Validation of mangled extremity severity score in assessing the need for extremity amputation

INTRODUCTION: The decision to either salvage or amputate a mangled extremity poses great challenge to a surgeon.Different scoring systems were therefore developed to aid orthopaedic surgeons in this decision,eitherto contemplate amputation or proceed to salvage a mangled extremity. Of these scoring systems, the mangled extremity severity score (MESS) is mostly used.However,the high predictive accuracy reported by its developers has not been replicated by other authors. This study was carried out to validate the use of this scoring system in Nigeria and by extension, Africa.PATIENTS MATERIALS AND METHOD:The study was a hospital based prospective descriptive one which studied all patients with mangled extremities that were admitted into the Accident and Emergency room of the Lagos University Teaching Hospital (LUTH), Idi- Araba, from April 2014 to March 2015. Injured patients with mangled extremities were resuscitated and relevant investigations conducted. The MESS was calculated at presentation in the emergency room by two senior doctors in orthopaedic and trauma units (not lower than senior registrar cadres) independently and an average score calculated, rounded up to the nearest positive integer and documented.Type of treatment offered was based on the experience of the managing consultants. Patients' progresses were monitored and functional outcomes documented. All data generated during the study were analysed using Statistical Package for the Social Sciences (SPSS inc. Chicago, Illinois. version 21.0.Year of release - 2012).RESULTS: Twenty-nine mangled extremities in 27 patients were studied.The male: female ratio was 3.5:1.Age of patients ranged between 21-70 years with a mean age of 39.9 ±12.3years. Nineteen (65.5%) extremities were salvaged while 10(34.5%) were primarily amputated. Average MESS of all mangled limbs reviewed was 8.1+ 2.6 with scores that ranged from 3 to 13. The mean MESS for limb salvage was 7.0 +2.2while that for primary amputation was 10.1+2.0(P value- 0.01).MESS in this study had a sensitivity of 90%,specificity of 47.4%,positive predictive value of 47.4%, negative predictive value of 90%.AUROC in this study was 0.853.The cost of treatment, number of surgeries, and duration of hospital stay were higher in those with Salvaged limbs.The functional outcome for salvaged upper and lower extremities were better than for those whose limbs were amputated.Level of satisfaction was better in the limbs salvaged group than for those who had ablative surgery with statistical significance (P value- .000).CONCLUSION: This study validated the clinical utility of MESS in predicting the need for amputation in patients with mangled extremity injuries but it had a low predictive accuracy for extremities that would eventually enter the limb salvage pathway.Therefore,when contemplating limb salvage for a patient with mangled extremity,in addition to the result of the MESS score,the surgeons experience cannot be overemphasized.KEY WORDS: Open fracture,mangled limb,amputation,MESS score,classificatio

Glomus tumours of the Hand in Lagos, Nigeria

Background: Glomus tumours of the hand are uncommon intriguing tumours which cause significant morbidity. Few reports have documented the epidemiology and presentation in the West African subregion. The aim of this review is to identify the common baseline demographics, the presentation, evaluation, diagnosis and treatment outcome of glomus tumours of the hand in Lagos, Nigeria Methods: A 10 year retrospective review of the records of all patients seen with histopathologically diagnosed glomus tumor of the hand at the Lagos University teaching hospital was carried out noting the biodata, demographics, method of presentation and treatment of this condition. Results: 11 patients were seen over the study period .There were nine females and 2 males seen. The mean age of the patients was 41 years. The symptoms had been on for between 3 and 40 months .All patients seen had a positive Love test. Only one patient had associated bony erosion. All had complete excision with no recurrence at 6 months Conclusion: Glomus tumor of the hand is an uncommon tumour often occurring in adult women. Clinical test (Love “test”) will correctly identify the diagnosis. Surgical treatment was curative in all our cases. High index of suspicion is needed to make earlier diagnosis

Profile of extremity injuries caused by Motorcycle accidents seen at Lagos University Teaching Hospital, Lagos Nigeria

Background: The increasing use of commercial motorcycle as a mode of transportation in urban cities like Lagos has become an important cause of morbidity and mortality. Injuries of the extremity, especially the lower extremity being the most common nonfatal injury with head injury as thecommon cause of mortality. This has led to several states in the country restricting or banning commercial motorcycle operation. The aim of this study was to determine the trend of motorcycle extremity injuries post restriction of commercial motorcycles in Lagos as seen in LUTH.Materials and Methods: This was a 2-year prospective hospital based study of all patients that presented at the Lagos University Teaching Hospital (LUTH) with motorcycle extremity injury that met the inclusion criteria. It evaluated the pattern of motorcycle extremity injury, determining associated injuries in patients with motorcycle - related extremity injuries and determining the impact of legislation against commercial motorcyclist in Lagos in terms of severity and type of injuries. Also outcome in terms of mortality, duration of hospital stay were assessed.Results: Out of 2670 patients admitted at the accident and emergency during the period of this study, 570 (21.3%) were road traffic accident victims. Of the victims of RTA, 282 (49.5%) patients sustained motorcycle accident. The male: female (M: F) ratio was 2.8:1. The age ranged from less than 1 year to 75 years with a peak at 30-39years. The total number of extremity injuries was 322. Abrasions were the commonest type of injury accounting for 180(55.9%) of all extremity injuries followed by extremity fractures 110(34.2%). 80 patients had isolated extremity injuries and 202 patients had associated injuries. Head injury 190 (94.1%) was the most frequently associated injury followed closely by blunt chest injury 6(3.0%). None of the patients wore protective helmet. 48 mortalities (17.02%) were recorded and all dead patients had head injury.Conclusions: Motorcycle extremity injuries still represent a common cause of morbidity despite its restriction in Lagos. Therefore, strict  enforcement of the law especially those closely associated with subject safety is advocated so as to reduce morbidity and mortality associated with motorcycle accidents .. restriction in Lagos. Therefore strict enforcement of the law especially those closely associated with subject safety is  advocated so as to reduce morbidity associated with motorcycle accident. Keywords: Motorcycle, Fractures, Head Injury, Extremity injury

Paediatric Hand Injuries At The Lagos University Teaching Hospital

Background: Paediatric hand trauma represents a subset of hand injury that can be quite challenging to manage. Local studies on this injuries are few therefore a 4 year retrospective study at the Trauma and hand rehabilitation unit of the Lagos University teaching hospital was carriedout. Objectives: To determine the percentage of hand trauma occurring in the paediatric age group, the predominant age group involved, place of injury, the major injury types occurring as well as the most common surgical procedure required. Methods: The case records of all cases that presented at the hand rehabilitation clinic or the emergency center of the Lagos University teaching hospital over a 4 year period were reviewed. Those below the age of 12 years were studied. Their biodata, type of injury, place of injury and other details were obtained. Results: 634 patients were seen over the study period, 61 cases of hand injuries were in the paediatric age group. Hand trauma constituted less than a third of all paediatric hand cases. The commonest age group affected was 2-6 years. Most of the injuries occurred around the home. Burns injury, blunt trauma, glass and knife cuts were the commonest causes of hand trauma. Soft tissue reconstruction was commonest procedure done. Conclusion: Infants and toddlers were the most vunerable groups while burns injury was the commonest cause of hand trauma seen at the Lagos university teaching hospital.Key words: Paediatric, hand, injury, LUT

Anterior knee pain associated with an anterior superior patellar bony spur: a case report

Anterior knee pain is a common presentation in Orthopaedic out patient practice. However anterior superior patellar spur is an uncommon cause.This case presentation is to highlight an anterior superior patellar spur with quadriceps tendonitis. The patient is a 52 year old man who presented with a recurrent anterior knee pain. The radiographic study revealed an anterio-superior patellar spur. The patient had a depo steroid injection as an adjunct therapy to physiotherapy and has been pain free

Prediction of outcome of management of clubfoot using pirani score

Background – Clubfoot can be assessed using Pirani scoring system.Ponseti protocol was used in the management of all the patients. The aims of the study were to evaluate outcome of management of idiopathic clubfoot, to correlate outcome with the initial Pirani score and the value of Pirani score in predicting outcome.Methods- Forty-one children (64 clubfeet) with idiopathic clubfoot were recruited into the study. The children were two years old and less. They were initially assessed using Pirani scoring system and subsequently managed with serial manipulation and cast application weekly with or without tendoachilles tenotomy according to Ponseti protocol. And then followed up for 3 months.Results- Tenotomy was done in 51.56% of feet. There was a statistically significant difference between the midfoot contracture score, hindfoot contracture score and initial scores in the tenotomy and 'non-tenotomy' groups. The initial Pirani score has a strong positive correlation to the number of casts required. The group that required tenotomy required more cast and as such longer duration of treatment than the 'no tenotomy' group. There was a relapse rate of 2% in the feet of the compliant group while the relapse rate was 69% in the group that were not compliant with use of foot abduction brace. The hindfoot score is a better predictor than both the initial total score and midfoot scores for relapse.Conclusion- The Pirani scoring system is reliable, quick, and easy to use. The initial Pirani score correlates with duration of treatment. Hindfoot score is a better predictor of tenotomy than midfoot contracture score

Poor Health Literacy in Nigeria: Causes, Consequences and Measures to improve it

Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make an appropriate decisions concerning their health. It is one of the link by which the health status of individual and the health indices and statistics of our country can be improved upon. Factors influencing health literacy in Nigeria include the culture and belief system, poor and ineffective communication, lack of education and low educational level, and low socioeconomic status Low health literacy predisposes to poorer health status, poorer disease outcome, lack of understanding in the use of preventive services, frequent hospital visitations amongst others. Factors influencing health literacy must be identified and modified to help improve the health literacy level of the populace. This will invariably improve the health status of the populace with a resultant improvement in the health indices of our country. This is a call for the Government and Health Care Professionals to acknowledge low health literacy as a problem and, therefore, be willing to play their roles in tackling this problem to achieve a healthy Natio

Epidemiological profile of open fractures at Lagos University Teaching Hospital Lagos Nigeria

Background: Open fractures remain a challenge for orthopedists' as far as stabilization, alignment and skin coverage are concerned all these aside from possible infection. They represent severe injuries with high socioeconomic impact.Objective: To define the epidemiological profile of patients with open fracture.Methods: A prospective study of open fracture at the Lagos University Teaching Hospital between July 2008 and June 2011 was carried out using a designed proforma. Data collected included biodata, aetiology of fractures, fracturesite, injury-duration interval, type of treatment, associated lesions, outcome as well as complications.Results: A total of 261 patients presented with open fractures over a 3year period between July 2008 and June 2011. The studied patients were aged 1 to 85 years with a mean of 32.59 ± 1.23 years. One hundred and ninety (72.8%) were aged below 40years. There were 200 males and 61 females showing male to female ratio 3:1. Road traffic accident was the most common aetiology (80.12%). The most frequently seen fractures were tibia 56.7%, fibula 12.6%. Associated injury was other closed fractures 38.7%. Others were vascular 16.12%, head injury 12.90% and infection rate was 7.3%. An overwhelming majority (64%) were treated with plaster of Paris (Non- operatively)Conclusion: This study has shown that open fractures of the lower limb were commoner than upper limb fractures. Majority of the injuries were caused by road traffic accident of which motorbike and automobile-pedestrian accident accounted for over 38%. It is our belief that appropriate education of road users and diligent enforcement of the laws will reduce these injuries. It is obviously important forthe orthopaedic surgeon to be familiar with the epidemiological characteristics of open fractures and aim for optimal outcome, prevent complications and decrease hospital stay and cost.Keywords: Open fracture, Plaster of Paris, Flap