Type I (Hannis - Steinthal) Capitellar Fracture: Case Report

Capitellar fractures of the elbow present with pain and swelling of the elbow following a fall on an outstretched arm and are rare injuries comprising 0.5-1% of all elbow fractures (1). This is a case report of an adult female who sustained this injury following a fall on her outstretched arm. CT scans revealed a Type I capitellar fracture of the right elbow. Open reduction and internal fixation was done with a functionally good result. Because of the cartilaginous nature of the capitellum humeri these injuries are easily missed on radiography. One must have a high index of suspicion especially when elbow movement is noticeably restricted. These injuries are discussed and the literature reviewed. Although controversial, treatment is mainly operative. One should carefully review radiographs of patients who present with injuries of the elbow with pain, swelling and markedly restricted joint range of motion and whose mechanism of injury(fall on an outstretched arm) is consistent with capitellar fracture. CT scans often clinch the diagnosis. Type I fractures may be treated conservatively but Type II injuries require operative intervention

Stabilisation of Posterior Sternoclavicular Joint Dislocation using Palmaris Longus Tendon Autograft: A Case Report

Posterior sternoclavicular joint dislocation is a rare injury. It is usually sustained acutely in activities such as contact sports eg. rugby and motorcycle accidents. Plain radiography of the chest will often miss the diagnosis and confirmation is by CT scans. However CT scans are often reported to miss epiphyseal injuries. Management is by closed reduction and if the injury is unstable, by open reduction and stabilisation. A case is reported where palmaris longus tendon was used to stabilise the joint following open reduction

Paediatric trauma at Kenyatta National Hospital, Nairobi Kenya

Background: Medical Literature identities injuries as the most important preventable cause of death and disability in children beyond the first few months of life.Methods: A descriptive prospective study undertaken between October 2003 and July 2004 at Kenyatta National Hospital on children below the age of 13 years.Results: A total of 187 patients were admitted to KNH with trauma during that period. The age range was liont3 weeks to 12 years 4 months with a mean age of 3.9 years. There were 53.5% males and 46.5% females. Burns accounted for 34.8% falls 25.1%. Foreign bodies 17.6% while 8% were a result of road traffic accidents.Conclusions: Traumatic burns accounted for the highest single cause of trauma at 34.8% (n = 65). 92.3% of those burnt were aged 5 years and below. Most of these burns occurred in homes and were preventable

Patterns of injuries in children who fall from a Height as seen at Kenyatta National Hospital

Objective: To describe injuries and outcomes among children who fall from a height Design: Prospective, convenience hospital based study. Setting: Paediatric surgical wards of Kenyatta National Hospital, Nairobi, from November 2006 to February 2007. Subjects: Children aged 1-13 years who sustained injuries after failing from any height. Results: Eighty children were recruited. There were 61 male (76%) and 19 female (24%), with an age range 1-13 years. Most injuries occurred at home (78.75%) after falling from buildings (33.75%), and were of mild-to-moderate severity. 13.4% sustained external haemorrhage, 16.5% sustained facial injuries, 25.2% sustained CNS injuries, 43.3% sustained various fractures, and 1.6% sustained abdominal trauma. The head and musculoskeletal systems were the most likely regions to be injured. The most common diagnoses were supracondylar fracture of humerus and mild head injury. No thoracic or pelvic fractures were recorded. Recovery was good in most instances. Conclusion: Most children who sustain injuries after a fall from height do so after falling from a building. The most common types of injuries sustained were to the head and distal limbs, especially fractures. They were mostly of mild-moderate severity and recovery usually complete.East African Medical Journal Vol. 87 No. 8 August 201

Aplasia Cutis Congenita. A Case Report and Review of Literature

Aplasia cutis congenita is a birth defect characterised by absence of skin and, in some cases, the subcutaneous tissues. This is a case report of the initial conservative management of a neonate in a rural hospital who presented with aplasia cutis congenita involving the trunk and the lower limbs. The literature is reviewed and the case discussed.Key words: Aplasia cutis congenital, rural, hospita

Patterns of poisoning among patients aged 0-13 years at a paediatric hospital in Nairobi

Objectives: To determine the pattern of poisoning amongst patients admitted at a paediatric hospital in Nairobi and compare it with that of other hospitals around the worldDesign: A retrospective hospital based multivariate study.Setting: Gertrude’s Garden Children’s Hospital, Nairobi, Kenya.Subjects: Medical records of all children admitted with a diagnosis of poisoning between January 2003 and December 2007Results: The age range of the study population was birth to 13 years. The mean age was 3.57 years with a standard deviation of ±1.57 with a peak incidence in the one to three years old age group (56.7%). Males comprised 61.7% of the cases. The most common cause of poisoning was ingestion of a drug ( 46.7%). Petroleum products caused 30.0%, detergents 8.3% and organophosphates 6.7%. Ninety six point seven percent of poisonings were unintentional and 93.3% of injuries took place at home. There were no mortalities.Conclusion: The majority of these incidents were preventable. Measures need to be instituted to reduce the number of incidents of poisoning in children. This can take the form of health and safety education particularly in relation to storage of common household poisons

Epidemiology of Burns in Patients Aged 0-13 Years at a Paediatric Hospital in Kenya

No Abstract

Prevalence of low back pain amongst workers at a paediatric Hospital in Nairobi

No Abstrac

Variability in olecranon AO fracture fixation: A radiological study

Background: Tension Band Wire(TBW) fixation of olecranon fracture is a commonly used technique by orthopaedic surgeons. However surgeons do not strictly adhere to the AO standard.Objectives: To determine the use and variability of this technique by surgeons at the hospital.Design: A hospital based retrospective study using anonymous radiological records.Setting: North Staffordshire University Hospital in United Kingdom.Materials and Methods: Computer software was used to retrieve, review and measure pre and postoperative radiographs of olecranon fracture cases. All identifying information was electronically masked.Results: The mean age was 50.1 years with a median of 56 years. 16.9% were open fractures. Fifty percent of the TBW met the AO standard

Effects of Tranexamic Acid on Death, Vascular Occlusive Events, and Blood Transfusion in Trauma Patients with Significant Haemorrhage (Crash-2): A Randomised, Placebo-Controlled Trial

Background: Tranexamic acid can reduce bleeding in patients undergoing elective surgery. We assessed the effects of early administration of a short course of tranexamic acid on death, vascular occlusive events, and the receipt of blood transfusion in trauma patients.Methods: This randomised controlled trial was undertaken in 274 hospitals in 40 countries. 20 211 adult trauma patients with, or at risk of, significant bleeding were randomly assigned within 8 h of injury to either tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo. Randomisation was balanced by centre, with an allocation sequence based on a block size of eight, generated with a computer random number generator. Both participants and study staff (site investigators and trial coordinating centre staff) were masked to treatment allocation. The primary outcome was death in hospital within 4 weeks of injury, and was described with the following categories: bleeding, vascular occlusion (myocardial infarction, stroke and pulmonary embolism), multiorgan failure, head injury, and other. All analyses were by intention to treat. This study is registered as ISRCTN86750102, Clinicaltrials.gov NCT00375258, and South African Clinical Trial Register DOH-27-0607-1919.Findings: 10 096 patients were allocated to tranexamic acid and 10 115 to placebo, of whom 10 060 and 10 067, respectively, were analysed. All-cause mortality was significantly reduced with tranexamic acid (1463 [14·5%] tranexamic acid group vs 1613 [16·0%] placebo group; relative risk 0·91, 95% CI 0·85–0·97; p=0·0035). The risk of death due to bleeding was significantly reduced (489 [4·9%] vs 574 [5·7%]; relative risk 0·85, 95% CI 0·76–0·96; p=0·0077). Interpretation Tranexamic acid safely reduced the risk of death in bleeding trauma patients in this study. On the basis of these results, tranexamic acid should be considered for use in bleeding trauma patients