Low Back Pains –The Orthopaedic Surgeon’s Enigma

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Deep intermuscular spindle-cell lipoma

We report the case of a 58-year-old man who presented with a deep intermuscular spindlecell lipoma. By pressure on the neurovascular bundle this tumour caused  neurological symptoms in the affected leg. The clinical 1 presentation, investigations, surgical intra- i operative Tidings, the gross pathology and histological light and  electron microscopy findings are described and the surgical outcome 1 and prognosis are discussed.Key Words: lipoma, spindle-cell, intermuscula

Anterior Cruciate Reconstruction Using Bone-patellar Ligament – Bone Autograft

Background: Injuries to ligaments of knee are common in our society especially in the young athletes and sports men participating in football, volleyball, rugby etc. Tears of the anterior cruciate ligament (ACL) leads to knee instability which leads to inability to participate in sports. In the none athletes ACL injury tends to decline in their level of daily activity. This is a study of ACL tears seen and managed by the author over a long period along with scientific data of clinical presentations, diagnosis, associated injuries, the ACL repair, rehabilitation protocol and the overall outcome. Objective: To review the authors experience of patients with anterior cruciate ligament tears who have been treated by bone-patellar tendon-bone autografts. That was to be achieved through clinical, radiological, athroscopy and extensive rehabilitation programme and arthroscopic review after one year follow-up. Setting: Menelik Hospital and the Nairobi Hospital. Methods: Thirty five patients with anterior cruciate ligament tear in one knee and a normal contralateral knee were evaluated and followed up for six years. Clinical history, physical evaluation, X-ray and athroscopies were done to rule out concomitant meniscal lesions and facilitate their treatment accurately. Follow up arthroscopy; physical examinations by Lachman test, pivot test and anterior drawer test were done. Subjective and objective data were obtained and reviewed to assess final outcome. Results: A total of 35 patients were seen and treated. Only 25 patients were available having been followed up fully. There were 18 males and seven females giving a male to female ratio of 2:1. The injuries were unilateral 18 (72%) on the right and seven (28%) on the left. Initial Lachman”s test was graded at 2 and 3 while anterior drawers test and pivot test at 2 and 3 respectively in all patients. Post operatively these improved to grade zero with negative pivot test in all patients. The subjective results were excellent and good in 80% of the patients, while the objective were 68% . Follow up arthroscopy showed a stable ligament at one year while follow up X-ray showed mild arthrosis. A few complications occurred with one infection and calcification of ligament in two patients, arthrofibrosis in two patients. Conclusion: This study is of clinical relevance as it shows alleviation of pain after surgical treatment of the torn ACL which has been described as the stabiliser of the knee and guardian of the Meniscus

Volkmann's Ischaemic Contracture following acute compartment syndrome - a case report

Background: Compartment syndrome involving the extremities is one of orthopaedic emergencies. If not well managed it can lead to serious damage to soft tissues rendering the limb non functional. Design: A case report Setting: PCEA Kikuyu hospital Methods: An eight year old boy was treated and followed up after he had suffered compartment syndrome on his left forearm. This occurred after he fell and sustained fractures of both radius and ulnar. He was put in a cast at a peripheral hospital. East African Orthopaedic Journal, Vol. 4: September 201

Incidence of early post operative surgical site infection after primary total hip athroplasty in the African setting

Background: Implant orthopaedic surgery is associated with a risk of post operative Surgical Site Infection (SSI). This can have devastating consequences in the case of arthroplasty. Due to the less than ideal circumstances under which surgery is conducted in Africa, there are concerns that the risk of SSI may be high.Objective: To determine the incidence of post operative SSI after primary total hip arthroplasty.Design: A retrospective cohort study.Methods: All primary total hip arthroplasties done from 1998 to 2011 were reviewed. The incidence of infection was determined on follow-up of the patients. The study was approved by the hospital ethics committee.Results: The overall incidence of post operative SSI was 1.5%. Co-morbidities identified were not associated with an increased risk of infection. Increased duration of surgery and increased body weight were also not found to increase the risk of post operative SSI.Conclusion: The risk of post operative SSI after total hip arthroplasties is low in the African setting. Further investigation is recommended to identify modifiable risk factors that may increase the risk of SSI.Key words: Post operative, Surgical site infection, Arthroplasty, Primary total hi

Total hip replacements at Kikuyu Hospital, Kenya

Background: Total joint arthroplasty is a highly effective procedure that is frequently performed in elderly patients. This is not so in the third world and is not frequently performed. Total hip replacement (THR) relieves the pain and functional disability experienced by patients with moderate to severe arthritis of the hip, improving their quality of life. It is a highly cost-effective procedure. Many patients deserving this operation cannot afford it in this part of the world and hence do not have it done. Objective: To analyse total hip replacement surgical procedures done in a mission orthopaedic hospital in Kenya with emphasis on early complications. Design: A retrospective hospital based study Setting: Kikuyu hospital Methods: Medical records of patients who underwent primary total hip arthroplasty between June 2006 and January 2008 in a sample of 97 patients done surgery at Kikuyu hospital. The patient’s medical records were looked at from the time a patient is first seen at the clinic by an orthopaedic surgeon and is recommended for a total hip arthroplasty and is followed up until 6 months after the operation. The difficulties encountered either by the surgeon or the patient during this period were recorded and analysed. Results: Of the 97 patients seen 99 operations were done and there were, two dislocations, two superficial and one deep wound infections, one upper gastro intestinal bleeding, two Deep Vein Thrombosis, one sciatic nerve neuropraxia, one haematoma formation and one intraoperative femoral fracture. Out of the 97 patients 40 of them had the surgery performed more than six months after a proper diagnosis was made and hip arthroplasty recommended. This is mainly due to lack of finances. At operation two cases were really difficult and took longer than the usual timing. Conclusion: Total hip arthroplasty is a safe operation even in the third world with satisfactory results. Just like in any other surgical procedure difficulties and complications are bound to occur. East African Orthopaedic Journal, Vol. 4: September 201

Early functional outcome of distal femoral fractures at Kenyatta National Hospital and Kikuyu Hospital

Background: Distal femoral fractures account for 4% to 7% of all femoral fractures. They cause considerable morbidity and mortality, especially in the elderly. Locally they occur mainly in the young socio-economically active age group; with the majority caused by automobile accidents. With increasing high energy lifestyles and increasing longevity, the incidence is projected to rise. Functional outcome of treatment of these injuries has however not been critically studied at Kenyatta National Hospital and PCEA Kikuyu Mission Hospital setup. Objective: To determine early functional outcome of operative treatment of distal femoral fractures.Design: Hospital based prospective study.Setting: Orthopaedics and trauma wards and fracture clinics at Kenyatta National Hospital and PCEA Kikuyu Mission Hospital.Patients and methods: Forty six patients were recruited by consecutive sampling after they underwent open reduction and internal fixation. They were followed up for a period of three months during which any complications were noted. At three months they were assessed for knee range of motion, pain, knee ligament stability, ability to walk and climb stairs and muscle strength. Femoro-tibial alignment was determined from a review of the AP and lateral radiographs of the knee. The hospital for specialized surgery knee score was then determined.Results: There were 18 females and 28 males all totalling to 46. Majority were in the age bracket 25-45 years (70.6%). The leading cause was RTA, followed by falls from a height. Thirty (65%) patients were treated using DCS, 11 (23.9%) with retrograde intramedullary nailing and 5 (10.9%) with 950-angle plate. Eighty nine percent had good to excellent functional outcome 12 weeks after surgery. One patient suffered periprosthetic fracture and poor function at 3 months. There was one patient who suffered superficial wound infection. Seventy eight percent had knee range of motion above 900 and 8.8% had below 600 of motion. One patient had no radiological union at 12 weeks.Conclusions: Following operative fixation, functional outcome was predominantly good or excellent. Knee stiffness was the leading complication. Young socio-economically active individuals formed the majority of those with these injuries, with a male: female ratio of 1.6:1 Road Traffic Accidents (RTA) was the leading cause.EAOJ; Vol. 7: September 201

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

Prolapsed Intervertebral Disc in an African Population: Kenyan Experience

Background: Characteristics of Prolapsed Intervertebral Disc (PID) in Africa, reports are scanty and often disparate.Objectives: To evaluate the distribution of PID by location, age, gender and predisposing factors among African patients at our hospital, the largest regional referral and teaching hospital in Kenya.Patients and Methods: Six hundred and three cases (267 males, 336 females) of prolapsed intervertebral disc over 11 years between January 1997 and December 2007 were analyzed for location, number of prolapsed disks, gender, age and predisposing conditions.Results: Of the determined locations L4/5 was the commonest (42.3%), followed by L5/S1 (25.5%). Seventy seven (20.9%) of the patients had multiple prolapsed disks. 1.4% were in the cervical region, and only one in the thoracic. PID was commonest in the 31 – 50 year age group females (M: F is 1:1.26, p=0.00), with mean age 40.90±13.80 years, (range between 11- 85 years).Conclusions: PID in Kenya is commonest in the lower lumbar region of young people more in females and is associated with trauma

Editorial: Acute compartment syndrome

No abstract