Fracture patternsas seen at the accident and emergency department of the university of maiduguri teaching hospital Nigeria: - a five year prospective study

Most trauma resulting from vehicular accidents or otherwise, often involve the skeleton (made up of 206 bones), resulting into a fracture. Fractures are a cause of high morbidity and occasionally mortality. Objective: The aim of this study is to analyze the anatomical regions most involved, fracture types, their causes, outcome of treatment and the commonest complication of the fracture in our environment. Method: A five year prospective study (January 2005 to December 2009) was undertaken. All patients presented at the Accident and Emergency Unit of the University of Maiduguri Teaching Hospital, both fresh and old fractures were included. All were followed up to discharge from the hospital and some years after. Those that died were noted. A proforma was used to collect the data. Follow up was between 2 to5 years. Results: During the period of the study, there were 24, 041 emergencies that reported to UMTH, 6,535(27.2%) were due to RTA and 596 (2.5%) had fractures, presenting with 677 fractures. There were 477(80.2%) males and 189(19.8%) females, giving a ratio of 4:1. The lower limbs were affected in 247(41.5%) patients, upper limbs in 146(24.6%), more than one region 54(9.1%), maxillofacial 47(7.9%), skull 41(6.9%), spinal fractures 33(5.5%) andpelvic fractures 28(4.7%). There were 435(73.2%) motor vehicular cases, (3.4%) follows domestic accidents and11(1.9%) from assaults. There were 66 associated injuries. Conclusion: Fractures occurred in about 10% of RTAs with males more involved than Females (4:1) and motor vehicular accidents causing most of the fractures. The lower limbs were more involved and most of the fractures were closed. Association with head injury leads to more mortality

Assessment of request pattern and utility of rheumatoid factor in a tertiary hospital in North east Nigeria

The diagnostic utility of Rheumatoid Factor (RF) test is not well documented. The question therefore is: - 'when is it appropriate to make this request'? When patients' own immunological defense mechanisms go awry and start attacking one's tissues, (autoimmune), there usually arises a problem. This usually affects the heart, musculo skeletal system and other organs giving rise to signs and symptoms that are seen in other ailments. The joints are the most common site of affectation and an early diagnosis may go a long way in managing the disease. Usually an antibody (Rheumatoid factor) is found in such patients. It is formed against the Fc portion of IgG, forming an IgG-Fc immune complex that normally leads to the disease process. It is this complex (usually an IgM) in the patient's serum that is exposed to a commercial antigen in the laboratory and the titer determined against a standard. The normal level is usually <14IU/ml. Levels higher are usually considered abnormally high, elevated or positive. A negative RF test however does not mean that the patient hasn't got the disease. Objective: To determine the frequency of positivity of rheumatoid factor and the context in which the requests are made by group of physicians and advise on when to make the request. Methods: A retrospective study of case notes of 354 patients requested to perform rheumatoid factor test at the immunology department over a period of 6 years were reviewed. The requesting departments, clinical and demographic characteristics of patients were reviewed and analyzed. Data analyzed using SPSS version 22. Results: Of the 354 requests made,265 (74.9%) were due to musculo skeletal symptoms and but20 (5.6%) were positive for RF. Of the 20, 19 (95%) had polyarthritis while 1 (5%) was asymptomatic. The mean age was 37.06±13.91 and 205 (57.9%) were females. Most (137 or 38.7%) of requests for RF were from the general out-patient department and 108 (30.5%) from medical out-patient department. The sensitivity and specificity for RF test in detecting MSK disease were 7.17% (95%CI, 4.37-10.97) and 98.88% (95%CI 93.90%, 99.97%). The positive likely hood ratio was 6.38% (95% CI 0.87, 40.99). The positive predictive value (PPV) and negative predictive value (NPV) were 95.0% (95%CI 77.02, 99.29%) and26.35% (95%CI 25.48, 35.30%). Test accuracy was 30.23% (95% CI25.48, 35.30%). Conclusion: We recommend that rheumatoid factor should be requested only in patients with fleeting arthritis,good clinical evaluation for signs and symptomsand looking for differentials

Malignant Myoblastoma: An Unusual Presentation of A Bony Origin? Case Report

Granular cell tumours or Myoblastoma is a rare entity and is generally benign with malignant cases even rarer; (accounting for only 2% of all cases)(1). We present a case following a closed spiral fracture of the humerus.Key Words: Malignant Myoblastoma, humeral fracture, TBS treatment

Musculoskeletal Tuberculosis: A Prospective Study

Background: Tuberculosis of the bone and joint is undertreated in the North-East sub region of Nigeria due to lack of knowledge of the disease, especially amongst Medical Officers who treat patients in most General hospitals. Most patients treated for osteoarthritis are indeed articular tuberculosis.Objective: To determine the incidence of this disease in our environment and proffer treatment regiments.Methods and Design: This is a three year (2000-2003) prospective study of the patients with diagnosis of muscularskeletal TB seen UMTH. All patients had complete history and clinical examinations conducted by the teams. Investigations included X-rays, Mantoux and full blood count (FBC) and ESR. Few of the patients were also tested for HIV. Diagnosis was based on history, X-ray features of TB of the bone and joints, Mantoux, raised ESR and physical findings. Extent of the severity of disease was measured by the degree of pain, physical disability and deformity and X-ray findings. Neurological complications were treated with spinal support in addition to drug treatment. Two of our patients had spinal surgery,(decompression) when they developed spondylosis three years after treatment. Treatment was by the use of INH, Rifampicin and Pyrazinamide at the appropriate doses for the patients' ages and weights. Ethambutol was included in those with disseminated disease while anti-retroviral drugs were added for those with positive and confirmed tests. The response to treatment was assessed using ESR, clinical improvement and followed up for three to seven years.Results: Fifty-four patients were enrolled into this study, aged 4 to 82 years. Thirty-five (64.8%) were males while 19 (35.2%) females. Forty-one (75.9%) of the patients had Pott's disease, 12 (22.2%) had TBOA, while 1 (1.9%) had Pott's disease and TBOA. Forty-four (81.5%) patients were treated with drugs alone, 8 (14.8%) had spinal support in the form of cossets or scotch cast jackets. Only 6 (11.11%) of the patients were admitted due to inability to walk because they were paraplegic. Eighty-one percent success rate was achieved using INH,Pyrazinamide(PZN) and Rifampicin for ten months. Forty-four of the patients (81.5%) got better and had no recurrence of symptoms 3-7 years of follow up. Five (9.3%) of the patients could not complete the treatment due to cost of the drugs, 1 (1.9%) relapsed and was found to be HIV positive and was lost to follow up, one (1.9%) died of PTB and HIV complications and one (1.9%) got better and was lost to follow up after the 6th month of treatment.Conclusion: Tuberculosis of the spine, bone and joints is under diagnosed and under treated. Successful treatment can be achieved using INH, PZN and Rifampicin.Key words: TB Spine, TB Bone and Joints, Incidence andResponse to proffered treatment

Volkmann's Ischemic Contracture Treatment: Our Experience.

Background: Volkmann's Ischemic Contracture (VIC) follows treatment of limb fractures by traditional bone setters in our environment and usually present for treatment of the deformity.Objectives: This study highlights the result of treatment by tendon elongation and subsequent physiotherapy.Methods: All patients presenting at the Orthopaedic Outpatient Department seeking for treatment of the deformity were operated upon.Results: Those with type I VIC do better in terms of cosmetics and function. It is also worthwhile to operate on all forms of VIC.Conclusion: It is beneficial to operate on patients with VIC

Background: Madelung's deformity is a congenital abnormality of the wrist caused by a disturbance of growth that retards the development of the ulnar and volar aspect of the distal radial physis, usually idiopathic, but can be associated with bone dysplas

Background: Madelung's deformity is a congenital abnormality of the wrist caused by a disturbance of growth that retards the development of the ulnar and volar aspect of the distal radial physis, usually idiopathic, but can be associated with bone dysplasias and Turner's syndrome, or acquired following trauma that disrupts growth of the radial ulnar volar physis. The exact nature of the pathologic process that causes the disturbance in growth is unknown.Method: This patient presented to us at the age of 20 years and we did closing wedge osteotmy with stabilisation with intrmedullary rush nail. Follow up was for two years. She no longer has pain and the deformity remains corrected.Results: Corrective osteotomy and stabilisation corrects the deformity and gives good results, both functionally and cosmetically.Summary: Even when they present late, patients with Madelung's deformity can benefit from surgery.Key words: Madelung's deformity, closing wedge osteotomy, Intramedulary Rush nail

Malignancy in Sinuses, Scars, and Chronic Ulcers, Invading Bones: A Review of 14 Cases in a Black African Population

Background: Malignant degeneration of chronic wound inflammation is a rare complication which almost always develops late. This study examines cases of squamous cell carcinoma developing in areas of chronic inflammation among blacks.Aim: To evaluate the patients that presented with histopathological evidences of squamous cell carcinoma in sinuses, scars, and chronic ulcers with bone involvementMethods: A retrospective review of 14 cases of squamous cell carcinoma of the extremities managed at Federal Medical Centre Azare and University of Maiduguri Teaching Hospital between July 2002 and June 2007 was carried out. The clinical, histopathological and radiological records were evaluated.Results: Out of the 14 patients diagnosed with squamous cell carcinoma, there were 9 males and 5 females. The predisposing lesions were chronic osteomyelitis in 8(58%) patients, and 3(21%) each for burns scars and chronic ulcers. The average duration of lesion before the diagnosis of malignancy was 23 years. The leg was the most frequently affected part of the extremities 10 (71%), followed by the feet 3(21%) and the forearm 1(7%). The most common radiological findings were soft tissue mass,osteolytic destruction and cortical thickening . The biopsies of all the lesions were exclusively well differentiated squamous cellcarcinoma. Treatment offered were mainly amputation in 13 (93%)patients.Conclusion: Chronic osteomyelitis was the most common predisposing lesions to malignant change in our centers. Well differentiated squamous cell carcinoma was the common histological pattern. Chronic ulcers and sinuses require biopsy at regular intervals for early detection of malignant change