Functional Outcomes of the Knee after Retrograde and Antegrade Intramedullary Nailing for Femoral Shaft Fractures

Background: Antegrade intramedullary nailing is currently considered the gold standard for treatment of femur shaft fractures although retrograde technique is gaining acceptance. Although introducing the nail through the knee has potential to damage the intra articular structures, several reports have indicated acceptable functional outcome. The results are not known in our centre that so far lacks an established patient selection and knee rehabilitative protocols inspite of the widespread use of the retrograde technique.Objective: To compare the functional outcome of the knee joint after retrograde and antegrade intramedullary nailing of femoral shaft fractures.Methods: A comparative cross sectional study carried out on patients who were treated with retrograde and antegrade intramedullary nailing for femoral shaft fractures between January 2007 and December 2009. Functional outcome was determined using modified HSS score.Results: A total of 124 patients participated in the study. According to the modified H.S.S knee rating system, overall, functional results were rated as excellent in 71.8%, good in 23.4% and poor in 3.2%.The retrograde group had poorer results than Antegrade group (p<0.001). There was a negative correlation between age and the functional outcome in the retrograde group (p < .001).The incidence of knee pain was higher in the retrograde group (37.5%) as compared to 10% in the Antegrade group, while the rate of knee stiffness was higher in the retrograde group (40.6%) compared to the Antegrade group (3%).Conclusion: Retrograde nailing is associated with poorer knee scores in our patient population. Increasing age is a factor associated with poorer scores especially after retrograde nailing

Burns injuries among in-patients at Moi Teaching and Referral Hospital, Eldoret, Kenya

Background: Africa contributes 12.2% to the total global deaths due to burn injuries. There are no data on burns in the Western region of KenyaObjectives: To determine the causes and outcome of burns injuries among in-patients at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya.Study design: Retrospective Cross-sectional study.Setting: The surgical wards of MTRH, an 800 bed tertiary teaching and referral hospital in the Western region of Kenya.Results: The age ranged between 4 days and 79 years (mean 7.9±13.7 years).The male to female ratio was 1.5:1. The common causes of burn injury were scalds and open fi re. The mean duration of hospitalization was 25.7 ±33.5days (Range 1 to 256 days). The mortality rate was 5%.Conclusion: Scalding is the leading cause of burns at MTRH. The length of hospitalization and mortality rate are comparable to those of the developing world

Management of Patients with Post- Traumatic Exposed Bones at Moi Teaching and Referral Hospital, Eldoret, Kenya

Background: The global frequency for open long bone fracture is at least 11.5 cases per 100,000 personsper year. Precise published research information regarding the characteristics and the management ofpatients with post- traumatic exposed bones for Africa, Kenya and Moi Teaching and Referral Hospital-Eldoret is non- existent. This study will provide the much needed research information.Objective: To assess the characteristics of patients with post- traumatic exposed bones with theirmanagement at Moi Teaching and Referral Hospital, Eldoret.Setting: Moi Teaching and Referral Hospital, Eldoret, Kenya.Design: Hospital based descriptive retrospective study.Subjects: One hundred and ninety six patients managed for post- traumatic exposed bones between 1stJanuary, 2006 and 31st December, 2010.Methods: The medical records (files) were retrieved from the Records Department; data was gathered,recorded in observation checklist, organized, cleaned and analyzed in the statistical package for socialscience software version 19.Results: Males-167, females-29; ratio: 5.76:1. Mean age: 32.51 years (SD=13.26). Referrals were 51%, at least 60% were of low literacy and income earning status. All patients had exposed bones due to open fractures (97%) and degloving injuries (3%). Road traffic accidents were responsible in 49.5% of the patients. Duration of ailment was 0-300 days (median= 1.00). All patients benefited from surgical  interventions. Waiting time for surgery was 0-67 days (median= 1.00); while number of procedures were 1-9 (mean= 2, (SD=1.6)). Survival was 99.5%; length of hospitalization was 2- 177 days (median= 24.00; mean= 36.3 days (SD= 32.8)). The main complication was infection (62 patients). Follow up was adhered to by 59% of the patients.Conclusions and Recommendations: Majority of patients were: referred, males, of low literacy and low income earning status. All patients had exposed bones and benefited from one form or another of thenumerous surgical interventions with satisfactory outcome. Scarcity of resources remained major  challenge. There is need to create awareness and empower people socio-economically; as well as providing resources required in prevention, control and treatment of this disorder.Key words: Exposed bones, Debridement, Fracture stabilization, Coverage procedur

Treatment and Outcome of Ankle Fractures at the Moi Teaching and Referral Hospital

Background: Ankle fractures are common and protocols for their  management are generally well established. Despite this, a significant  proportion of the patients get unfavourable outcomes after being managed for this injury. This study looked at the treatment options offered and their outcome at our unit.Methodology: A prospective study was conducted to examine ankle fracture patients presenting at our unit from 1st November 2009 to 30th April 2011. All patients were followed up was for 6 months where clinical and  radiological evaluations recorded to determine outcome. Results: The mean age of patients was 47years with the ratio of female to male being 1.5:1. An infection rate of 10% in patients treated by ORIF and 33.3% in open fractures was documented. At 6 months follow up, there was a higher rate of complications in the unstable fractures treated   non-operatively (92.3%) compared to unstable fractures treated surgically (37.7%) (p<0.001).Conclusion: The rate of infection after surgical  management was high and measures are required to mitigate this. The unstable ankle fractures  treated non-operatively have a high rate of complications and should be managed operatively.Key Words: Ankle fractures, Treatment outcome, Developing countr

Congenital pseudoarthrosis of the clavicle: case report

A case of a 20-year-old medical student with pseudoarthrosis of the right clavicle is presented. Open reduction, bone grafting and plating were done. The pseudoarthrosis healed and the plate was removed after two years. This case is presented to highlight the treatment of this rare condition.East African Medical Journal Vol. 82(5) 2005: 270-27

The anatomy of pelvic corona mortis vessles in black Africans: A cadaveric study

Objective: To study prevalence and variant anatomy of the corona mortis vessels in a black African population in relation to side and gender.Methodology: Forty embalmed hemipelvices obtained from the Department of Human Anatomy at Moi University were used for this descriptive cross sectional study. The cadavers were dissected at the preperitoneal area of the abdominal wall from inside to look for corona mortis. Chi-Square test was used to compare the incidence of the corona mortis between males and females. The level of significant difference used was p < 0.05. The unpaired t-test was used to compare mean of incidences of corona mortis in males and females.Results: Corona mortis was present in 38% (15 of 40). Of these, 47% were in men and 53% in women. The mean distance from the pubic symphysis to the point where the corona mortis traverses the pubic ramus was 53.2mm (arterial) and 54.3mm (venous). The mean distance from the pubic ramus to the point of anastomosis with the external iliac systems were 16.4mm and 11.5mm for the artery and vein respectively. Regarding the nature of connection, 2(13.4%) were purely arterial, 5(33.3%) were purely venous while 8(53.3%) had both. From the chi-square results it showed that there was no significant relationship between the gender and nature of connections or side of the pelvis; (χ2=0.134, df=2; p>0.05).Conclusion: In pelvic and acetabular surgery, the corona mortis must be ligated or clipped to advance the dissection further along the pelvic brim and quadrilateral surface during the modified Stoppa approach which enables access to the anterior wall, anterior column, and associated anterior column and posterior hemitransverse fractures, as well as certain both-column, T-shaped, and transverse fracture