Indications and complications of major limb amputations in Kano, Nigeria.

OBJECTIVES: To determine the indications and complications of major limb amputations in a Nigerian hospital. DESIGN: A five-year retrospective descriptive study. SETTING: National Orthopaedic Hospital, Dala, Kano, Nigeria. PARTICIPANTS: Patients who had amputations above the wrist or ankle between January 2006 and December 2010. MAIN OUTCOME MEASURES: Indications, complications and mortality. RESULTS: There were 132 unilateral amputations. The patients were mostly males and below the age of 40. Lower limb amputations (74.2%) exceeded upper limb amputations (25.8%). The commonest indication was trauma (42.4%) followed by TBS gangrene (31.8%) and malignant tumours (12.9%). Wound infection, the commonest complication, occurred in patients who had identifiable predisposing factors. The 3 deaths that occurred were in patients who had had traditional bone setter intervention: 2 were due to septicaemia; 1, due to severe tetanus. CONCLUSION: Trauma and traditional bone setter gangrene were the commonest indications. Most of the amputations were avoidable. Institution of preventive measures is imperative. Paying attention to predisposing factors can reduce complications.

Fixation of ankle arthrodesis in a national orthopaedic hospital in Nigeria.

BACKGROUND: Internal fixation is currently preferred for ankle arthrodesis. There are, however, situations in which external fixation is a safer choice. This is a five-year retrospective study of ankle arthrodesis to assess the choice, technique and outcome of fixation methods used. METHODS: Case notes and radiographs of patients with complete records who had ankle arthrodesis between January 1st, 2004 and December 31st 2008 were reviewed. RESULTS: Twenty ankle arthrodeses in 20 patients were reviewed. External fixation, commonly with Charnley's device, was used in 95% of the arthrodeses. Initial alignment was lost in 62.5% of arthrodeses with Charnley's device without immediate short leg cast support. One tibiotalar arthrodesis done with a single screw had subtalarjoint penetration. Fusion and complication rates were 90% and 45% respectively. Foot and ankle oedema and pin-tract infection were the commonest complications. CONCLUSION: External fixation was more commonly used than internal fixation because most of the patients had altered bone anatomy, wounds, active infection, or osteopenia. Charnley's device was the most commonly used external fixator and incorporating it in a short leg cast immediately after operation might improve its rotatory stability. The use of image intensifier is recommended for the placement of two crossed tibiotalar screws to avoid subtalar penetration.