Acquired boneless forearm as a complication of traditional bone setting.

An 8-year-old girl sustained closed fracture of the right ulna 10 weeks prior to presentation. She was taken to a traditional bone setter who applied a tight splint. The patient reported pain, but the splint was not removed. A week after application of the splint, a foul odor was detected and removal of the splint showed extensive exposure of the forearm bones. Above elbow amputation was rejected by the patient's parents when she was taken to hospital, where she was admitted for 8 weeks by a second traditional bone setter. A trained nurse applied herbal concoctions and dressed the wound daily in anticipation that the skin would cover the exposed bone fragments. She was brought to our hospital for wound dressing so that the skin would cover the exposed bones fragments. Examination revealed a grossly shortened right forearm--by 7 cm compared with her left--extensive exposure of both radius and ulna at the anterior aspect of the forearm, and loss of sensation and movement of the fingers. Radiographs showed sequestrated radius and ulna with involucrum around the olecranon process. Above elbow amputation was offered to the patient but the parents again declined. The forearm bones detached while scrubbing the wound for review and removal of the sequestrated bone. The wound healed within one and a half weeks of dressing, resulting in an acquired boneless forearm.

Achieving interlocking nails without using an image intensifier.

Interlocking nails are commonly performed using an image intensifier. These are expensive and are not readily available in most resource-poor countries of the world. The aim of this study was to achieve interlocking nailing without the use of an image intensifier. This is a prospective descriptive analysis of 40 consecutive cases seen with shaft fractures of the humerus, femur, and tibia. Fracture fixation was done using Surgical Implant Generation Network (SIGN) nails. Forty limbs in 34 patients were studied. There were 12 females and 22 males, giving a ratio of 1:2. The mean age (years) was 35.75+/-13.16 and the range was 17-70 years. The studied bones were: humerus 10%, femur 65%, and tibia 25%. The fracture lines were: transverse 40%, oblique 15%, and communited 45%. Fracture grades were: closed 90%, grade I, 5%, grade II, 2.5%, and grade IIIA, 2.5%. Surgical approaches were: antegrade 62.5% and retrograde 37.5%. Indications for fixation were: recent fracture 92.5%, non-union 5%, and malunion 3%. Methods of reductions were: open 85% and closed 15%. The mean follow-up period (years) was 1.50+/-0.78. The union time averaged 3 months. Complication was mainly screw loosening due to severe osteoporoses in one case. It is, therefore, concluded that, with the aid of external jigs and slot finders, interlocking can be achieved without an image intensifier.

Septic arthritis in a Nigerian tertiary hospital.

BACKGROUND: Septic arthritis is a disabling disease that requires early diagnosis and prompt management for optimal outcome. Late presentations with deformities were noticed in our clinic. The aim of this study was to determine the pattern of septic arthritis in our environment. METHODS: This was an 18-month prospective study in a Nigerian teaching hospital. Thirty-nine consecutive patients with 45 incidences of septic arthritis were studied. Joint aspirates were taken for microbiologic investigation. RESULTS: Patient ages ranged between 0.5-60 years and the mean age was 7.4 years. The male to female ratio was 2.9:1, and the knee was the most commonly affected joint. The duration of symptoms before presentation ranged between 4-17 days with a mean of 11.1 +/- 3.6 days. Twenty-five (64.1%) of the patients were on inadequate antibiotics before presentation. Seventy-three percent of septic arthritis involving the upper limb joints occurred below the age of one year and 92.3% of the involved lower limb joints occurred after one year of age. CONCLUSION: The upper limb joints were significantly affected below one year of age and the joints of the lower limb were more involved after one year of age (p = 0.001). Improper prescription of antibiotics before presentation to the hospital was noticed in 64.1% and should be discouraged.

DAREJD simple technique of draining acute paronychia.

The severe deformities of the fingers seen in poorly treated or late presenting cases of paronychia stimulated this prospective study. The aim was to make early diagnosis and to find a simple method of draining the pus in the paronychia. This was a prospective hospital based study at the Wesley Guild Hospital (WGH) Ilesa for 9 months. Using simple materials like 23G or 21G needle, cotton wool, chlorohexidine solution, methlylated spirit and zinc oxide plaster, abscess in acute paronychia was drained by lifting the nail fold with the tip of the needle. Ten cases of paronychia in 8 patients were drained with the method. Combination of the early drainage and antibiotics showed that all the patients were relieved of pain and could use their fingers normally within 2 days. There was no need of anesthesia and daily dressing. The drainage technique is simple and effective. The early drainage prevents the occurrence of any form of complication.

Normal leg compartment pressures in adult Nigerians using the Whitesides method.

In Caucasians, the range of normal intracompartmental pressure of the leg is from 0 mmHg to 15 mmHg. In the literature, such measurements have not been done in Africa to identify normal leg intracompartmental pressures. We have sought to identify the normal range of pressures in such a population of Nigerians, and to demonstrate the reproducibility of the Whitesides injection technique with materials that are easily available in most hospitals so that compartment syndromes could be identified promptly and inexpensively in developing countries. We performed a 16-month hospital-based prospective study at Wesley Guild Hospital in Ilesa, Osun State, Nigeria, to measure the intracompartmental pressures in the anterior and deep posterior compartments of 49 contralateral uninjured legs of patients with closed contralateral tibial fractures, measured at presentation. The Whitesides infusion technique was used with the aim of determining the normal range of compartmental pressure in Nigerians. The anterior compartment pressures ranged from 3 mmHg to 18 mmHg with a mean 7.6 +/- 2.6 mmHg. The pressure in the deep posterior compartment ranged from 3 mmHg to 14 mmHg with mean of 7.4 +/- 2.7 mmHg. The values are similar to those reported in the literature. There was no statistically significant difference between the pressures in the two compartments (p = 0.668).

Compartmental pressure in adults with tibial fracture.

Acute compartment syndrome is associated with tibial fractures and failure to diagnose it leads to grave consequences. This study was conceived with the aim of determining the intra-compartmental pressure in adults with closed tibial fractures and intended to provide early diagnosis of acute compartment syndrome. The Whitesides injection method was used, using hospital [corrected] available materials. The intra-compartmental pressure in the anterior and deep posterior compartments of 52 patients with closed tibial fractures was measured at presentation and 4 hourly for 24 h. In three patients, the pressure was very high, and the differential pressure (i.e. the difference between the diastolic blood pressure and the intra-compartmental pressure) was less than or equal to [corrected] 30 mmHg, which was diagnostic of acute compartment syndrome. They were all treated by fasciotomy. It is concluded that Whitesides' [corrected] method can be used to diagnose acute compartment syndrome. The apparatus is easy to set up, cheap [corrected] and therefore ideal for use in our environment where sophisticated devices of tissue pressure measurement are not available.