Treatment of Brodie's abscess: excellent results from curettage, bone grafting and antibiotics.

INTRODUCTION: Brodie's abscess is not a common variant of subacute osteomyelitis; however, when it does occur, the presentation is atypical and usually late. This study aimed to describe the mode of presentation of Brodie's abscess and evaluate the results of surgical treatment in a resource-poor setting. METHOD: Over a five-year period, we retrospectively reviewed 20 patients who presented to two tertiary health institutions in south western Nigeria with clinical and radiological features of Brodie's abscess. RESULTS: Brodie's abscess accounted for just 2 percent of all patients with osteomyelitis. Most patients were adults (mean age 21.5 +/- 7.8 years) and males (75 percent). In the series, the tibia was involved in 50 percent of the cases, the femur in 30 percent, and the radius and fibula each in 10 percent. The diaphyseal part of the long bones was affected in 65 percent of the patients and the metaphysis, in the remaining patients. The average size of the cavities was 3.0 +/- 0.8 cm. 65 percent of the isolates yielded Staphylococcus aureus. All patients were treated by curettage of the abscess cavities, cancellous bone grafting and antibiotics. All patients had satisfactory outcomes, with complete incorporation of the grafts and new bone formation in the cavities. No patient reported any recurrence. CONCLUSION: Patients with Brodie's abscess respond well to surgical curettage of the abscess, cancellous bone grafting and antibiotic therapy.

Mortality among orthopaedic and traumatology admissions: a ten year review.

OBJECTIVE: Mortality in orthopaedic patients is not a common event. This study sets out to review the incidence and causes of mortality in orthopaedic and trauma admissions in a tertiary centre in a developing country. METHODS: Medical records of patients admitted to the Orthopaedic wards of the Obafemi Awolowo University Teaching Hospital, Ile-Ife over a ten year period (January 1999-December 2008) were retrospectively reviewed. The death certificates and postmortem examination findings were used in conjunction with the medical records to arrive at the possible cause of death in the deceased patients. Frequency analysis was done using SPSS version 13. RESULTS: Over this period, 2418 patients were admitted for orthopaedic and trauma with 84 deaths giving an overrall crude mortality rate of 3.47% (1.27% for paediatrics and 4.39% for the adults). Fourty nine patients (58.4%) died from trauma (fracture) related diagnoses followed by tumour (21, 25%) and infection (14,16.7%). Males were more affected 73.8% and the average age at death was 45.7years. Co-morbid conditions were found in 393% of the deceased patients. CONCLUSION: Trauma related deaths were the leading cause of mortality in our ward admissions and male patients at the prime of their lives were more often involved. Accident prevention and provision of facilities for appropriate management of trauma victims will help reduce substantially these untimely deaths in our world. The high incidence of co-morbid conditions emphasizes the role of multidisciplinary care in orthopaedic and trauma patients.

Motorcycle crash characteristics in Nigeria: implication for control.

Despite being the second most common cause of road traffic injuries (RTIs) in Nigeria, no study had examined the peculiarities of motorcycle crash site characteristics in Nigeria. We examined and interviewed 363 motorcycle RTI patients in three tertiary hospitals in southwest Nigeria. All the motorcycles are small with capacities between 80 and 125cm3. 68.9% of the patients sustained their injuries while working or going to work and 23.4% on their way to school. 176 (48.5%) of the crashes were with moving vehicles and in 83 (22.3%) cases, either the motorcycle or the other vehicle is moving against the traffic. 37.8% of all crashes occurred at junctions with no roundabout versus 5% at junctions with roundabout. Some risky practices of the patient included carrying more than 2 persons (15.02%), travelling without headlight at night (31.7%) and not wearing helmets (96.5%). This study showed that risky behavior among motorcycle riders, chaotic traffic and road design faults accounted for most of the motorcycle crashes. The implications for the prevention and control of motorcycle injuries were discussed.

Management of motorcycle limb trauma in a teaching hospital in south-western Nigeria.

BACKGROUND: To evaluate the management of limb injuries sustained from motorcycle accidents. METHOD: Consecutive 115 patients managed for limb injuries secondary to motorcycle trauma over a one-year period were prospectively studied. RESULTS: There were 115 patients out of which seventy-six (66.1%) sustained injuries to the lower limbs, 25 (21.7% to the upper limbs, while 14 (12.2 %) injured both the upper and the lower limbs together. Seventy-nine (68.7%) patients had fractures of which 24 (30.4%) were open. There was no organized pre-hospital care, a high referral rate and long injury-treatment intervals. Treatment was by closed manipulation and splintage with casts (57.6%), tractions (30.4%), and external fixation (5.4%); 18 patients had elective ORIF. The complication rate for cases was 71.3% while 4 (3.5%) patients died. CONCLUSION: Management of motorcycle injuries is still difficult in developing countries. Attention needs to be paid to provision of organized trauma care to improve outcomes.

The causes and outcomes of cancellation of orthopaedic surgeries at the obafemi awolowo university teaching hospital complex ile-ife, Nigeria.

BACKGROUND: Cancellation of cases on the scheduled day of surgery leads to an inefficient utilisation of scarce hospital and patient's resources. Identifying the causes of such cancellations will assist in taking steps to avoid them. METHODS: This is a retrospective study spanning 10 years. Record was taken of all patients who had orthopaedic surgery at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife Nigeria. The age, sex, type of operation, whether or not the surgery was ever postponed or cancelled, the duration and reasons for such postponements and the duration of admission were collated and analysed. RESULTS: Five hundred and fifty two (40.8%) of the 1,353 orthopaedic patients scheduled for surgery experienced cancellation. The most common reasons were attributable to the hospital (48.7%) mainly due to infrastructural breakdown (28.7%) and procedural lapses by hospital personnel (20.0%). Self cancellation by patient (37.8%) followed and was mainly due to financial constraints (25.6%). Upper respiratory tract infections were responsible for the cancellation in 8.6%. These delays were responsible for more than 30% of the duration of admission in 93 (16.8%) patients. CONCLUSION: The incidence of postponement of cases on the scheduled day of surgery is still high. Most of the causes are preventable. Better infrastructural facilities, enhanced interdepartmental communication and improved attitude to work would reduce the rate and thus enhance utilisation of theatre space.

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

Pre-hospital care of the injured in South Western Nigeria: a hospital based study of four tertiary level hospitals in three states.

Pre-hospital care in developing worlds has been found to be grossly deficient compared to high income countries. The pre-hospital care given to road accident victims attending the casualty departments of four tertiary level hospitals in South Western Nigeria was assessed using a one-page pro-forma. 1996 patients with injuries from road crashes were seen in the hospitals, only 172 had any form of pre-hospital care, just 160 were transported in ambulances and none had any form of organized pre-hospital care. The mean arrival time in the hospital after crashes was 93.6 minutes and there was a high rate (29.5%) of inter-hospital referral. For every Revised Trauma Score (RTS), the Probability of survival (Ps) of the patients was higher than the Ps of patients from high income countries.

Motorcycle limb injuries in a developing country.

BACKGROUND: Motorcycles have become a very popular means of transportation in Nigeria. This paper is a hospital based study of limb injuries resulting from motorcycle accidents in an urban centre in Nigeria. METHOD: All patients reporting to the emergency department of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife with limb injuries resulting from motorcycle accidents between June 1998 and May 1999 were selected for this prospective study. RESULT: One hundred and fifteen (79.3%) out of the 145 victims of motorcycle accidents that reported to the hospital had injuries involving their limbs. The Male: Female ratio was 2.8:1. The mean age was 31.9 +/- 16.7 (S. D.) years, and 20-29 years; the most commonly involved age group. 42.2% were due to collision with automobiles, 22% pedestrian while 8.7% were collisions between motorcycles. The use of protective/safety devices was practically non-existent. Seventy-six (66.1%) patients had lower limbs injuries, 25 (21.7%) patients had upper limb injuries while the remaining 14 (12.2%) injured both upper and lower limbs. The tibia was the most commonly fractured bone (32 patients, 27.8%) followed by the femur (25 patients, 21.7%). Eighty-six patients (74.8%) with fractures were managed by close reduction and splinting. Eighteen (15.7%) patients had internal fixation. CONCLUSION: Motorcycle accident is an important cause of limb injuries in the developing worlds. Motorcyclists need to be encouraged to use protective/safety devices.

Indications for amputations in Ile-Ife, Nigeria.

This is a retrospective study of limb amputations in Ile-Ife, Nigeria during a thirteen-year period (1987-1999). 82 patients were studied with a mean age of 35 +/- 22 years. 63 of the patients were adults, while 19 patients were children aged 15 years and below. Trauma was indicated as a reason for amputation in 60 patients (73.4%). Road traffic accident with peripheral vascular compromise was the single most common reason for amputation (41.7%). Forty-seven of the 82 patients had lower limb amputations, while the others were in the upper limbs. There was delay in performing amputation in some patients due to refusal to accept the procedure in 10(12.1%), logistics in 5(6.1%) and lack of finance in 3 (3.7%). The average healing time of the amputation stump wounds was 47 +/- 36 days. In 68.3% of cases, there was wound infection and the wound healing time was 63 +/- 45 days, much longer than than the general average. Other complications were flap necrosis, gas gangrene, osteomyelitis of the bony stump, and tetanus. Six patients died from sepsis and one from chronic renal failure, a hospital mortality rate of 8.5%. Prosthesis could not be fitted in any of the patients during the hospital admission and only three of the diabetic patients attended follow up clinic for up to two years; others absconded within 3 months of discharge from hospital. It will be possible to reduce the rate of amputation and improve the quality of life of patients with amputation if more attention is placed on accident prevention and injury control.

Spinal tuberculosis: a 15 year review at OAUTHC Ile-Ife.

A review of the hospital records over 15 years was made. The objective of the study was to describe the clinical presentation, management and outcome of spinal tuberculosis. Thirty-four patients were studied. There were 15(44.16%) males and 19 (55. 9%) females. Their age range was 2-80 years with mean (+/- SD) of 25.28 +/- 22.33 years. The occupations most commonly affected are Students (44.1%), Pre-school Children (17.6%) and Traders (14.7%). Back pain (100%), weight loss (47.1%), paraparesis (47.1%), kyphotic spinal deformity (32.4%) and night sweats (29.4%) were common features. Only 26.5% patients had active pulmonary tuberculosis. All the vertebral segments were involved. The Lumbar spine was the most involved vertebral segment in 50% patients. Using the Westergren method the mean (+/- SD) Erythrocyte Sedimentation Rate (ESR) mm/hour at the initial diagnosis was 83.58 +/- 31.11 mm/hour whereas three months after the commencement of antituberculosis chemotherapy it was 30.06 +/- 11.96 mm/hour. All the patients were given multiple antituberculosis drugs therapy and spinal traction. Spinal support was offered when the patients became ambulant. At the end of two years follow-up, 94.1% patients were alive, while 5.9% patients died during the course of treatment due to overwhelming sepsis. Among the patients that were alive, 14.7% still had persistence of their neurological deficit ie. paraparesis. Ten percent of the patients were mobilised on crutches while 5.96% were confined to wheelchair. This study shows that in tuberculosis endemic areas, symptom of back pain especially in the younger age group should be thoroughly investigated as this group constituted the largest affected population.