Lower Limb Injuries Arising From Motorcycle Crashes

Background: Motorcycle accidents are the second most common cause of road traffic accidents in both developing and developed countries. In this study we aim to look at the pattern and characteristics of lower limb injuries arising from motorcycle accidents and evaluate early outcome of treatment. Methods: All the patients with lower limb injuries arising from motorcycle accidents who presented in our hospital between 1st October 2006 and 30th September 2007 were reviewed. History was obtained and detailed examination was done after resuscitation to determine the site, nature and the characteristics of injuries. Definitive treatment (conservative or operative) given was based on the pattern and type of injuries. Patients were followed up in the clinic for both clinical and radiological review. Functional outcome assessment was commenced after the onset of weight bearing. The data were recorded on a designated proforma and analyzed using a statistical programme. Results: A total of 429 motorcycle accident victims were seen during this period and lower limb injuries represented the commonest type of injury(238, 55.5%). Male: female ratio was 2.2:1 with a mean age of 43.1years. Fractures were the commonest lower limb injuries(73.4%) and closed fractures were commoner than the open fractures. The commonest anatomical location of fractures in lower limbs was tibial shaft. Joint stiffness was found to be the commonest post treatment complication. Conclusion: Lower limb injuries represent the commonest form of injuries among the motorcycle accident victims. Fractures were the commonest type of injury seen and the most common location was shaft of tibia.Keywords: Motorcycle, Accident, Lower limbs, injuries, fractures, Joint stiffnes

Outcome analysis of surgical treatment of Blount disease in Nigeria

Objective: The objective was to evaluate the results of surgery of Blount diseases using the postoperative metaphysealdiaphyseal angle (MDA) at 2-year follow-up.Background: The goal of surgery in Blount disease is to restore the normal configuration of the articular surface of the proximal end of the tibia in proper relationship to the mechanical axis of the limb. Our hypothesis is that patients will demonstrate significant clinical improvements following surgery and predictive models can be developed.Materials and Methods: All patients who had surgery for Blount disease from January 2002 till December 2007 at the National Orthopaedic Hospital Lagos Nigeria and follow-up for 2 years were included. Data extracted were gender, affected limb, Blount’s type, age when deformity was noted, and age at presentation, preoperative femoral tibial angle (TFA), Langenskiold score, preoperative MDA, and postoperative MDA. Linear regression was used to assess the predictive effect of selected clinical and radiographic measures on post-MDA. The model was adjusted for confounders: age deformity noted, age at presentation, affected limb, Blount’s type, and gender. Variables in the adjusted model achieving significance at P < 0.05 were included in a multiple regression analysis.Results: Eighty-six knees in 57 patients were included. The mean preoperative and postoperative MDA at 2 years was 34.6° ± 8.9° and 10.6° ± 4.3°, respectively. Seventy-three knees (84.9%) have correction of ≤10° with recurrence in 13 (15.1%) knees at 2 years (P < 0.001). The postoperative MDA was graded into good outcome if ≤10°. There was a significant improvement between preoperative MDA and postoperative MDA (P < 0.001). The multilinear analysis demonstrated that the preoperative MDA was a significant predictor of the postoperative MDA. The postoperative MDA was predicted with a standard error of 0.92 with the following formula: post-MDA = ̃1.027 + 0.404 pre-MDA.Conclusion: The mean postoperative MDA of 84.9% of the knees operated at 2 years was 9.4° ± 3.1° with recurrence rate of 15.1%. Postoperative MDA is a good outcome measure for surgical treatment of Blount disease and surgical correction should aim at producing post MDA ≤10°

Using Health Information Technology to Engage African American Women on Nutrition and Supplement Use During the Preconception Period

Importance: Healthy nutrition and appropriate supplementation during preconception have important implications for the health of the mother and newborn. The best way to deliver preconception care to address health risks related to nutrition is unknown. Methods: We conducted a secondary analysis of data from a randomized controlled trial designed to study the impact of conversational agent technology in 13 domains of preconception care among 528 non-pregnant African American and Black women. This analysis is restricted to those 480 women who reported at least one of the ten risks related to nutrition and dietary supplement use. Interventions: An online conversational agent, called Gabby , assesses health risks and delivers 12 months of tailored dialogue for over 100 preconception health risks, including ten nutrition and supplement risks, using behavioral change techniques like shared decision making and motivational interviewing. The control group received a letter listing their preconception risks and encouraging them to talk to a health care provider. Results: After 6 months, women using Gabby (a) reported progressing forward on the stage of change scale for, on average, 52.9% (SD, 35.1%) of nutrition and supplement risks compared to 42.9% (SD, 35.4) in the control group (IRR 1.22, 95% CI 1.03-1.45, P = 0.019); and (b) reported achieving the action and maintenance stage of change for, on average, 52.8% (SD 37.1) of the nutrition and supplement risks compared to 42.8% (SD, 37.9) in the control group (IRR 1.26, 96% CI 1.08-1.48, P = 0.004). For subjects beginning the study at the contemplation stage of change, intervention subjects reported progressing forward on the stage of change scale for 75.0% (SD, 36.3%) of their health risks compared to 52.1% (SD, 47.1%) in the control group (P = 0.006). Conclusion: The scalability of Gabby has the potential to improve women\u27s nutritional health as an adjunct to clinical care or at the population health level. Further studies are needed to determine if improving nutrition and supplement risks can impact clinical outcomes including optimization of weight. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT01827215

Nature and Outcome of Prehospital Care in an Informal Trauma System

Objective: Our aim was to describe the features of prehospitalmanagement in our region with no formal trauma system, andmeasure its effectiveness using survival and complication asoutcome parameters.Patients and Methods: This is a prospective analysis ofprehospital management of the injured in an informal traumasystem using 180 consecutive patients seen in a tertiary traumacare centre.Results: The mean injury severity score (ISS) was 13. The meanprehospital time was 16.46 hours. Prehospital care (PHC) wascarried out in 15 of 180 patients (8.3%), and in 14 of these by thepopulace. The relative risk of complication when no prehospitalcare was given was 2.64. There was a statistically significantrelationship between PHC vis-a-vis survival and complication (p 16 hrs) isindicative of non-existence of a formal trauma care system. PHC isof greater relevance, than speed of presentation, to outcome in thispopulation of patients with less than major trauma

Domestic injuries in childhood in Lagos, Nigeria

A prospective study was carried out to ascertain the pattern of soft tissue and skeletal injuries sustained by children at home in Lagos, Nigeria. 182 patients who entered the study sustained 185 injuries . Age ranged from 7days to 14years with mean of 5.17years. Male to female ratio was 1.28:1. Fall was the leading cause of injury accounting for 162 cases (89.0%). Fracture was the most common injury sustained (86.8%) with supracondylar fracture of the humerus being the single most common fracture (28.5%). Injuries sustained by children at home can have far-reaching consequences. Prevention involves active participation of all stakeholders. Nigerian Journal of Surgical Sciences Vol. 17 (1) 2007: pp. 33-3

Femoral neck fractures: A prospective assessment of the pattern, care and outcome in an orthopaedic centre

OBJECTIVE: To review the pattern of femoral neck fractures, complications and outcome following fixation with Austin-Moore endoprosthesis. METHOD: A two year prospective study in patients who had fracture of the femoral neck based on strict inclusion criteria. All the patients were treated by Austin-Moore hemiathroplasty via the classical southern approach. Complications were ocumented as they developed and probable causative factor evaluated. Minimum follow up was 32 completed weeks. OUTCOME MEASURES: Interval between surgery and mobilization, return to full activity and modification of lifestyle after surgery. RESULTS: Thirty patients were recruited, 21 males and 9 females with a mean age of 67.4 years. Twenty (66.7%) sustained injuries in a road traffic accident. Garden's grade 3 and 4 were the most common types. The presence of co-morbid factors and initial management by traditional bonesetters caused delay in instituting definitive surgery. Infective complication was the most common complication; mainly post operative wound infection (20.0%) urinary tract infection (23.3%) and upper respiratory tract infection(30.3%).Existing co-morbid factors, prolonged pre-operative stay, duration of operation and invasive ancillary procedures were responsible for these. Twenty (66.7%) patients had returned to full mobilization at 12 weeks of follow-up. CONCLUSION: Austin-Moore hemiathroplasty is the preferred choice of fixation in elderly Nigerians especially if displaced. Correction of co-morbidfacors pre-operatively, antithrombotic prophylaxis, perioperative antibiotics and early mobilization should form the cornerstone of treatment if good outcome is to be expected. KEY WORDS: Femoral neck, Austin-Moore endoprosthesis, co –morbid factor. Nigerian Journal of Orthopaedics and Trauma Vol.3(1) 2004: 42-4

Injuries in children: the Lagos experience

No Abstract. Nigerian Journal of Orthopaedics and Trauma Vol. 4(1&2) 2005: 54-6

The home: common place of childhood injuries

No Abstract. Nigerian Journal of Orthopaedics and Trauma Vol. 4(1&2) 2005: 67-7