evaluation for union, range of motion and complications. Radiological assessment for union was also done.Results: A total of 46 patients with humerus diaphysis non union met the inclusion criteria. Their ages ranged from 23 to 95 years with a mean of 43.6 years. The overall healing rate was 92.8 % (39/42 cases) at 6 months follow up. 3 failures occurred of whom one was a smoker and diabetic, another had a loose plate and screws following replating. The third case went to nonunion. Three cases of postoperative radial nerve palsy all of which resolved within six weeks were documented. All four treated with a plate and rush pin construct healed uneventfully.Conclusion: The results of this study indicate that our standard surgical procedure for treatment of nonunion of the humeral shaft is reliable with a 92.8% union rate in our study with few complications. The plate and rush pin construct is useful in dealing with nonunion involving osteoporotic bone

Ankle Arthrodesis Using a Vertical Steinman’s Pin in a Severely Osteopenic Bone

Background: Ankle arthrodesis is generally considered the gold standard  for the treatment of a painful arthritic ankle not responding to conservative treatment. The goal is to eliminate pain and achieve a stable plantigrade foot. There are over 30 different methods of ankle fusion to date. Weutilized a technique of placing one smooth Steinman’s pin across the ankle joint after excising the articular cartilage and aligning the joint in patients with severely osteoporotic bone where screws did not have good purchase.Methods: A retrospective study was undertaken of patients done ankle fusion between 2007 and 2010 at PCEA Kikuyu Hospital. Biodata,  indications for surgery, complications, and functional as well as radiological outcome were analyzed.Results: Thirty three patients were evaluated, 17 males and 16 females. The age of the patients ranged from 11 to 80 years (mean 50). Ankle arthrodesis was done for ankle arthritis in most cases. Follow up period ranged from 2 to 5 years (mean 3 years and 2 months). At 12 weekspostoperatively 31(94%) joints were fused clinically and radiologically. The two (6%) cases of nonunion required revision surgery with bone grafting and screw fixation. However one of these patients declined further surgery. There was one case of pin site infection and one case of cellulitis. According to the Mazur ankle score at final follow-up, 22 patients (67%) had excellent results, 8 (24%) good, 2 (6%) fair and 1(3%) poor results.Conclusion: Ankle arthrodesis using a vertical Steinman’s pin is a reliable technique in low resource settings and in patients with severely osteoporotic bone.Key Words: Ankle, arthrodesis, osteopenia, Steinman’s pin

Diagnostic value of plain radiographs in patients with low back pain of non-traumatic origin at a national teaching and referal hospital in Kenya

Background: Low back pain is a commonly recognized problem worldwide. Plain radiography is used in many of these patients as an initial investigative and evaluative tool. However, it was not known how truly useful this investigation was in making definitive diagnosis for non traumatic low back pain. The main objective of the study was to determine the value of plain radiographs in patients presenting with low back pain that is of non-traumatic origin.Methods: A prospective study 102 consecutive patients with low back pain was conducted at the Kenyatta National Hospital (KNH) from 1st February 2013 to 30th May 2013. Data was collected using a structured questionnaire and analyzed. Plain radiograph films were reviewed by two qualified radiologists.Results: The mean age of patients presenting with low back pain was 50.9years, with a male to female ratio of 1:2.4. Majority of the patient had chronic low back pain. There was a high rate of positive radiological findings (98%). The most common findings included muscle spasm, osteoporosis, reduced lumbar lordosis, spondylosis, disc degenerative disease and osteophytes. Assessment of inter-rater variability showed good level of agreement on presence of spondylolisthesis and vacuum phenomenon (k=0.71), moderate agreement on reduced disc space, reduced lumbar lordosis, spondylosis (k=0.42-0.56) and poor agreement on film quality, infections, tumor metastasis, osteophytes, prolapsed intervertebral disease (PID), osteoporosis, scoliosis, muscle spasm and sacroilitis (k=0.13-0.21)Conclusion: Most of the patients presenting to KNH with low back pain have a chronic type and therefore have increased probability of having positive radiological findings. There was a poor ability to diagnose infectious causes, inflammatory conditions, transitional vertebrae and tumor metastasis. In such cases, more advanced imaging such as CT scan and MRI may be required

Proximal row carpectomy in a 23 year old female with Kienböck’s disease: A case report

Kienböck’s disease is a rare disorder of the lunate bone resulting from vascular compromise to the bone. We describe a 23 year old female with a 6 year history of non traumatic left wrist pain and swelling. Radiography and Computerized Tomography (CT) scan were in keeping with late Kienböck’s disease. The patient underwent a proximal row carpectomy and had good outcome at 2 years follow up. There is no previous documented case or such treatment in this region. This case highlights the clinical presentation of this rare disorder and suggests its consideration as a differential diagnosis when dealing with non traumatic persistent wrist pain and swelling