Plasma homocysteine, B vitamins and bone mineral density in osteoporosis: a possible risk for bone fracture.

BACKGROUND: Changes in plasma total homocysteine (tHcy) folic acid, vitamins B12 and B6 in individuals with osteoporosis are reported to impair collagen cross-linking and contribute to low bone mineral density (BMD). There is paucity of information on these associations in osteoporotic patients at risk of bone fractures in Nigeria. The study evaluated plasma tHcy, folic acid, vitamins B12 and B6, in relation to BMD in individuals with osteoporosis. METHODS: Fifty osteoporotic patients age 57.05 +/- 1.9 years were selected and fifty non osteoporotic volunteer's age 54.8 +/- 0.9 years were included as controls. The osteoporotic group consisted of 11 males and 39 females (1:3.5) while the controls consisted of 13 males and 37 females (1:2.8) respectively. Bone mineral density, anthropometric indices plasma tHcy, folic acid, vitamins B12 and B6, were determined using standard procedures. RESULTS: The results showed remarkably significant increase in plasma tHcy (p < 0.001) (180%) compared with the control value. Striking significant decreases were observed in folic acid (62%), vitamins B12 (42%), B6 (59%) and BMI p < 0.001) compared with control values. Positive correlation was obtained between vitamin B12 and BMD (r = 0.311, p < 0.05). CONCLUSION: Significant increase in tHcy with corresponding decreases in folic acid, vitamins B12 and B6 are related to decrease in BMD in osteoporotic patients. These changes could be important risk factors for bone fracture in osteoporotic Nigerians. Supplementation with the B vitamins may be beneficial to the patients.

Orthopaedic anaesthesia for upper extremity procedures in a Nigerian hospital.

BACKGROUND: General anaesthesia and regional anaesthesia have been used successfully for upper extremity orthopaedic procedures. Despite the advantages of regional anaesthesia, there is low utilisation in Nigeria. In this study, we assessed the types of anaesthesia employed for upper extremity surgeries in our centre. METHODS: After obtaining approval from the institutional ethics committee, all the patients who had upper extremity surgeries from 1 January 2011 to 31 December 2012 were included in this review. Both prospective and retrospective data were gathered. The choice of anaesthesia was at the discretion of the attending anaesthetist. RESULTS: A total of 226 patients with a male-to-female ratio of 1.6:1 and median age of 35.0 (range 2 - 89) years, had orthopaedic upper extremity procedures during the study period. Sixty-three cases (27.9%) had general anaesthesia, 5 (2.2%) combined regional and general anaesthesia while 158 (69.9%) had regional blocks. The regional blocks comprised 145 (89%) different approaches to the brachial plexus and 18 (11%) local anaesthetic infiltrations. The arm was the site mostly operated upon; while supraclavicular and axillary brachial plexus blocks were performed in equal amounts. In 14 (6.2%) patients, brachial plexus blocks were performed with spinal anaesthesia because of concomitant iliac crest bone grafts. While the duration of surgery did not differ significantly, regional anaesthesia provided a significantly longer duration of anaesthesia than general anaesthesia (251 ± 70.8 min versus 141.3 ± 65.5 min; p = 0.0000001). CONCLUSION: There is a high use of regional anaesthesia for upper extremity orthopaedic surgeries in our centre, which is a positive development in a resource limited setting.

Predisposing factors and outcome of treatment of non-union of long-bone fractures in Ibadan, Nigeria.

AIMS AND OBJECTIVES: This study was done to find out factors that contribute to development of Non-union of long bone fractures in this environment and the outcome of operative intervention. This is a prospective hospital based study. PATIENTS AND METHODS: All patients with Non-union of long bone fracture that presented in the hospital since January 1997 were recruited into the study. The data included causative factors, treatment given before presenting in the hospital, type of surgical procedure and result of treatment. The study was completed in December, 2005. RESULTS: 78 patients presented with 87 Non-union of long bones. A male, female ratio of 1.6:1 was encountered while 69.2 per cent of the patients were below the age 55years. Road Traffic Accident accounted for 68 fractures (78.2 per cent) while duration of injury before presentation varies from 6 months to 22 months. Atrophic non-union occurred in 60 cases (69.0 per cent) and hypertrophic non-union in 21 cases. Non-union of the femur occurred in 33 cases (37.9 per cent) humerus in 24 cases (27.6 per cent), tibia in 16 cases (18.4 per cent), radius and ulna in 14 cases (16.1 per cent). The initial treatments of the fresh fracture in the 78 patients with nonunion were by the traditional bonesetters in 51 patients (65.4 per cent) while the remaining fractures were treated by plaster of paris in hospital. Open reduction and internal fixation using plate and screws with bone grafting was the most common procedure for treating the non-union in most cases. Union was achieved in the entire patients following surgical intervention. CONCLUSION: Important factor that appears to contribute to non-union of long bone in this environment is soft tissue interposition between the fracture ends of the bone, which is found in all fractures with more than one diameter displacement. Another factor is interference with periosteal blood supply from disruption of soft tissue envelope as a result of high energy injuries which is also responsible for the displacements that were observed in these fractures. The treatment by traditional bone setters which entails daily massage of the fracture creating a macro movement at the fracture site is also an important contributing factor.

Traditional bonesetters in south western Nigeria--friends or foes?

OBJECTIVE: To highlight the dangers inherent in the practice of traditional bone setting in south western Nigeria as evidenced by the preventable complications that accompany treatment of fractures, joint dislocations and limb deformities by traditional bonesetters (TBS). METHOD: Twenty-five consecutive patients with fractures, dislocations and limb deformities who had been previously managed by TBS and who subsequently presented to the University College Hospital, Ibadan (on account of complications from treatment at the TBS) between 15 October 1999 and 31st March 2000 were evaluated. RESULT: Fourteen patients had fracture non-union or malunion necessitating open reduction and internal fixation. Two patients with wet gangrene of the extremities had amputations. CONCLUSION: Traditional bone setting is an ancient trade practiced in Nigeria and most developing countries without government regulations and they lack guidance. The complications that accompany these practices are unacceptable and it is imperative that there should be legislation to curb their activities and save the unsuspecting public from further harm or even death.

The complications seen from the treatment by traditional bonesetters.

Traditional bone setters are rampant in the West African subregion but the atrocities committed by them have never been reported hence the need for this article that deals with the menace caused by them. All patients referred to the University College Hospital between 1996 and 2001 were included in this study. Only a few number of the patients have been selected just to illustrate the menace caused by the traditional bonesetters in so many African societies. The deformities, financial loss and amputations resulting from the management by traditional bonesetters have been highlighted. Suggestions are made on how to improve awareness in the way of adequate communications through televisions, radio and the press. Much need to be done in the society as it was found in the study that poverty or lack of education alone is not the major cause of the society seeking the help of the traditional healers, but probably the culture and traditional beliefs of the society.

Intra-operative antibiotic bead maker--point of technique.

Chronic osteomyelitis is a disease of soft tissue and bone and it is common in the developing countries. The management of this debilitating disease requires the delivery of the appropriate chemotherapeutic agent at the site of the infection after adequate debridement. The search for a suitable carrier for these chemotherapeutic agents is the advent of the 'septopal' or gentamycin-polymethylmethacrylate (gentamycin-PMMA) beads. Septopal beads are expensive and are not affordable by patients in the developing countries. Moreover, most of the micro-organisms (mixed flora) responsible for chronic osteomyelitis in our hospitals are sensitive to ceftriaxone and only in a few cases were gentamycin-sensitive micro-organisms isolated. Therefore, it was imperative that patient-specific and antibiotic-specific PMMA beads would be the way forward and this is the reasoning behind the production of the intra-operative antibiotic bead maker (IABM) and the point of technique is hereby presented.