Examining the adequacy of preoperative informed consent in a developing country: Challenges in the era of surgical specialisation.

Preoperative informed consent is a legal and ethical requirement that ensures patients understand a procedure, its associated risks and benefits, alternative treatment options, and potential complications to make an informed decision about their care. This cross-sectional study evaluated the informed consent process for major orthopaedic surgeries at a tertiary hospital in Nigeria. A self-administered questionnaire was used to collect data from 120 adult participants. Results showed that many patients do not read the consent form before signing it, and surgeons do not adequately explain the alternatives to surgery, potential risks, and available anaesthetic options. Higher-educated patients are more likely to read the consent form. Surgeons performed well in explaining the nature of the condition and prognosis, the procedure's potential benefits, and answering patients' questions. The study emphasises the need to improve the informed consent process to ensure patients understand and can make rational decisions about their healthcare.

Comparative prospective study of early outcomes after osteosynthesis with locked intramedullary nailing or plating for closed femoral shaft fractures at the National Orthopaedic Hospital Enugu, Nigeria.

AIM OF THE STUDY: This was to compare the early outcome of closed femoral shaft fractures treated with locked intramedullary nailing and plating at the National Orthopaedic Hospital Enugu. METHODS: The study was a prospective study over 12-month period at the National Orthopaedic Hospital Enugu. Ethical clearance was obtained from the hospital ethical committee. Written informed consent was obtained from all prospectively recruited participants. Patients who met the inclusion criteria were randomly selected by simple balloting into either intramedullary nailing group or plating group. The patients were evaluated at presentation and postoperatively within 48 hours, then at two weeks, six weeks, 12 weeks and 18 weeks, respectively. Participants were evaluated using Thoresen criteria. RESULTS: A total of 52 femoral shaft fractures in 50 patients were included and analysed using SPSS version 20.0. Bone union was obtained in all the patients in the intramedullary nailing group at 12 weeks and in 84.6% patients in the plating group between 12 and 18 weeks. The overall wound infection rate was 11.5% in the locked intramedullary group and 7.7% in the plating group. Similarly, the overall limb length discrepancy was 11.5% in the locked intramedullary nailing group and 19.2% in the plating group. Based on the Thoresen criteria, good to excellent outcome was achieved in 65.4% of patients in the locked intramedullary nailing group. DISCUSSION: The patients in both groups were evaluated clinically, radiologically and functionally based on the Thoresen criteria and significantly higher number of patients in the intramedullary nailing group (17; 65.4%) than the plating group had good to excellent outcome (x2 = 9.734; p = 0.020). CONCLUSION: The early outcome of treatment of closed femoral shaft fractures in adults is significantly better following locked intramedullary nailing than plating.

Early outcome after the use of the triceps fascia flap in interposition elbow arthroplasty: a novel method in the treatment of post-traumatic elbow stiffness.

BACKGROUND: Post-traumatic elbow stiffness (PTES) results in severe interference with the activities of daily living (ADL), affecting mainly young people. Total elbow arthroplasty (TEA) is relatively contraindicated in the young patient and arthrodesis is poorly tolerated. Interposition elbow arthroplasty (IEA) improves the range of motion (ROM) buying time for future reconstructive surgery. While the fascia lata remains the most common material used in IEA, the triceps fascia is a native vascularized tissue, and it does not require a separate incision to harvest. To our knowledge, there are no published studies on the use of this technique of IEA. METHOD: Sixteen patients with post-traumatic elbow stiffness had IEA with the triceps fascia between January 2009 and January 2017. The ROM was assessed pre-operatively and post-operatively at the 6th and the 24th week. The researchers also evaluated the functional outcome with the Mayo Elbow Performance Score (MEPS) at the 24th week. The data were analysed with the software IBM SPSS Version 20. RESULTS: Nine males and seven females had IEA with the triceps fascia. The mean age of the subjects was 22.8 years (SD = 6.39). The median duration of the stiffness was eight months (range: 2-168 months). Fall was the most frequent cause of post-traumatic elbow stiffness, and the non-dominant side was more frequently involved. Fourteen patients had an intervention at the native bone setters before presentation to the hospital. The mean elbow ROM increased from 16.4° pre-operatively to 97.2° at the 24th week (p < 0.001), while the mean MEPS improved from 42.5° pre-operatively to 81.2° post-operatively (p < 0.001). CONCLUSION: The triceps fascia flap provides an excellent alternative to the fascia lata for IEA without the complications of the donor site morbidity.

Pattern of bone tumours seen in a regional orthopaedic hospital in Nigeria.

BACKGROUND: Primary bone tumour is a challenge to Orthopaedic surgeons working in developing countries due to late presentation as a result of ignorance and poverty. This is further compounded by limited number of specialist personnel, diagnostic and therapeutic centres. Consequently, they are associated with high rate of morbidity and mortality, which can be reduced with early presentation. MATERIALS AND METHODS: This is a retrospective review of all histologically proven primary bone tumours seen at National Orthopaedic hospital Enugu, South east Nigeria, over a 6 year period. RESULTS: Sixty eight (68) cases met the study criteria and were reviewed. Male:Female ratio was 1.35:1, with a mean age of 22.8 years and peak frequency in the 11-20 years age range. A total of 28 (41.1%) were benign, 21 (30.9%) were malignant while 19 (27.9%) were tumour-like conditions. The commonest benign tumour was osteochondroma, accounting for 44.7% of non-malignant lesions, while fibrous dysplasia was the commonest tumour-like condition (23.4%). Primary malignant bone tumours accounted for 30.9% of all pathologies, with osteosarcoma (17) accounting for 80.1% of all malignant lesions. The commonest region affected is the leg i.e proximal tibia. Duration of symptoms before presentation ranged from 1 month to 12 years, with the commonest presenting complaint being a painless lump. CONCLUSION: Primary bone tumours is commonest in young males, usually benign and affecting the Tibia. Associated late presentation results in increased morbidity and mortality. Hence, efforts need to be geared towards public enlightenment in developing countries, to ensure early presentation, thereby reducing morbidity and mortality.