The role of medical-grade maggots in facilitating healing of diabetic foot ulcers in Kano, northern Nigeria: a case series.

OBJECTIVE: Approximately 13% of people living with diabetes develop one or more ulcers during the course of the disease, and diabetic foot ulcer (DFU) is responsible for >60% of lower limb amputations worldwide. This case series aimed to demonstrate the effectiveness of medical-grade maggots on DFUs in promoting wound healing and reducing related hospital stays in northern Nigeria. METHOD: Maggot debridement therapy (MDT) was applied to the DFUs of patients who consented to this treatment between January-August 2021 at the Orthopaedic Unit of the Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Sterile first instar larvae of Lucilia sericata were obtained indigenously and applied using the confinement (free-range) method under aseptic procedure. RESULTS: A total of 15 patients with DFUs of Wagner classification grades III (33.3%) and IV (66.7%), were seen and documented. The patients included 10 (66.7%) females and five (33.3%) males, giving a female:male ratio of 2:1. The mean age (±standard deviation) of the respondents was 51.6±10.8 years. The surface area of the wounds ranged from 24-140cm2, with a median value of 75cm2. Among the patients, 60% had two cycles of MDT, with a median duration of five days. Most of the wounds (53.3%) were debrided within five days; 13.3% (two wounds) took seven days to be fully debrided. A paired sample t-test showed a statistically significant association between wound surface area and therapy duration (t=8.0; p=0.000) and between wound surface area and cycles of therapy (t=8.3; p=0.000). Before maggot application, 14 (93.3%) DFUs were completely (100%) covered with slough and only one (6.7%) was 95% covered with slough. After maggot application, 10 (66.7%) wounds were completely debrided while five (33.3%) wounds required bedside surgical debridement to achieve complete debridement. A paired sample t-test showed statistically significant difference between the pre- and post-MDT slough covering the wounds (t=45.1; p=0.000). CONCLUSION: In this case series, MDT was successfully used in the debridement of DFUs, which facilitated the healing process with an encouraging clinical outcome.

Early Functional Outcome of Hemiarthroplasty in the Elderly with Neck of Femur Fracture: A Single Centre's Experience.

Introduction: Neck of femur fractures in the elderly population are common and often a devastating condition. The optimal treatment has been a subject of debate. Arthroplasty has been shown to be the most viable treatment option. The high cost of total hip replacement makes hemiarthroplasty a suitable option in our environment. Materials and Methods: This study was designed to measure the outcome of hemiarthroplasty after femoral neck fracture using Harris hip score in patients aged 60 and above at the National Orthopaedic Hospital, Dala, Kano, Nigeria. Results: Twenty-five consecutive patients 60 years and above with femoral neck fracture who met the inclusion criteria and gave consent were enrolled into the study. The mean Harris hip score at the pre-operative period was 16.92. Fourth week after the surgery, the mean Harris hip score was 69.96. The score rose further to 75.24 and 80.96 at 12 weeks and 6 months post-operatively. The difference between the mean pre-operative and post-operative scores at 4th week, 12th week, and 6th month was statistically significant. During the pre-operative period, all patients had a poor Harris hip score grade. Six months after the surgery, 7 patients (28%) had an excellent Harris hip score grade, 12 patients (48%) had good grades, and 1 patient (4%) had a fair Harris hip score grade. Five patients (20%) had a poor Harris hip score grade at 6 months. Conclusion: From the findings of this study, it can be concluded that early functional outcomes of hemiarthroplasty for femoral neck fracture in the elderly are good and satisfactory.