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

Outcome of management of humerus diaphysis non-union

Background: The majority of diaphyseal humerus fractures heal uneventfully when treated nonoperatively, however, nonunion is not a rare event. Nonunion after conservative treatment can be successfully treated by open reduction and internal fixation. A nonunion of a diaphyseal fracture of the humerus can present a major functional problem. The main of our study was to document the outcome of management of non united diaphyseal humerus fractures with plate or plate and rush pin fixation.Methods: A 4 year retrospective study was undertaken at Presbyterian Church of East Africa (PCEA) Kikuyu Hospital, Orthopedic Unit in Kenya from April 2004 to April 2008. Records of consecutive patients with nonunion of the humeral diaphysis were reviewed. Four cases were lost to follow up. The rest were treated with a single posterior, anterior or anterolateral plate while four with a plate and rush pin construct. Autogenous iliac crest bone graft was utilised in most of the cases. A clinical evaluation for union, range of motion and complications. Radiological assessment for union was also done.Results: A total of 46 patients with humerus diaphysis non union met the inclusion criteria. Their ages ranged from 23 to 95 years with a mean of 43.6 years. The overall healing rate was 92.8 % (39/42 cases) at 6 months follow up. 3 failures occurred of whom one was a smoker and diabetic, another had a loose plate and screws following replating. The third case went to nonunion. Three cases of postoperative radial nerve palsy all of which resolved within six weeks were documented. All four treated with a plate and rush pin construct healed uneventfully.Conclusion: The results of this study indicate that our standard surgical procedure for treatment of nonunion of the humeral shaft is reliable with a 92.8% union rate in our study with few complications. The plate and rush pin construct is useful in dealing with nonunion involving osteoporotic bone

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

Melorheostosis

This case study is a report on the rare mesodermal disorder typically characterized by abnormalities of the skeleton and soft tissues. We present a 56 years old woman who was diagnosed with melorheostosis affecting the left arm. Chronic pain odema and cosmetic deformities were her presenting problems. Melorheostosis is a bony dysplasia with characteristic X-ray appearance resembling wax dripping down one side of the candle. Soft tissue calcification and even ossification may rarely be seen. In some rare and complicated cases corrective surgery or amputation may be done in very painful and ischemic limbs (1). Until very recently the aetiology of melorheostosis was unknown but now it has been established that melorheostosis is due to a loss-of-function mutation in LEMD 3 gene (also called MAN 1), which encodes an inner nuclear membrane protein (2). This is the first reported case in this region. The purpose of this case report is to describe the presentation and course of the disease. A comprehensive review of literature describing etiology, clinical aspects, diagnosis and treatment is included. Patients symptoms vary considerable in melorheostosis and consequently their treatment should be individualized

Effect of Drought Stress on Fibre Digestibility of Corn for Silage

Limited information exists about the impact of drought stress on corn silage digestibility. The objective of this study was to determine the effect of irrigation on in situ NDF digestibility of corn tissues grown under controlled conditions in a greenhouse. Five commercial corn hybrids were planted in pots and grown in a greenhouse. Pots were subjected to an abundant or restricted irrigation regime. Leaf blades and stem internodes were collected from the upper and bottom portion of each hybrid. Tissue samples were incubated in the rumen of 3 rumen-cannulated cows for 0, 3, 6, 12, 24, 48, 96, and 240 hours. Drought stress did not affect the concentration of undigested neutral detergent fibre (uNDF) in upper or bottom internodes but slightly decreased in leaf blades (17.5 and 15.7% for abundant and restricted watering, respectively). The concentration of uNDF varied substantially among corn hybrids in upper internodes (13.4 to 28.3% uNDF), bottom internodes (21.5 to 42.3% uNDF), and blades (11.6 to 20.1% uNDF). Drought stress did not affect the fractional digestion rate (kd) of fibre in any tissue. The kd of fibre varied substantially among corn hybrids in upper (3.8 to 6.6%/h) and bottom internodes (4.2 to 6.7%/h) but did not vary in blades (3.8%/h). Significant interactions existed between irrigation treatment and corn hybrid for the effective ruminal degradation (ERD) of upper and bottom internodes. This interaction did not exist for blades. The ERD of fibre varied substantially among corn hybrids in blades (32.5 to 39.1%). The conclusions of this study are that drought-stressed corn had a marginal increase in fibre digestibility of blades but not in internodes, that drought stress had no effects on ERD of fibre within hybrids, and that the effect of drought stress on fibre digestibility of corn for silage is still inconclusive

'Rumours' and clinical trials: a retrospective examination of a paediatric malnutrition study in Zambia, southern Africa

BACKGROUND: Many public health researchers conducting studies in resource-constrained settings have experienced negative 'rumours' about their work; in some cases they have been reported to create serious challenges and derail studies. However, what may appear superficially as 'gossip' or 'rumours' can also be regarded and understood as metaphors which represent local concerns. For researchers unaccustomed to having concerns expressed from participants in this manner, possible reactions can be to be unduly perturbed or conversely dismissive.This paper represents a retrospective examination of a malnutrition study conducted by an international team of researchers in Zambia, Southern Africa. The fears of mothers whose children were involved in the study and some of the concerns which were expressed as rumours are also presented. This paper argues that there is an underlying logic to these anxieties and to dismiss them simply as 'rumours' or 'gossip' would be to overlook the historic and socio-economic factors which have contributed to their production. METHODS: Qualitative interviews were conducted with the mothers whose children were involved in the study and with the research nurses. Twenty five face-to-face interviews and 2 focus group discussions (FGDs) were conducted with mothers. In addition, face-to-face interviews were conducted with research nurses participating in the trial. RESULTS: A prominent anxiety expressed as rumours by the mothers whose children were involved in the study was that recruitment into the trial was an indicator that the child was HIV-infected. Other anxieties included that the trial was a disguise for witchcraft or Satanism and that the children's body parts would be removed and sold. In addition, the liquid, milk-based food given to the children to improve their nutrition was suspected of being insufficiently nutritious, thus worsening their condition.The form which these anxieties took, such as rumours related to the stealing of body parts and other anxieties about a stigmatised condition, provide an insight into the historical, socio-economic and cultural influences in such settings. CONCLUSIONS: Employing strategies to understand local concerns should accompany research aims to achieve optimal success. The concerns raised by the participants we interviewed are not unique to this study. They are produced in countries where the historic, socio-economic and cultural settings communicate anxieties in this format. By examining this study we have shown that by contextualizing these 'rumours', the concerns they express can be constructively addressed and in turn result in the successful conduct of research aims