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.

Morphometric study of post menarcheal nulliparous breasts, their clinical relevance and relationship with body size indicators in a Nigerian population.

Background: The female breast is a symbol of femininity and aesthetics having a great psychosocial impact on the woman's sense of wellbeing and self-esteem. To optimize satisfaction of patients in cosmetic and reconstructive breast surgeries, there is a need to define the dominant breast size and shape that connotes feminine attractiveness. This necessitates the knowledge of ideal data for normal nulliparous female breast parameters and volume for various body sizes in the particular population, nationality, and race. Aim: To establish reference data for normal breast parameters and volumes for the various body sizes amongst the Nigerian population and to determine their relationships with other body parameters. Patients and Methods: A total of 528 breasts from 264 Nigerian undergraduate post-menarcheal nulliparous students of the University of Nigeria Enugu Campus aged between 17 and 29 years were measured. Thirty-one (31) anthropomorphic parameters and five body size anthropometric indicators were measured. Data obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 21(IBM) and were summarized using various descriptive statistics tools. Results: The mean nipple-nipple distance is 23.37 ± 3.10. The mean left Midclavicle-nipple Length (22.17 ± 3.5 cm) is significantly (P = 0.04) higher than the right (21.79 ± 3.3 cm) just as the mean left (12.60 ± 2.5) medial radius is significantly (P = 0.0001) longer than the right (12.45 ± 2.4 cm). The mean left nipple projection (0.37 ±0.2 cm) and left vertical surface dimension (32.27 ± 5.7 cm) are significantly (P > 0.05) longer than the right (0.33 ±0.2) and (31.76 ± 5.2 cm). Also the mean volume for the left breast (605.26 ± 280.52 cm) is significantly (0.0001) higher than that of the right breast (592.53 ± 278.69). Breast volume correlated well with most of the breast parameters, BMI, and other anthropometric variables. Most breasts were ptotic (51%, 55%), especially the left breasts. Breast dimensions were asymmetrical in >50% of subjects, where the left breasts were seen to have slightly greater breast dimensions than right. Conclusion: Breast values and related body size parameters were noted to be comparatively higher than earlier reported values mostly for the Asian population.

Proximal femoral geometry analysis of igbos of South East Nigeria and its clinical application in total hip replacement and hip surgeries: A dry bone study.

BACKGROUND: Proximal femoral geometry(PFG) plays a role in the biomechanics of the hip. During total hip replacement detailed efforts are made to restore this biomechanics in other to ensure patients satisfaction and implant survival. There are variations in these parameters. Ethnicity is one of the most influential factors accounting for these variations. AIM: To determine the values of the parameters of the proximal femoral geometry among the ethnic Igbos of the South Eastern Nigeria, determine any correlation between these parameters, and compare these values with known populations as well as discuss the clinical application in total hip replacement and other hip surgeries. Materials and Method: Seven hundred and sixteen (716) femoral bones taken from the osteology unit of department of anatomy of University of Nigeria Enugu Campus (UNEC) were screened and proximal femoral parameters measured using Vernier calipers. Results: There were 356 right and 360 left femoral bones with the following values: Femoral Neck Anteversion Angle (FNAVA): M=19.04°, SD=2.075°, Proximal Femoral Length(PFL): M=73.24mm,SD=7.622, Femoral Head Vertical Diameter(FHVD):M= 44.64mm, SD=3.134, Femoral Head Transverse Diameter(FHTD),M=44.55mm, SD=3.379mm, Femoral Head Diameter(FHD),M=44.60mm, SD=3.119mm, Femoral Neck Anterior Length(FNAL), M=31.86mm, SD=5.383mm, Femoral Posterior Neck Length(FPNL):M=22.23mm, SD=3.520mm, Femoral Neck Diameter (FND), M=32.71mm,SD= 3.315mm, Proximal Femoral Width Head to Side (PFWHS), M=89mm.80,SD= 10.331mm, Proximal Femoral Width Side to Side (PFWSS), M=31.47mm, SD=2.812mm, Femoral Neck Shaft Angle(FNSA), M=132.15°, 7.305°. CONCLUSION: The parameters of the proximal femoral geometry of the ethnic Igbos of the South East of Nigeria, differed from other populations and exhibited laterality.

The morphometric analysis of the male cadaveric native knees of the ethnic igbos of South East Nigeria and its implication in total knee replacement.

BACKGROUND: In spite of its consideration as a very successful procedure nearly all total knee replacement (TKR) prostheses were designed based on the parameters of male 4,Western, and primarily white native knees. Mismatch between prosthesis and bone surface or malposition can lead to poor outcome of TKR. AIM: To determine the parameters of the native knee of the ethnic Igbos of South East Nigeria, determine any correlations amongst them ,compare the values with that of other populations and discuss its implication in total knee replacement. MATERIALS AND METHOD: The study was carried out on male adult cadavers with normal knees found at the museum of the Department of Anatomy University of Nigeria and all cadavers whose knees were deformed or had any pathological condition were excluded from the study. There were 60 knees from 30 male cadavers. Measurements were taken independently from the distal femur and proximal tibia with a method with the aid of a Vernier sliding calipers. RESULTS: The determined values of the parameters of the cadaveric knees in centimeters are as follows: FLAP: M=7.10,SD=.44, FMAP: M=6.83,SD=.42, FML:M=7.78,SD=.40, FAR: M=1.10,SD=.06, TLAP:M=4.65,SD=.23, TMAP:M=5.17,SD=.27, TML: M=7.88,SD=.29, TAR:M=1.53. SD=.06. CONCLUSION: The normal values of the knee parameters of the native knee of the ethnic Igbos of the South Eastern Nigeria has been established and these should be taken into consideration by medical engineers during component design and arthroplasty surgeon during total knee replacement. There are correlations between these parameters that could be useful as a decision making tool during TKR and finally, the differences between these parameters and that of ethnic Western and Asian populations should be noted by implant manufacturers and arthroplasty surgeons.

Geometrical Analysis of the Proximal Femur and the Clinical Application in Total Hip Replacement: A Study of the Igbo Population of South East Nigeria.

BACKGROUND: Adult hip reconstruction following trauma and hip pathologies depends on a sound knowledge of the proximal femoral geometry (PFG), which varies from one ethnic population to another. AIM: The aim of the study, therefore, was to evaluate parameters of the proximal femoral geometry in Igbos of South Eastern Nigeria. METHODOLOGY: A 5-year review of normal X-rays of the pelvis showing both hips of patients' age 18-64 between 1 January 2012 to 31 December 2016 at Radiology Department of University of Nigeria Teaching Hospital Enugu was done. RESULTS: There were 554 patients, 273 (49.3%) males and 281 (50.7%) females. The values of the head width established in this study showed there was a mean difference between the right and left proximal femurs, which was statistically significant (P < 0.05). There was statistical significant difference (P < 0.05) between the means of the parameters of the proximal femoral geometry when compared between gender, the only exception being the left medial cortical thicknes, which did not show any difference (P > 0.05). A comparison of means of PFG parameters of the Igbos and that of the Turkish population showed that there was statistically significant difference on both sides. CONCLUSION: Our study demonstrated that there was no difference in the means of both sides of femoral neck width and the intertrochanteric width of the left side. The correlations between PFG parameters showed that there was strong positive correlation that was significant apart from the right acetabular angle that did not correlate with other parameters.

The morphology of proximal tibia geometry amongst the Igbos of South East Nigeria and its implication in total knee replacement.

BACKGROUND: The morphological parameters of the proximal tibia play a major role in total knee replacement and there are ethnic and gender variations to these parameters. AIM: To evaluate parameters of the proximal tibia geometry amongst the Igbos of South Eastern Nigeria and discuss the clinical implications in total knee replacement. METHODS: The proximal tibia parameters of 558 adult tibiae bones, 300 right-sided and 258 left-sided, collected from the osteological unit of the department of anatomy University of Nigeria Enugu campus were measured using a Venier calipers. RESULTS: The values of the determined parameters are as follows: anterior posterior dimension (APD): 5.50 cm, medial lateral dimension (MLD):7.53 ± 5.56 cm, proximal length (PL): 7.32 ± 0.67 cm, proximal width (PW) CM: 4.10 ± 0.30 cm, medial tibia posterior slope (MTPS):11.36 ± 4.15° and lateral tibia posterior slope (LTPS):5.65 ± 2.72°. The correlation test between these parameters of the proximal tibia shows a strong significant correlation between LPTS and MPTS (r =0.814, P < .001). The comparison of the means of the MPTS of both sides using independent samples t test shows a mean difference that is not significant (p =0.628). A comparison of the values with other populations shows significant mean difference for MLD with that of Chinese and American populations (p < .05). The mean difference between the APD of this study and the Chinese is significant (p =0.007). A comparison of MPTS and LPTS for Malaysian, Chinese, and white Americans shows a significance difference for all the three populations (p <.05). CONCLUSION: These determined values should be taken into consideration during tibia surface coverage in total knee replacement amongst the Igbo population.

Acetabular reconstruction using a cage in complex primary total hip replacement in a developing country: An assessment of early functional outcome.

BACKGROUND: Acetabular reconstruction following bone loss is a major challenge facing the arthroplasty surgeon. Traditionally, the armamentarium for the treatment of large bone defects (Paprosky Type 2C or 3) included antiprotrusio cages (APC). The aim of this study is to determine the pattern of presentation and assess the early functional outcome of patients who had undergone acetabular reconstruction using APC in complex primary total hip replacement (THR). PATIENTS AND METHOD: Between November 2008 and November 2015, 38 THR were carried out in 35 patients who required acetabular reconstruction, at Davidson and Judith Consultants Clinics Enugu, Nigeria. RESULTS: There were 25 males and 10 females, with a ratio of 2.5:1. The average age of the patients was 61.33 ± 6.92 with a range of 56 to 72. The mean pre-op Harris score was 49.02 ± 2.3.The mean post-op Harris hip score (HSS) was 88.75 ± 10 (P < 0.001) at one year and 92.25 ± 13 (P < 0.001) at 5 years. The etiology showed that most (52.63%) of our patients had primary osteoarthritis with Type 3 acetabular defect. Two (5.26%) patients had the following complications: dislocation (2.63%) and screw breakage (2.63%). The minimum follow-up period was 5 years. DISCUSSION: After follow-up at 1 year and 5 years, the hips showed significant improvement concerning pain, gait, and mobility based on HHS and were able to return to their various professions. CONCLUSION: APC provides a satisfactory solution for patients who present with acetabular deficiency in complex primary THR.

Total knee replacement in Nigeria: An assessment of early functional outcome of 68 consecutive knees.

BACKGROUND: Although there are many methods of treatment for knee osteoarthritis (OA), total knee replacement (TKR) is a very effective way of managing this condition as it improves function and alleviates pain with a consequential improvement on quality of life of patients. To our knowledge, no comprehensive study of the outcome of TKR has been published in our environment, hence the need for a study of our TKR outcomes. OBJECTIVES: The aim of this study is to describe the pattern of presentations of our patients with knee OA who have undergone TKR, assess the outcome, and identify any variables that affect the outcome. PATIENTS AND METHOD: Between November 2008 and November 2013, 68 TKRs for treatment of end stage arthritis were carried out for 52 patients. All the patients were implanted with the same prosthesis design (DePuy and Biomet) and had posterior cruciate substituting knee. The average follow-up was 5 years. The preoperative and postoperative Oxford knee score (OKS) was used for outcome measurement at 1 and 5 years. RESULTS: There were 20 males and 32 females (M:F ratio = 5:8). The mean age of the patients was 63.54 ± 0.62 with a range of 55 to 77. There were 18 (26.47%) valgus knees with a mean angle 22.07° ± 5.73°, 12 (17.65%) varus knees with a mean angle 14.69° ± 2.84°, 8 (11.77%) knees with flexion deformity with a mean angle of 10.2° ± 1.32°, and 30 (44.11%) knees had no deformities at all. The variables like deformities, comorbidities, gender, side-affect, and occupation did not affect the outcome (P > 0.05). At 1 year and 5 years, there was no radiological evidence of osteolysis, loosening, or component subsidence. CONCLUSION: Despite the deformities and comorbidities, our patients presented with quality of life improved based on the improved OKS of the patient. We recommend a well-planned meticulously executed TKR for patients with debilitating OA in our environment.

Total hip replacement in sickle cell disorder: A preliminary report of challenges and early outcome of 21 consecutive patients.

OBJECTIVE: The aim of this study is to describe the pattern of presentation osteoarthritic patients with sickle cell disorder (SCD) in our environment, determine the implant sizes taking the peculiar nature of the pathology and our operating environment into consideration, highlight the challenges and technical difficulties encountered during the procedure, measure the functional outcome and observe complications of treatment, recommend ways of improving outcome. PATIENTS AND METHODS: Between November 2008 and November 2012, 29 consecutive primary total hip replacements (THRs) were performed on 21 patients with avascular necrosis of the head of femur secondary to SCD. Patients' evaluation was performed at two different times of follow-up (1 and 5 years, respectively). RESULTS: Twenty-one patients were available at 1 year as well as 5-year follow-up. The mean preoperative Harris Hip Score was 20.17 ± 11. The mean postoperative Harris Hip Score was 92.25 ± 13 (P < 0.001) at 1 year and 88.75 ± 10 (P < 0.001) at 5 years. Eighteen patients had regional anesthesia while three had general anesthesia. The average cup size used was 49.43 with a range of 46-54. The average liner size was 49.43 with a range of 46-54. The head size used in all patients was 28. The average stem size was 6.57 with a range of 6-8. The offset used in all the patients was standard All the patients had 1-2 screw fixation of the acetabular shell. Four patients had complications as follows: periprosthetic fracture 1, superficial wound infection 1, pulmonary complication 1, and abdominal crisis 1. CONCLUSION:: THR is a veritable means of treatment of patients with avascular necrosis of the femoral head arising from SCDs. The challenges encountered during the surgery are related to the quality of bone of the affected patient. Arthroplasty Surgeons in our environment must be fully prepared for the challenges by ensuring a preoperative plan that will take care of the technical problems such as recreating femoral canals, wiring of intraoperative fractures as well as treatment of acetabular defects. A detailed planned total hip arthroplasty can be performed in patients with SCD in younger patients with good clinical benefits.

Implant associated surgical site infection in orthopaedics: a regional hospital experience.

BACKGROUND: Post operative surgical site infection following implant surgery is a major problem in orthopedic surgical practice. Infection occurring after internal fixation of a fracture is a devastating complication and may be difficult to treat. The frequency of occurrence of surgical site infection has decreased with improvements in aseptic technique. The objectives of the study are to determine the incidence of surgical site infection following orthopaedic related implant surgeries and to indentify the predisposing factors. METHODS: The study was a prospective study conducted at the National orthopedic hospital, Enugu. Wound surveillance was carried out for the 97 patients included in this study for a period of 6 months postoperatively. The diagnosis of surgical site infection was in accordance with the CDC's guideline for prevention of surgical site infection published in 1999. RESULTS: The study included 61 males and 36 females giving a ratio of 1.7:1. The study population was aged 7 to 83 years with a mean age of 38.7 +/- 18.3 years. The infection rate was found to be 9.3% with staphylococcus aureus as the most common causative organism in 55.6% of cases. Two of the nine infected cases required implant removal. Significant factor was a theatre population of more than 6 persons. CONCLUSION: Surgical site infection following implant surgery is relatively common in our environment with staphylococcus aureus as the major causative organism. Increased theatre populations increase the risk of implant associated surgical site infection.

Limb gangrene following treatment of limb injury by traditional bone setter (Tbs): a report of 15 consecutive cases.

UNLABELLED: This study is done to evaluate cases of limb gangrene resulting from treatment of limb injury by traditional bonesetter. METHOD: This is a prospective study in which patients with limb gangrene are evaluated as each presents. Data extracted for evaluation include history of having been to a traditional bonesetter, the original injury, type of treatment given by the traditional healer, progression of condition while on treatment and reason for not coming to orthodox orthopaedic centre ab initio for treatment. RESULTS: 15 cases were seen during the 5-year of study spanning June 1997 to May 2002. Upper limbs were involved in 4 cases while 11 involved the lower limbs. The original injuries were 3 cases of soft tissue injury to the joints, 7 closed fractures and 5 open fractures of type I and II. There was associated sepsis and toxemia in all except one. All the cases were treated by amputation. There were 4 deaths. CONCLUSION: Limb gangrene was not a justifiable end-result of treatment in all the cases judging by the nature of the original injury. Reasons for this end result were adduced. The need to avert unnecessary limb loss from mismanagement of limb injury by education of public in general and enlightenment of the traditional bonesetters of the harmful procedures in their practice is highlighted.

Outcome of a 12-week programme for management of the spinal cord injured with participation of patient's relations at Hilltop Orthopaedic Hospital, Enugu, Nigeria.

STUDY DESIGN: Description of 12-week programme of treatment. OBJECTIVES: In Enugu, Nigeria, not all spinal injured (SCI) can be treated in teaching and orthopaedic hospitals. The 12-week programme was developed with the aim of getting such patients back into society as useful and independent as possible, using the patients relations to complement the deficiency in personnel. SETTING: Enugu, Nigeria. METHODS: Staged weekly programmes of assessment and treatment were mapped out to end at the twelfth week. Spinal injured patients of less than 2 weeks duration were entered into these programmes as they presented. Outcome was assessed at the end of the twelfth week. The study lasted for 6 years (January 1996 to December 2000). RESULTS: Seventy-four patients were admitted into the study. Nine patients had incomplete cord injury of Frankel C while 65 had clinically complete injury of Frankel A on admission. Eight of the nine incomplete injuries improved to Frankel D and walked home within the 12-week programme. In the clinically complete group, eight died. Out of the 57 remaining, six recovered to Frankel D and walked home, while the remaining 51 who did not recover, 49 were conversant with wheelchair use within the 12-week programme. CONCLUSION: It is concluded that adoption of this programme would allow the spinal cord injured to get expert treatment within a reasonable time in less ideal hospital settings where man-power and skilled members of the spinal cord injury treatment team are lacking.