Opinion: Role of rural orthopaedic and trauma assistants in orthopaedic and trauma care

In recent times it is quite obvious that bone and joint ailments have almost been forgotten about in our primary health care scheme. Yet this is the problem that is most prevalent in our rural/urban communities. The dearth of specialist in this area and the concentration of the few in specialist centres have left the rural areas solely to the hands of “traditional bone setters” (TBS). This unfortunate pattern of health arrangement has left the specialist with the option of receiving more of complicated cases already mismanaged by our “TBS”. This report highlights the problem and proffer suggestions on how to improve the outcome of our rural orthopaedic and trauma practices in line with government policy of primary health care and health for all by the year…….! Key Words: Rural, orthopaedic care, traditional bonesetters Annals of African Medicine Vol.3(3) 2004: 150-15

Treatment of Congenital Genu Recurvatum - a Preliminary Report

Background: Congenital genu recurvatum is a rare anomaly which is diagnosed clinically. Treatment may be non surgical or surgical. Study was aimed at demonstrating the efficacy of non-operative treatment of the condition by manipulation and serial correction with casting.Methodology: This was a prospective study of consecutive patients with congenital genu recurvatum presenting at a teaching hospital over a four year period entered the study. Socio-demographic characteristics of the patients were obtained, they were then examined and investigated. Treatment was by manipulation and serial correction with Plaster of Paris application (POP) which was changed every three weeks until correction of deformity was achieved. Patients were followed up till walking when a final review was done.Results: Five patients were seen over the period of this report. There were 4 females and 1 male; mean age was 14.2days. The deformity affected the right knee in 40%, the left in 20% and was bilateral in 40% of cases. An average of 6 casts over a mean period of 14 weeks (range 10 to 20  weeks) were needed to achieve full correction of the deformities. All the patients had good outcome of treatment without the need for surgery.Conclusion: Congenital genu recurvatum is predominant in the female. In this study, the patients responded excellently to serial manipulation and casting. Surgery was not necessary in of the patients.Key Words: Congenital; Genu recurvatum; Surger

Exposure risk to HIV infection among casualty staff: The University of Calabar Teaching Hospital experience

BACKGROUND: Human Immune Deficiency Virus Infection and Acquired Immune Deficiency Syndrome is prevalent in our population and in emergency situations. Hospital staffs (particularly the accident/emergency staff and traumatologists) are at high risk of contracting this deadly disease. BODY: 1434 of surgical emergencies were received in the casualty unit between May and October 2001. 860 (60%) of these had open wounds that required emergency surgical procedures. 340 (39.5%) of these were admitted to the ward, while 520 (60.5%) were discharged home from the casualty unit. Seven (2.1%) of those admitted to the ward for further management were found to be HIV positive. This is reported to create awareness among traumatologists and all health workers in emergency services .We call on our health managers and Government to provide adequate protection for staff in emergency units. CONCLUSION: Every trauma patient should be treated as HIV positive until proven otherwise. Nigerian Journal of Orthopaedics and Trauma Vol.3(1) 2004: 39-4

Chronic foot ulcer complicating a traumatic arteriovenous fistula

Background: Chronic foot ulcers could be a complication of traumatic arteriovenous (A-V) fistulation. We report a rare case of chronic foot ulcer and deformity resulting from arteriovenous fistula of the anterior tibial artery. Method: The clinical presentation and the outcome of treatment in a patient treated at the University of Calabar Teaching Hospital (UCTH) Calabar are reported. The relevant literature on this subject matter is briefly reviewed. Result: A case of chronic foot ulcer and oedema secondary to traumatic arteriovenous fistula of the anterior tibial artery was managed by the authors at the University of Calabar Teaching Hospital. The diagnosis was mainly clinical as sophisticated equipment was not readily available and satisfactory healing was achieved by exploration, quadruple ligation, skin grafting and cast application. Conclusion: Prompt diagnosis and treatment of difficult cases should warrant sophisticated equipment to make diagnosis. Port Harcourt Medical Journal Vol. 1(1) September 2006: 68-7

Incidence of leaving against medical advice (LAMA) among patients admitted at the accident and emergency unit of the Univeristy of Calabar Teaching Hospital, Calabar, Nigeria

No Abstracts.Nigerian Journal of Clinical Practice Vol.9(2) 2006: pp.120-12

Gunshot injuries in Calabar, Nigeria: an indication of increasing societal violence and police brutality

BACKGROUND: Gunshot injuries were rare in Calabar before the Nigerian civil war. This has changed in subsequent years and has reached a near epidemic proportion in the last three years. These are caused by civil violence, police brutality and armed robberies. OBJECTIVE: To evaluate the incidence, pattern and causes of gunshot injuries in this region and draw the attention of Nigerians and the Government to the above problems for a possible solution. METHODOLOGY: Records of patients admitted into the University of Calabar Teaching Hospital (UCTH) with gunshot wounds between April 2002 and May 2004 were extracted. Parameters analyzed included patients' biodata, sources of injury, anatomical site (s) of injury, modalities of treatment and the outcome RESULT: There were 51 injuries in 49 patients as follows: The lower limbs 25 (51%), upper limbs 6 (12.4%), upper limbs/ chest 2 (4.1%), chest 4 (8.2%), abdomen 7(14.1%) and head/neck 5(10.2%). Male/female ratio was 48:1. Twenty-four (49%) sustained their injuries from either accidental discharge or deliberate shooting by the police while armed robbers wounded 10 (20.4%) and cultists, 2 (4.1%). Two patients had amputations and mortality was 8.2%. CONCLUSION/RECOMMENDATIONS: The police should be cautious with guns; they and the Government should be alert to the menace of robbery, political violence, cultism and communal clashes. Good Governance, creation of employment, eradication of corruption and political violence may help

High birth weight babies: Incedence and foetal outcome in a Mission Hospital in Benin City, Nigeria

Objective: To determine the incidence of delivery of high birth weight (HBW) babies in Benin City and document their foetal outcome. Methods: All babies with HBW (defined as birth weight  4000g) were recruited into the study. The maternal records were examined for maternal age, parity, height, gestational weight gain and mode of delivery. The sexes, head circumferences and lengths at birth were documented. Foetal outcome such as stillbirth, birth asphyxia, Erb\'s palsy, fracture of the clavicles and the need for admission into the Special Care Baby Unit in HBW babies (study group) was compared with that of a control group. Results: The incidence of delivery of a HBW infant was 8.1% with a male preponderance. Maternal parity and age influenced the incidence. The highest incidence was among para 4 women and those aged between 35 and 39 years. The lowest incidence was among para zero and teenage women respectively. Women with a history of delivery of a previous baby with birth weight of  4000g, a gestational weight gain of 13-15 kg and a height >1.63m had an increased tendency towards delivery of a HBW infant. High birth weight babies were at a higher risk of foetal death and delivery by Caesarean Section. Conclusion: Incidence of delivery of HBW infant is relatively high in Benin-City.It is associated with increased rate of Caesarean delivery and foetal death . Keywords: High birth weight; Incidence; Foetal outcome Nigerian Journal of Clinical Practice Vol. 9 (2) 2006: pp.114-11

Methods of Pain Management by Traditional Bonesetters: Experiences in the South-South Zone of Nigeria

BACKGROUND:- Traditional bone setting is popular in our culture. Pain is a usual accompaniment of this treatment METHOD:- A prospective study of pain perception and the methods of analgesia/ anesthesia used in six traditional bonesetting centers (TBSC) was carried out in Calabar using a structured interview format. RESULTS: - 92 inmates (clients) with closed fractures of the lower limbs were interviewed. Using the verbal response scale, majority of the inmates, 78 (85%) expressed severe pain while 14 (15%) had mild to moderate pain during bone manipulation. 66 (71.7%) inmates had no form of pain relief (No analgesia-NA-group). Twenty-six (28.3%) had either herbs or orthodox medication for pain relief (Analgesia-A-group). During manipulation, the A-group had mild-moderate pain, an indication of pain relief while the (NA) group had severe pain. Considering the attitude of the Traditional bonesetters, 55 (.9.8% inmates found them hostile and nonchalant while 37 (40.2%) claimed that they were empathetic during painful manipulations. 78 (85%) inmates preferred TBSs because of the relative cheap cost, 9 (10%) chose TBS because of fear of limb amputation or other operations in the hospital while 5 (2%) did so because they do not like the delays associated with hospital treatment. Despite their unpleasant experiences, all the respondents claimed that they were satisfied with the TBS treatment. CONCLUSION: The study revealed clear evidence of ignorance of a need for adequate and proper analgesia and anesthesia during bone treatment among the TBS and their clients. There is a need to draw the TBS together for the purpose of education and awareness so as to discourage this aspect of harmful Tradition practices in our society. KEY WORDS: Pain perception, Traditional bone setting, analgesia, anesthesia, manipulation. Nigerian Journal of Orthopaedics and Trauma Vol.3(2) 2004: 176-18

The use of Pin-In-Plaster Technique in The Management of Complex Tibial Fractures, the Calabar Experience

BACKGROUND: This study highlights the difficulties of managing complex limb injuries by specialists working in areas where there are scarce resources and the methods used in overcoming the challenges. METHOD: A retrospective study of methods used in managing type III open tibial factures were analyzed at the University of Calabar Teaching Hospital between 1997 and 2001 focusing on the use of the pin in plaster (PIP) technique and conventional external fixators as initial management tools. RESULT: A total of 565 patients were treated for complex open tibial fractures within this period. Eighty-five (15%) of this were treated using Pin-in-plaster method while 25(4%) had conventional External fixation. Others were treated with Traction and or POP application. One hundred patients (18%) left against Medical advice (LAMA). The male: female ratio was 4:1 and they were in the age range 15-75 (mean 36.6) years. The commonest complication encountered was pin tract infection in 12 (48%) of those with external device and 30 (35.3%) in those with PIP. The outcome of treatment was satisfactory in 71% and 64% of PIP and external Fixator respectively while one (1%) patient among those with PIP died of tetanus. CONCLUSION: There is a need to equip our hospitals. Doctors working in the rural areas are to encouraged use this affordable and simple device in the initial management of complex tibial fractures, KEY WORD: Pin in Plaster, External fixation, complex tibial fractures, limb salvage Nigerian Journal of Orthopaedics and Trauma Vol.3(2) 2004: 163-16