Non-operative treatment of neglected bilateral posterior four-part fracture- dislocation of the shoulders--a case report.

BACKGROUND: Bilateral posterior dislocation of the shoulders is rare and may result from a seizure. A 48 year-old HIV-positive man who presented eight weeks after bilateral posterior shoulder dislocation and bilateral fractures of the surgical necks of both humeri is reviewed. He was treated with an algesics and physiotherapy and was able to return to work after 9 months. CONCLUSION: The rarity of this lesion, its late presentation, the importance of a high index of suspicion in making the diagnosis and the fair outcome of non-operative treatment informed this report.

Removal of orthopaedic implants from patients at the University College Hospital, Ibadan.

BACKGROUND: Removal of orthopaedic implants is often done after complete healing of fractures. Orthopaedic implants are removed for a variety of reasons such as patients' request after fracture union, implant failure and other complications arising from the use of implants. AIMS AND OBJECTIVES: To determine the indications and complications of removal of orthopaedic implants in our hospital. METHODS: A retrospective study of medical records of all patients who underwent removal of orthopaedic implants used for fracture fixation at a Nigeria teaching hospital during the five year period between 2007 and 2011. Information about age, sex, indications for fracture fixation, indications for removal of implant, types of implants removed, complications of implant removal and its treatment were studied. RESULTS: Thirty patients whose orthopaedic implants had been in place for a mean duration of 12 months before removal were included in the study. 80% of the implants were removed from the femur. Implant failure is the commonest indication for implant removal accounting for 60% of cases. CONCLUSION: Healed fractures and implant failure are the commonest indications for removal of orthopaedic implants in our centre. Implant removal should be advocated when they have failed or become symptomatic. However, appropriate patient selection and adequate surgical technique should be employed to achieve satisfactory outcome.

Ponseti clubfoot management: changing surgical trends in Nigeria.

BACKGROUND: Congenital clubfoot treatment continues to be controversial particularly in a resource-constrained country. Comparative evaluation of clubfoot surgery with Ponseti methods has not been reported in West Africa. OBJECTIVES: To determine the effects of Ponseti techniques on clubfoot surgery frequency and patterns in Nigeria. METHODS: This was a prospective hospital-based intention-to-treat comparative study of clubfoot managed with Ponseti methods (PCG) and extensive soft tissue surgery (NPCG). The first step was a nonselective double-blind randomization of clubfoot patients into two groups using Excel software in a university teaching hospital setting. The control group was the NPCG patients. The patients' parents gave informed consent, and the medical research and ethics board approved the study protocol. Biodata was gathered, clubfoot patterns were analyzed, Dimeglio-Bensahel scoring was done, the number of casts applied was tallied, and patterns of surgeries were documented. The cost of care, recurrence and outcomes were evaluated. Kruskal-Wallis analysis and Mann-Whitney U technique were used, and an alpha error of < 0.05 at a CI of 95% were taken to be significant. RESULTS: We randomized 153 clubfeet (in 105 clubfoot patients) into two treatment groups. Fifty NPCG patients (36.2%) underwent manipulation and extensive soft tissue surgery and 55 PCG patients (39.9%) were treated with Ponseti methods. Fifty-two patients of the Ponseti group had no form of surgery (94.5% vs. 32%, p<0.000). Extensive soft tissue surgery was indicated in 17 (34.0%) of the NPCG group, representing 8.9% of the total of 191 major orthopaedic surgeries within the study period. Thirty-five patients (70.0%) from the NPCG group required more than six casts compared to thirteen patients (23.6%) of the PCG (p<0.000). The mean care cost was high within the NPCG when compared to the Ponseti group (48% vs. 14.5%, p<0.000). The Ponseti-treated group had fewer treatment complications (p<0.003), a lower recurrence rate (p<0.000) and satisfactory early outcome (p<0.000). CONCLUSION: Major clubfoot surgery was not commonly indicated among patients treated with the Ponseti method. The Ponseti clubfoot technique has reduced total care costs, cast utilization, clubfoot surgery frequency and has also changed the patterns of surgery performed for clubfoot in Nigeria.

Factors influencing the outcome of elective paediatric orthopaedic operations in Ile-Ife, Nigeria.

There is a paucity of published data on the types of paediatric orthopaedic conditions that require surgery and factors influencing their outcome in most parts of Sub-Saharan Africa. This is a necessary audit to improve paediatric orthopaedic practice. We carried out an audit of all elective orthopaedic operations performed in children at Awolowo University Teaching Hospitals Complex in Ile-Ife, Nigeria from January 2000 through December 2005. The aim was to document the clinical outcomes and the factors that influence them. This is with a view to instituting necessary measures to improve paediatric orthopaedic practice in the area. A total of 146 children who had elective operations on 210 limbs were included in the study. Their mean age was 75.6 +/- 66.8 months (range 0.3-396 months). The commonest indications for surgery were angular knee deformities (from Blount's disease and rickets) and club foot. The mean hospital stay before surgery was 12 +/- 8.8 days (range 1-38 days). The mean duration of operation was 78.4 +/- 36 min. (range 30-195 min). The total length of hospitalization was 34.97 +/- 19.91 days in males and 41.97 +/- 25.15 days in females. Wound infection was the commonest postoperative complication (8.2%). The patient's age (P = 0.002), indication for surgery (P = 0.008), length of preoperative hospital stay (P = 0.048), length of operation (P < 0.001) and intraoperative blood loss above 200ml (P < 0.001) were found to be statistically significant factors adversely affecting the surgical wound outcome. We conclude that most of the factors that predicted poor outcome in this study were patient and environment-related and are preventable. There is need to upgrade facilities in health institutions in Nigeria.

Esmarch tourniquet in orthopaedic surgery.

A bloodless field is important in many orthopaedic operations necessitating the use of a pneumatic tourniquet or Esmarch bandage. The outcome of the use of an Esmarch bandage for exsanguination and as a tourniquet in 112 consecutive patients who had elective orthopaedic operations on 131 limbs was evaluated. The setting was at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, from March 2003 to February 2005. The mean age of the patients was 25.7 + standard deviation years (range 1-70 years). The duration of tourniquet application ranged from 20 min to 2 h 35 min. Four limbs (3.1%) developed acute compartment syndrome; four (3.1%) had tourniquet paralysis with ulnar nerve involvement in three limbs. All limbs regained full neurological function following physiotherapy. There was wound infection in two limbs (1.5%). In spite of its drawbacks, the Esmarch bandage is still useful for exsanguination and as a tourniquet in orthopaedic surgery where there is no pneumatic tourniquet.

Causes of limb amputations in Nigerian children.

BACKGROUND: Most reports on amputations in Nigeria have been on adults. Few published data exist on the causes of amputations in children. METHODS: A retrospective analysis of all children who had limb amputations from January 1998 to December 2004 at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife was made. RESULTS: Thirty five (32.7%) out of 107 patients who had major limb amputations were children. The mean age was 9.9 years. Trauma accounted for 74.3% of the amputations, 92.3% of which had developed gangrene from treatment of simple fractures by traditional bone setters. Fifty one point four percent of the amputations were in the upper limbs. The most common complications were anaemia (88.6%) and wound infection (68.6%). One patient had tetanus while one died from septicaemia. Only two patients had prosthetic fitting following amputation. CONCLUSION: Most amputations in Nigerian children are due to traditional bone setters who manage simple, straight forward fractures in children causing gangrene of the limbs.