Complications of traditional bonesetting in contemporary fracture care in low- and middle-income countries: A systematic review.

OBJECTIVE: To provide an overview of the evidence on the prevalence and pattern of complications among patients treated by traditional bonesetting presenting for modern orthopaedic services in low- and middle-income countries (LMIC). METHODS: Systematic review following PRISMA guidelines. Articles were identified by searching PubMed, Embase, ScienceDirect, SCOPUS, and Web of Science using the keywords "fracture care", "traditional bonesetters" and "complications". Papers included for review were original articles set in an LMIC that directly reported the prevalence and pattern of musculoskeletal complications of traditional bonesetters' fracture treatment in LMIC settings. RESULTS: A total of 176 papers were screened for eligibility and 15 studies were finally included. Nine were prospective studies, six were retrospective studies. All were hospital-based, observational studies that investigated the outcomes of treatment of fractures by traditional bonesetters published between 1986 and 2018. In total, this review covers 1389 participants with 1470 complications of fracture treatment. CONCLUSION: Traditional bonesetting complications are associated with significant morbidity. However, traditional bonesetters have the potential to contribute positively to primary fracture care when they are trained.

Road traffic injuries in a Nigerian referral trauma center: Characteristics, correlates, and outcomes.

BACKGROUND: Globally, road traffic injuries (RTIs) are a leading cause of disability and trauma-related deaths. We aimed to describe the clinical and epidemiological characteristics and outcomes of RTIs in our environment to provide the evidence for effective control measures. METHODS: This was a 1-year retrospective study of all patients with RTIs treated at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria. RESULTS: Four hundred and twenty-one patients with 484 injuries were studied. The mean age of the patients was 34.4 ± 14.6 years, and the male-to-female ratio was 3.3:1. Most of the injuries occurred on intercity roads/highways (48.7%) and involved motorcycle crashes (31%). Soft-tissue injuries (27.7%) and fractures (21.9%) were the most common types of injuries. The lower extremities were the most common sites of injury. The mean injury-arrival interval was 23.2 ± 2.4 h. The injury severity score (ISS) ranged from 1 to 50, with a mean of 9.2 ± 2.9. The 1-year mortality rate was 10.7%. Traumatic brain injury, open vehicular injuries, and increased ISS were the potential risk factors for mortality. CONCLUSION: Soft-tissue injuries and fractures were the most common types of injuries. The majority of the injuries occurred on the inter-city roads and highways and involved head-on-collisions with motorcycles. The young male adults were the most commonly affected age group.

Adaptation of the driver behaviour questionnaire and behavioural risk factors for traffic violation arrest and self-reported crash involvement among Nigerian drivers.

CONTEXT: Few studies have been conducted to investigate the driving behaviour of drivers in Africa. AIMS: This study aims to determine the behavioural risk factors for road crashes among Nigerian drivers. SETTINGS AND DESIGN: This is a case-control study. Cases were drivers who were booked for traffic violation or who had been involved in road crashes in the past, while the controls were drivers with no such histories. SUBJECTS AND METHODS: Both the cases and controls were administered the Driver Behaviour Questionnaire (DBQ). Principal component analysis with varimax rotation was run to examine the factor structure of the scale. Cronbach's alpha was used for assessing the internal consistency of the DBQ, and logistic regression was used to determine risk factors for crash involvement. RESULTS: Six hundred active drivers consisting of 300 cases and 300 controls were selected. The mean scores of all DBQ items, except one, were significantly higher among booked drivers compared to those who had never been booked. Consistent with many previous studies, factor analysis identified three factors in the DBQ (aggressive violation, ordinary violation and error). However, the factors were constructed differently with most ordinary violation items in the original DBQ loading as aggressive violation in the present study. Eight variables were predictive of being booked for traffic offences while only five variables were predictive of self-reported crash involvement. CONCLUSIONS: The most important variable associated with previous crash involvement was alcohol use. A major policy implication of this is the need for better attention to anti-drunk driving measures.

Epidemiology and pattern of paediatric injuries in a developing country: an analysis of 170 injuries.

BACKGROUND: Paediatric injuries have significant physical, psychological and socioeconomic consequences. This study aimed to determine the epidemiology and pattern of paediatric injuries presenting at a teaching hospital in Enugu South-East Nigeria. METHODS: A retrospective study of injured patients less than 18 years who presented to the Accident and Emergency department of University of Nigeria Teaching Hospital Ituku/Ozalla, in Enugu Nigeria, was conducted from 1st January to 31st December 2015. Analysis of data was done using Statistical Package for the Social Sciences version 22.0. RESULTS: A total of 1191 children presented to the hospital within the study period and 120 injured paediatric patients (10.1%) with 170 injuries were attended to in the A & E. Adolescents (12 - 17 years) accounted for 34.2% of injuries and males (70%) were more affected than the females. Road traffic crashes and falls were the most common causes of paediatric injuries. There was a significant correlation between age of the children and the aetiology of the injuries (X2 = 28.08, p = 0.001). Bruises/lacerations/abrasions (27.6%) and fractures (27.1%) were the most common types of injuries sustained. The injury severity score (ISS) of the patients ranged from 1-25 with a mean of 6.4 + 2.8. Roadside/street (35%), school (23.3%) and home (21.7%) were the main locations where injuries occurred. Mean injury-arrival interval was 1.2 + 0.7 days. Majority (67.5%) of children had full recovery and the mortality rate was 5.8%. CONCLUSION: Road traffic crashes and falls were the most common cause of paediatric injuries. Soft tissue trauma and fractures were the predominant types of injuries. Roadside, school and home were the leading locations of childhood injuries. Prevention of road traffic crashes and falls, prompt treatment of injuries, and rehabilitation of injured children will reduce the negative impact of paediatric injuries.

Mortality Pattern of Hospitalized Surgical Patients in a Nigerian Tertiary Hospital.

There is paucity of reports describing the pattern of surgical mortality in Nigeria. The aim of this study was to determine the incidence and pattern of mortality associated with surgical care in our hospital and to identify areas of improvement. The records of all patients who died after admission for surgical care at the Federal Medical Centre Makurdi between January 2009 and December 2011 were studied retrospectively. Data extracted were patients' demographics, surgical diagnosis, co-morbidity, surgical procedures performed, duration of hospital admission and outcome of treatment. Data were analyzed with SPSS version 17. There were 2,273 admissions into the surgical wards within the study period. During this period, there were 151 deaths with a crude mortality rate of 6.6 %. Ninety-four (62.3 %) patients were males and 57 (37.7 %) were females (M:F = 1.6:1). The age of the patients ranged from 8 days to 95 years with a mean age of 36.1 ± 20.1 years. Acute abdomen (37, 24.5 %), traumatic brain injury (32, 21.2 %) and malignancy (28, 18.5 %) were the commonest surgical diagnosis. Trauma-related deaths accounted for 48 (31.8 %) of all the deaths. Road traffic crash (89.6 %) was the commonest cause of injury. Surgical operations were performed in 75 (49.7 %) of the patients who died, while 76 (50.3 %) did not have any operative intervention. Mortality in patients admitted into the surgical ward was 6.6 %. Trauma-related death was the commonest. Traumatic brain injury, typhoid perforation of the bowel and malignancy were the leading causes of surgical death in our centre.