Paediatric Hand Injuries at the Lagos University Teaching Hospital

Background: Paediatric hand trauma represents a subset of hand injury that can be quite challenging to manage. Local studies on this injuries are few therefore a 4 year retrospective study at the Trauma and hand rehabilitation unit of the Lagos University teaching hospital was carried out. Objectives: To determine the percentage of hand trauma occurring in the paediatric age group; the predominant age group involved; place of injury; the major injury types occurring as well as the most common surgical procedure required. Methods: The case records of all cases that presented at the hand rehabilitation clinic or the emergency center of the Lagos University teaching hospital over a 4 year period were reviewed. Those below the age of 12 years were studied. Their biodata; type of injury; place of injury and other details were obtained. Results: 634 patients were seen over the study period; 61 cases of hand injuries were in the paediatric age group. Hand trauma constituted less than a third of all paediatric hand cases. The commonest age group affected was 2-6 years. Most of the injuries occurred around the home. Burns injury; blunt trauma; glass and knife cuts were the commonest causes of hand trauma. Soft tissue reconstruction was commonest procedure done. Conclusion: Infants and toddlers were the most vunerable groups while burns injury was the commonest cause of hand trauma seen at the Lagos university teaching hospital

Pattern of peripheral traumatic neuropathy of the upper limb in Lagos.

A total of 181 patients with 254 injured nerves in the upper limbs were prospectively studied. The ages of the patients ranged from 6 weeks to 70 years, with a mean of 25.9 years and a male to female ratio of 4:1. The site of injury for 123 nerves in 83 patients was the wrist. A torn wound was the commonest type of injury, causing nerve damage in 127 patients. The ulnar nerve (114) was more frequently involved than other nerves. There were 92 median, 34 radial and 14 cervicobrachial nerves. The nerve injury was missed at the initial emergency operation in 31 patients (17 per cent). Glass of various types caused the injury in 89 patients involving 119 nerves. Of all glass wounded nerves 60 per cent were caused by domestic architectural window, door and furniture glass. Accidental fall or punch and forced opening or closure were the mechanism of injury in 71 patients. Strict glass safety regulations and education of the public on the dangers of glass are recommended for prevention of glass-related injuries.

Primary malignant tumors of the hand.

Three cases of primary malignant tumors seen at the Hand Rehabilitation Clinics of the Lagos University Teaching Hospital from 1980 to 1983 are reported. The primary diagnoses were malignant synovioma, trabecular carcinoma of the sweat glands, and alveolar rhabdomyosarcoma. These three cases occurred in young Nigerian females and constituted 3.3% of 90 hand tumors treated at the clinic during this period.

Juvenile aponeurotic fibroma.

A large aponeurotic fibroma situated on the dorsum of the hand of a fourteen-year-old Nigerian male is reported. Out of forty-three juvenile aponeurotic fibromata of the hand documented in the literature, only two cases occurred on the dorsum.

A new course in basic therapeutic skills for medical and dental students at the College of Medicine, University of Lagos: student evaluation.

A new course in basic therapeutic skills for first-year students at the College of Medicine, University of Lagos began in July 1980. The course is designed to teach basic medical procedures in nursing, first aid, medicine, surgery, paediatrics and dentistry. It also introduces the students, early in their medical or dental training, to the role in treatment and rehabilitation of dietetics, physiotherapy, prosthetics and orthotics, occupational therapy and medical social work. The course is in its second year of implementation with 152 students participating in the inception year and 166 in the second year. The former group of students had a pre-test and post-test consisting of fifty multiple choice questions. The latter group were also examined in the performance of the skills taught them using check lists and rating scales of the Objective Structured Clinical Examination (OSCE) type. At the end of the course the students completed an evaluation questionnaire. As a result, the organization of the course in its second year took account of many of the findings from student evaluation in the first year. The particular learning needs of dentistry students were included, hence the second class of dental students found the courses more relevant than the previous class. The teachers were encouraged to develop audiovisual presentations of their subjects and the increased use of simulators permitted greater opportunity for students to practise skills. The study indicates that student evaluation of course organization and management can be of great value in providing the feedback required to progressively improve the learning environment.

Keloids: the natural history.

There is abundant evidence in the literature that keloids and hypertrophic scars are different stages of the same process. The evidence, clinical and histogenetic, also shows that the hypertrophic scar is the earlier of the two stages. It therefore follows that all keloids do evolve through the hypertrophic scar phase. These conclusions have largely eased the confusion of nomenclature and made a clinicopathologic correlation of the available knowledge on keloid possible.