Bilateral wrist drop complicating axillary crutches mobilization in a young adult.

OBJECTIVE: Axillary crutches are simple rehabilitative devices that are globally used temporarily or permanently to assist in ambulation of patients and rarely present with complication. This report is about bilateral wrist drop incidentally noticed in a young adult patient mobilized on axillary crutches after internal fixation of a simple right tibia fracture. METHODS: The fracture was fixed by intramedullary nailing and the patient was mobilized on axillary crutches. At six weeks, patient fearfully refused to be commenced on partial weight bearing and at 12 weeks after surgery he was noticed to be totally weightbearing on the bars of the appropriately long axillary crutches and had developed bilateral wrist drop. There was radiological evidence of healing at the fracture sites. Treatment included mobilization on one elbow crutch on the left, physical therapy and nerve stimulation. RESULTS: At six weeks of physiotherapy, the power of the dorsiflexors of the wrists had recovered completely. CONCLUSION: Bilateral posterior cord palsy of brachial plexus could occur even in young healthy patients but total recovery could occur if the diagnosis and treatment are prompt. Patients should be told in unequivocal terms not to weight bear directly on axillary bars.

Motorcycle trauma in a St Lucian hospital.

OBJECTIVE: A motorcycle is a single-track, two-wheeled motor vehicle that is used worldwide for transportation. The use of the motorcycle has resulted in trauma that is associated with significant morbidity and mortality. The aim of this study is to document the pattern of motorcycle accidents and the demographics of the cyclists in St Lucia. METHOD: This is a 15-month prospective study on all patients with motorcycle injuries that reported to the emergency room at the Victoria Hospital. Information on patients: age, gender helmet use, intake of alcohol/drugs before the motorcycling and mechanism of injury were obtained and filled into a prepared proforma by the attending physician. Those admitted were followed-up to know the outcome and complications of treatment. RESULTS: Total number of patients studied was 136 in 115 accidents, males (M) were 127 while females (F) were 9, with M:F ratio of 14.1:1.0. There were 105, 28 and 3 riders, passengers and pedestrians respectively; 87.5% of the patients were below the age of 35 years. Fifty-three per cent of the accidents occurred over the weekend. The limbs were mostly injured, constituting 81.9% of the parts of the body injured. CONCLUSION: The study revealed that young and productive males were mainly injured in motorcycle accidents and the injuries were more in the limbs. More than fifty per cent of the accidents were found to occur during the weekends and more than fifty per cent of the motorcyclists were not wearing crash helmets.

Recurrent metachronous acute compartment syndrome in the legs of a child.

BACKGROUND: Compartment syndromes in children are rare, rarer still is the occurrence of metachronous compartment syndrome. OBJECTIVE: To report an unusual and rare presentation of metachronous acute compartment syndrome. METHODS: A seven-year-old boy presented with four separate episodes of acute compartment syndrome of the legs within three years. The recurrent nature of the illness prompted detail review of the records of the child. RESULTS: There was involvement of each leg twice between the ages of three and seven years following trivial trauma. At first presentation of each leg, fasciotomy was carried out in one or two compartments. There was no recurrence after fasciotomy of the four compartments during the second presentation of each leg. CONCLUSIONS: This case shows that a child could develop metachronous compartment syndrome in the legs following trivial injury and high index of suspicion is needed to recognize it. It also illustrates the importance of carrying out fasciotomy of all the four compartments to avoid recurrence of the pathology.

Gunshot injuries in a Nigerian hospital

Background: Gunshot injuries are major problems worldwide from the medical and economic perspectives and are associated with profound morbidity and significant mortality. Many previousstudies were focused on specific sites of injury but this study was aimed at the pattern and presentation of the gunshot injuries. Patients and Methods: This was a combined retrospective and prospective study of gunshot injuries in a Nigerian hospital. The medical records of patients with gunshot injuries between January and December 2004 were reviewed. Prospectivedata collection was done between January and October 2005. Results: Total number of patients was 38 and male: female ratio was 18:1. Thirty (78.9) were below the age of 40 years. The locally made dane gun was the instrument of attack in 24 (63.1) and 19 (50.0) of the patients were victims of armed robbery. The most frequently injured sites were the extremities of which the lower limb was 28 (73.7) and the upper limb was in 10 (26.3) patients. Conclusion: It was concluded that gunshot injuries occur more below age of forty years and the limbs were more injured. Armed robbery attack contributed to about half of the attacks and injuries results mainly from locally made dane guns. It was found that pistols were usually loaded with multiple pellets thus there could be multiple entry and exit wounds in patients attacked with pistol in our environment