Current concepts in external fixation

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Epidemiology and Outcome of Limb Fractures in Nigeria: A Hospital Based Study

Background: The Olabisi Onabanjo University Teaching Hospital, Sagamu is a tertiary hospital that caters for accident victims with various injuries including limb fracture. The hospital is located close to the Lagos-Ibadan and the Sagamu-Ore-Benin expressways.Objectives: To study the epidemiology and outcome of patients presenting to the hospital with limb fractures.Methods: This is a prospective study of all consecutive patients that presented with fractures of either the upper or the lower limbs at the accident and emergency department of the Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun state between the 1st of January 2009 and 31st December 2009. At presentation, the patients' bio-data, the circumstances surrounding the incident, and the results of their clinical and radiological examinations were recorded. They were then followed up till discharge from the hospital.Results: A total of two hundred and three (203) patients were studied. The age range was between 2 and 87 years with a mean of 34.8±17.4. The male : female ratio was 2:1. The commonest aetiological factor was motor vehicular accidents. The most frequently affected bones were the tibia/fibula followed by the femur.Conclusion: Motor vehicular accident due to burst tyres was the commonest cause of limb fractures with majority of them occurring along the Lagos-Ibadan expressway. The most frequently affected bones were the tibia/fibula followed by the femur.Keywords: Epidemiology, outcome, limb fractures

Trauma at a Nigerian teaching hospital: pattern and documentation of presentation

Background and Objectives: This study is aimed at identifying the characteristics of injuries and determining the efficiency of documentation of patients' records in a tertiary hospital where there is no trauma registry. Patients and Methods: A retrospective case record analysis was conducted of injured patients seen at the Accident and Emergency unit over a 12 month period from January to December 2003. Results: A total of 1078 records of injured patients that attended the A&E were analysed. Their mean age was 31years (range 3 months to 85 years). Laceration (n = 408) and fractures (n = 266) representing 62.5% of injuries were seen. Injuries to the lower limb occurred in 239 patients, multiple anatomical sites 224, head 224, upper limb 203, the neck 20, and the abdomen 11 patients. Trauma was due to road traffic accident in 977 patients, fall in 39, assault in 14 while burns and firearm injuries occurred in 5 and 7 patients respectively. The mean injury severity score (ISS) was 4. Severe injuries, ISS > 15 occurred in 54 patients with mean ISS of 21, and resulted from RTA in 92.6% of cases. Mortality from severe injuries occurred in 31.5% of cases while overall mortality was 2%. Most deaths were associated with multiple injuries (60.9%) and head injury (30.4%). Incomplete documentation of accident and injury data occurred frequently, from 2% of some data to 100% of others. Conclusions: Lacerations and fractures were the most common injuries. Mortality is due usually to head and multiple injuries. Research into appropriate strategies for prevention of injuries, especially RTA, is required but this must start with the establishment of institutional and regional trauma registries for complete documentation of relevant data. African Health Sciences Vol. 6(2) 2006: 104-10

Baseline anthropometric measurements and Obesity among students in Sagamu, Ogun State, southwest, Nigeria: Baseline anthropometric measurements and Obesity among students

Objectives: This study was designed to determine the anthropometric characteristics and prevalence of obesity among secondary and undergraduate students in Sagamu. Methods: This cross-sectional study involved a selection of 260 students aged 10 to 33 years in Sagamu using a convenience sampling method. The weight, height, and waist and hip circumferences of each subject were measured. The body mass index was then calculated. Data were analyzed using SPSS version 25.0 and p-values< 0.05 were considered statistically significant. Results: The age ranges were 1o to 17 years (Secondary school (SS) students) and 14 to 33 years (undergraduate students). There were 130 students in each group, comprising 52.7% males and 47.4% females. Underweight was commoner among the SS students (20.8% versus 6.2%). Most of the subjects were of normal weight 52.3% in SS and 68.5% in undergraduates. Only 3.1% of SS students were obese compared to 4.6% of undergraduate students. The mean BMI of SS students (22.2± 0.39 versus 23.24±0.34) was statistically lower (p=0.019). The mean waist circumference of SS students (66.92±0.44 versus 74.64±0.67) was also statistically lower (p=0.000). The mean BMI of SS students was higher in females than in male subjects (23.14±0.62 versus 20.86±0.42). The mean waist and hip circumferences and BMI were lower in female subjects for both study groups. Conclusions: The mean BMI and hip circumferences were higher in female subjects while the mean waist circumferences were lower in females than males in both study groups

Pattern of CT Findings in Head Injuries: A Sub-urban Tertiary Hospital Experience

Head injury is a major public health issue in this environment and accounts for the high mortality from Road traffic injuries (RTI). Plain radiography is seriously limited in diagnosis. With the advent of Computerized Tomographic (CT) machine, diagnosis has become easier and more specific, with early referrals, quicker intervention, and consequent reduction in mortality. To evaluate the pattern of CT diagnoses and their link with clinical indications in patients with Road traffic Injuries. Fifty Eight patients referred to the Radiology department for Computerized axial Tomography following a road traffIC injury with a suspicion of head injury were studied. A retrospective review of the CT request cards, film reports and case notes (where available) were carried out. The mean age of patients was 34.8 ± 19.3 yrs, and male: female ratio was 4.2:1. The most frequent clinical indication was RTL The most frequent CT finding was intracranial heamorrhage occurring in temporal, parietal, frontal and occipital bone in a descending order. Temporal bone fracture occurred more frequently. Although frequency of linear fractures was more in the study, depressed skull and multiple fractures were seen in significant number. The study confirmed the usefulness of CT in head injury especially as filter mechanism for quick and efficient transfer to other centre with Neurosurgeons in situations in which surgical intervention may be life-saving. It also established the usefulness of CT in identifying the site and type of fractures occurring in the bones of the skullKeywords: Head injury, Computerized Tomography, Trauma

Trauma at a Nigerian teaching hospital: pattern and documentation of presentation

BACKGROUND AND OBJECTIVES: This study is aimed at identifying the characteristics of injuries and determining the efficiency of documentation of patients' records in a tertiary hospital where there is no trauma registry. PATIENTS AND METHODS: A retrospective case record analysis was conducted of injured patients seen at the Accident and Emergency unit over a 12 month period from January to December 2003. RESULTS: A total of 1078 records of injured patients that attended the A&E were analysed. Their mean age was 31years (range 3 months to 85 years). Laceration (n = 408) and fractures (n = 266) representing 62.5% of injuries were seen. Injuries to the lower limb occurred in 239 patients, multiple anatomical sites 224, head 224, upper limb 203, the neck 20, and the abdomen 11 patients. Trauma was due to road traffic accident in 977 patients, fall in 39, assault in 14 while burns and firearm injuries occurred in 5 and 7 patients respectively. The mean injury severity score (ISS) was 4. Severe injuries, ISS > 15 occurred in 54 patients with mean ISS of 21, and resulted from RTA in 92.6% of cases. Mortality from severe injuries occurred in 31.5% of cases while overall mortality was 2%. Most deaths were associated with multiple injuries (60.9%) and head injury (30.4%). Incomplete documentation of accident and injury data occurred frequently, from 2% of some data to 100% of others. CONCLUSIONS: Lacerations and fractures were the most common injuries. Mortality is due usually to head and multiple injuries. Research into appropriate strategies for prevention of injuries, especially RTA, is required but this must start with the establishment of institutional and regional trauma registries for complete documentation of relevant data

Paediatric Orthopaedic Disease Pattern In Sagamu, Nigeria

A prospective descriptive study of the orthopaedic diseases and injuries in children seen over a 24month period in the orthopaedic clinics of Olabisi Onabanjo University Teaching Hospital (OOUTH) Sagamu was done. One hundred and thirty-six orthopaedic disorders in 134 children were studied. Of these children, 60% were males and 40% were females. 66% of them were below age 5 years while older children were 34%. Deformities (48%) were the most frequent presenting conditions of which congenital malformations and acquired deformities occurred in the ratio 4.5:5.5. The most frequently seen congenital and acquired deformities were congenital talipes equinovarus (CTEV) and genu valgum/genu varum representing 9.6% and 17% respectively. Accidental injuries constitute 41% of all cases. 75% of the injuries were fractures which occurred mostly in the upper limb while soft tissue injuries were 14%. 59% of the injuries were due to fall most often at home, and 25% of them resulted from road traffic accidents, most commonly being knocked down. There is no significant difference between preschool and early school children among those injured from fall and traffic accidents, p = 0.89 and p = 0.31 respectively. Non- accidental injuries, from battering for example, were not seen. Six percent of the cases were due to infections. Key Words: children, disease, injury, orthopaedics - congenial, acquired Nig. Medical Practitioner Vol. 44(3) 2003: 52-5

Blood Loss And Transfusion Need During Operative Treatment Of Major Limb Fractures: Incidence And Risk

OBJECTIVE: To determine the incidence of excessive blood loss and transfusion needs during operative treatment of long bone fractures and identify risk factors for excessive blood loss. METHODS: A prospective study of fifty-nine patients was conducted, with excessive blood loss defined as blood loss in excess of 10% of patients' mean blood volume. RESULTS: Forty male and 19 females were studied, with mean age 43 years (range 14–85 years). Excessive blood loss occurred in 80% of the patients. The mean estimated blood loss (EBL) was 697mls. Twenty-five patients, 42%, were transfused and the mean number of unit transfused was 1.6 units per patient. Operative fixation, in the lower limb, of femur fracture, is a risk factor for excessive blood loss (p = 0.0007). The fixation device, fracture nonunion and preoperative haematocrit were not. CONCLUSION: Excessive blood loss may be common during operative treatment of long bone fractures. Adequate preoperative preparation should be made for transfusion especially in surgical environments where blood may not be readily available when urgently required. Nig Jnl Orthopaedics & Trauma Vol.2(2) 2003: 116-11

Pattern And Outcome Of Treatment Of Musculoskeletal Conditions By Traditional Bonesetters In Southwest Nigeria

OBJECTIVE: Complications of treatment by traditional bonesetters (TBS) of musculoskeletal injuries and diseases are not infrequently seen in modern orthopaedic practice in developing countries. The TBS are still being patronized despite the array of complications arising therefrom. Also they treat musculoskeletal conditions other than fractures. METHODS: A prospective descriptive study was conducted on patients who had earlier been treated by the TBS, using interviewer-administered questionnaire, to identify the types of conditions treated by the TBS and the complications arising there from. RESULTS: Forty-one patients, mostly Yoruba of South-West Nigeria were studied. Fractures, especially of the femur were the most common conditions treated by the TBS, representing 71% of all conditions. Others include soft tissue injuries 9.8%, chronic osteomyelitis 7.3%, genu valgum 2.4%, and chondroblastoma 2.4%. The most frequently seen complications are nonunion of fractures, 36.6% of all cases as well as lower limb shortening, 29% of all complications. Others are ankylosis, malunion, delayed union, ulcers, contractures and gangrene. The difference in the number of complications and nonunion of fracture rate in the upper and lower limbs are insignificant,