Does the Proximal Femur Geometry Predict Early Functional Outcome after Plate Fixation of Geriatric Pertrochanteric Fractures?

BACKGROUND: The proximal femur geometry determines the hip force distribution. The femoral neck axis length (FNAL), the hip axis length (HAL), the femoral head diameter, and the femoral neck-shaft angle (FNSA) could influence the risk and outcome of pertrochanteric fractures. Restoring these parameters to their prefracture values could predict early hip function. AIM: To determine if the postoperative proximal femur geometry of geriatric patients with plating for pertrochanteric fractures predicts the early functional outcome. MATERIALS AND METHODS: The study was a prospective study carried out at the National Orthopaedic Hospital Enugu for 18 months. Geriatric patients who had Proximal Femoral Locking fixation for pertrochanteric fractures were recruited. Radiological parameters of the proximal femur in the unaffected and fixed hips were measured and compared. The functional outcomes of the patients were measured at 3 months postoperative period using the Harris hip score (HHS). Multiple linear regression was conducted on the parameters to determine the HHS. RESULTS: Thirty patients participated in the study, with a significant difference (P < 0.001) in the mean FNSA between unaffected (M = 128.69, standard deviation (SD) =2.93) and operated hips (M = 121.81, SD = 8.86). The FNSA was the only significant predictor of hip function, with a 1-degree increase improving the HHS by 1.30. CONCLUSION: There is a significant difference in the FNSA between the unaffected and the operated hips. The FNSA significantly predicts the early hip function and should be reconstructed to within normal range during surgery.

Assessment of handgrip strength in healthy african subjects: Establishing age and gender stratified reference values.

Background: The handgrip strength assesses hand function in traumatic and non-traumatic upper extremity conditions. It is also a surrogate marker for other systemic diseases unrelated to the upper limb. Various reference values have been established in different world regions, with few studies in our population. Aim: To determine the average handgrip strength by gender and age categories among healthy subjects in Nigeria. Materials and Methods: It was a cross-sectional study assessing handgrip strength by age category (ten-year bin width), gender, and handedness in 210 healthy persons aged 10 to 79 in Nigeria. Its relationship with age, height, weight, mid-arm circumference, triceps skinfold thickness, and mid-arm muscle area was evaluated using multiple linear regression. Results: The mean handgrip strength in the dominant and non-dominant hands was 31.09 kg and 28.45 kg, respectively, P < 0.001. Males have higher values than females in all age categories. The grip strength peaked in the 30-39-year age group in both genders and declined afterward. Age exhibited a nonlinear pattern but had an overall negative relationship, while height was positively related to grip strength in both genders. In contrast, mid-arm circumference and mid-arm muscle area predicted handgrip strength only in males. Triceps skinfold thickness was excluded from the model because of multicollinearity with the mid-arm muscle area, while weight did not predict grip strength in either gender. Conclusion: The handgrip strength in this study is less than that in western literature. Hence, test interpretation should reference the values from this study.

Leukocyte profile of adult Nigerian subjects with acute musculoskeletal trauma.

BACKGROUND: Leukocyte levels are evidently useful in trauma assessment, prognostication and management. Leukocytosis is a known physiologic response to trauma but suggested to be absent among Africans origin. The aim of present study is to investigate the existence of leukocytosis among adult Nigerians who sustain acute musculoskeletal trauma, S and also assess its prognostic value in management. METHODS: A calculated sample size of 223 subjects participated following informed consent while 50 apparently healthy adult Nigerian volunteers served as control. Data obtained included age, sex, duration of hospitalization and leukocyte counts using improved Neuabauer chamber while differential count was done on stained thin film. RESULTS: Analyzed results expressed as mean +/- SDM show significant male dominance (p < 0.05) among the acutely traumatized subjects with majority (70%) aged between 20 and 49 years. The mean total white blood cell count was 8184.96 +/- 201.087 cells/m3, significantly higher than mean for the control group (4922.00 + 1282.264 cells/mm3) at p < 0.05. The mean values for neutrophil and lymphocytes also show significant neutrophilia and lymphocytopaenia among the test population (p < 0.05). Pearson's correlation test for duration of hospitalization was positive for higher levels of total White Blood Cell count, with strong positive correlation between the levels of neutrophil and total White Blood Cell count suggesting the source of the observed leukocytosis. CONCLUSION: Thus adult Nigerians exhibit posttraumatic neutrophilic leukocytosis contrary to some widely accepted postulations. The post-traumatic neutrophilia exhibit an inverse relationship with observed lymphocytopaenia. This can be expressed as a ratio called Neutrophil Lymphocyte Stress Factor (NLSF) and used in trauma management and prognosis determination.

Above-elbow amputation and death following human bite mismanaged by quacks: a case report and review of literature.

BACKGROUND: Human bite is a common injury sustained during a fight, love passion, self mutilation, cannibalism or vampirism. Although widely reported as being more dangerous than animal bites, such complications as limb amputation from gangrene and eventually death is either uncommon or scarcely reported in our environment. OBJECTIVE: To highlight the dangers of human bite as a potential cause of severe morbidity and mortality especially when poorly managed. METHODOLOGY: A 30 year old Fulani herdsman with gangrene of the right hand, and distal forearm presenting in coma 10 days after sustaining human bite is presented and relevant related literature reviewed. CASE REPORT: M.U. is a 30 year old Fulani herdsman who presented to us at the accident and emergency unit with 10 days history of human bite to the first web space of the right hand, 5 days history of gangrenous hand and distal foreman, and 2 days history of loss of consciousness. The injury was inflicted by a fellow herdsman during a fight. He then commenced treatment with a patent medicine dealer. A few days later the hand became swollen with associated severe pains, serous discharge and subsequent darkish discoloration, frank pus exudates and loss of hand function. Two days prior to presentation, he lapsed into unconsciousness after complaining of severe weakness and fever. Following his presentation, clinical examination and investigation, he was offered a below elbow guillotine amputation. However by the next day, he deteriorated with GCS of 5/15 and subsequently died after 24 hours of presentation. CONCLUSION: Human bite can be a cause of severe morbidity and mortality. Treatment by quacks should be discouraged while early presentation, surgical debridement and delayed wound closure should be emphasized along with other surgical principles.

Austin-moore hemiarthroplasty; the Enugu experience.

BACKGROUND: Femoral neck fracture is the commonest fracture among the elderly who frequently have co-morbid medical conditions. It commonly follows trivial falls at home. Prosthetic replacement with Austin Moore prothesis is one of the treatment options open to Orthopaedic Surgeons in this age group who need to be mobilised as early as possible to prevent the complications of prolonged immobilization. This study shows our experience with Austin Moore hemiarthroplasty [AMH] as a treatment option for femoral neck fractures over a 10 year period. METHOD: Hospital records of 46 out of 59 patients who had AMH in NOHE between 1995-2004 (10 year period) were reviewed retrospectively. The 13 patients who had incomplete records were excluded. RESULTS: The age range of the patients was 26-99 yrs with 67:2 yrs as the mean. There was a slight female to male preponderance [F:M = 1.1:1]. Most of the patients clustered between 61 and 80yrs. Majority presented late [76%], with only 2 patients presenting within 24hrs of injury. Fracture neck of femur was the commonest indication for AMH [89.1%] with domestic falls and RTA having 54.3% & 32% respectively as aetiological factors. Hypertension was the most prevalent co morbid medical condition [76%]. Majority of the patients had preoperative traction, 58% (skin: 32.6%, skeletal 26.1%) while general anaethesia was used in 63% of patients. Blood transfusion was common; 87.1. 58.7% of patients were mobilized within 2-3 wks of operation while 26.9% were delayed for more than 3 wks. 2 patients [4.3%] died while on admission. 76.1% were mobilized initially on Zimmer frames, 13.0% on crutches, 6.5% on wheel chair. 80% were able to walk with walking stick[cane] in 6 weeks while 87% achieved this in 12 weeks. Follow up time of patients was poor as patients default frequently after few visits. Wound infection was the commonest complication 26.1%, mostly treated by dressing and antibiotics. 13.0% were hospitalized for 2-3 weeks, 36%-4-6 wks while 50% stayed beyond 6 wks. Mortality rate was 4.3% [2].