Reasons for Patronage of Traditional Bone Setters.

AIMS AND OBJECTIVES: The objectives of this study were to analyze the different reasons why patients with fractures patronize traditional bone setters (TBS) and their impression of the outcome of the treatment by the TBS. MATERIALS AND METHODS: A 24 month prospective observational study was conducted from February 2012 to January 2014. All the patients were recruited from the orthopedics outpatient clinic. The demographic data of each patient, the type of injury, presentation to hospital or not, reasons for leaving the hospital, reasons for patronage of the TBS and their impression of the outcome of TBS' treatment, effect of educational background on patronage of TBS and reason for presenting to hospital for orthodox treatment. DATA ANALYSIS: Analysis was done with SPSS software Version 20. RESULTS: A total 79 patients were recruited for the study and they had different reasons for patronizing TBS. These reasons include an external locus of decision making in 19 (24.1%) patients, and greater faith in TBS compared to orthodox medicine in 16 (20.3%). Twelve (15.2%) believed that TBS are more competent than orthodox medical practitioners while another group 11 (13.9%) considered the fees of TBS cheaper than those in the hospital. The delay in treatment in the hospital, forceful removal of patients from hospital against their will and nonsatisfaction with hospital treatment accounted for 5 (6.3%). Poor attitude of hospital staff, fear of amputation, and patients being unconscious during the injury accounted for 2 (2.5%). Their ages ranged from 17 to 83 years, with mean age of 36.8 ± 11.8 years. The male: female ratio was 1.5:1. CONCLUSIONS AND RECOMMENDATIONS: With recent advancements in the practice of orthopedics and trauma, there is still a very high patronage of the TBS by most of our patients. This is largely due to the dependence of the patients on their sponsors for treatment, while the influence of cultural and religious beliefs continues to play a major role in these decisions.

Lower limb amputation in diabetic foot disease: experience in a tertiary hospital in southern Nigeria

The diabetic foot is characterised by the triad of neuropathy, infection, and ischaemia, which may ultimately lead to limb amputation. It is important to understand the factors that place diabetic patients at increased risk of amputation in our society, hence the need for this study. The medical records of all patients admitted and treated for diabetic foot complications over a 3-year period (January 2007 to December 2009) were retrieved. Relevant information was obtained from the case notes. Thirty-six (36) patients entered the study, 25 males and 11 females (M:F ratio 2.3:1.0). Mean age was 54 years (range 24­74). Patients presented with foot gangrene (58%), ulceration (31%) and infection (11%) with trauma being the most common precipitating factor (53%). Nineteen patients (53%) had lower limb amputation, the commonest of which was below knee. Of the patients that had amputation, 18 (95%) had type 2 diabetics. Adequate diabetic foot disease preventive strategies need to be designed and implemented to reduce the incidence of lower limb amputations

Diagnosis and treatment of pyogenic bone infections.

BACKGROUND: Pyogenic osteomyelitis is still frequently seen in the developing world and the treatment of chronic osteomyelitis presents a considerable challenge despite advances in microbiological techniques, antibiotics and surgical techniques. Acute haematogenous osteomyelitis is commoner in children. RESULTS: In the pre-antibiotic era, mortality rate was high and progression to chronic osteomyelitis was common. A near similar scenario still exists in many developing countries due to the combination of inappropriate and/or inadequate antibiotic therapy, delayed presentation and unorthodox interventions by traditional healers. DISCUSSION: Chronic osteomyelitis may result from poorly treated or untreated acute osteomyelitis, open fractures, surgery for an array of orthopaedic conditions and from contiguous spread from infected soft tissue as may occur in diabetic foot infections. A large array of treatment techniques hinged on sequestrectomy/ debridement, management of dead space, improvement of oxygenation and perfusion to ischaemic tissue exist. Despite these, total eradication of disease is difficult. CONCLUSION: This article summarizes the pathology and methods of management available for pyogenic osteomyelitis. In its acute and chronic forms, the disease is likely to remain prevalent in the developing world until issues of ignorance, poverty and prompt access to appropriate and efficacious medical care are addressed.

Footcare practices among Nigerian diabetic patients presenting with foot gangrene

Diabetic foot ulceration and gangrene is a major cause of morbidity andmortality. This study has examined potential preventive footcare practices in a cohort of diabetic patients presenting with foot gangrene. One hundred and two (102) diabetic emergencies presented during the study period. Diabetic foot gangrene accounted for 27 (26%) of these cases. There were 18 males and 9 females (M:F = 2:1), with a mean age of 52+13 years. The mean duration of ulceration was 4±3 weeks and mean ulcer­gangrene interval was 1.2±0.5 weeks. Only 9 patients (33%) had been exposed to any form of footcare education, 15 patients (55%) treated their ulcers by unorthodox means, and 63% of the patients practiced no significant footcare. More widespread education and awareness is needed to prevent the continuing and serious problem of diabetic foot gangrene and consequent lower limb amputation

Motorcycle Road Traffic Injuries in Southern Nigeria: The Small Motorcycle as a Prevention Strategy

Background: The commonest mode of public transportation in Uyo is by motorcycle. There are two sizes of motorcycle in common use - the big one (Qlink or Skygo model; made in China) and the small one (C90; made in China). The study was carried out to determine if there is a lower risk of RTI severe enough to be brought to the hospital; attributable to using a small motorcycle. Methods: Motorcycle RTI victims admitted at the Accident and Emergency department of the University of Uyo Teaching Hospital (UUTH); were reviewed prospectively over a 15 month period. Three community visual surveys of the proportion of small to large motorcycles were also conducted. Results: A total of 131 RTI victims were reviewed over 15 months. The visual surveys of motorcycles in Uyo revealed that the mean proportion of small to large is 38 to 62; a ratio of 1:1.6. Eighty-three (63.3) of the 131 RTI's involved motorcycles. 74 of these occurred in large motorcycles. There was a statistically significant relationship between motorcycle size and occurrence of an RTI severe enough to be brought to hospital. Conclusion: There is a lower risk of RTI severe enough to be brought to hospital; from using a small motorcycle

Cutaneous squamous cell carcinoma in Calabar, southern Nigeria.

BACKGROUND: Several studies have shown that in Africa squamous cell carcinoma (SCC) is commoner than other skin malignancies. The risk factors are grouped generally into solar and nonsolar factors and their contributions vary with race, geographical region and site of lesion. This study attempted to identify risk factors and outcome of management of this problem in our region of southern Nigeria. METHODS: All patients with histological diagnosis of SCC presenting to the University of Calabar Teaching Hospital during the period January 2005 to December 2006 were evaluated. RESULTS: In total, 10 patients (6 male, 4 female, mean age 39.3 years, range 16-62) were seen. There were six patients (60%) with Marjolin's ulcer (MU) of the leg, with a male:female ratio of 5:1 and a latency period of 14.7 years, with trauma as the leading cause of injury. The other four patients (40%) had non-MU SCC. Two of these four patients (one man, one woman) were albino, and had lesions that involved the head. The other two patients were both women, and had vulval lesions. All 10 patients had delayed hospital admission, after poor results with topical herbal treatment. After hospital treatment, the results were satisfactory in three patients (two with MU and the male albino patient). The other seven patients had generally poor results from treatment, which comprised various combinations of excision, adjuvant chemotherapy and radiation. CONCLUSION: Ignorance and sociocultural factors were underlying issues in delaying treatment. Education highlighting the risk associated with chronic wounds and albinism, and the need for prevention, prompt treatment and proper surgical management, would improve prognosis with a reduction in the healthcare cost of this problem.

Lightning burns and traditional medical treatment: a case report.

BACKGROUND: Lightning strikes are relatively uncommon. In our culture where superstitions are strong and natural events often linked to evil forces, the traditional bonesetter/healer is often consulted first. Patients then seek orthodox care when complications develop. Patients also have difficulty accepting ablative treatment when indicated. OBJECTIVE: To present an usual case of bilateral upper limb burns caused by lightning and complicated by refusal to receive orthodox treatment. CASE REPORT: A 22 year old woman was struck by lightning while asleep. Instead of going to hospital, she was taken to a traditional healer where she spent two months before presenting with gangrenous upper limbs to hospital. Patient refused amputation and abandoned hospital against medical advice. CONCLUSION: This case report of bilateral upper limb burns resulting from lightning is rare. Importantly, the case highlights the role of ignorance, superstition and the disastrous results of traditional medical practice in our healthcare delivery.

Acute bilateral anterior shoulder dislocation following domestic assault--case report.

A rare case of acute bilateral anterior shoulder dislocation in an elderly woman is presented. This injury resulted from domestic physical assault by her daughter inlaw. Patient defaulted after initial treatment--a common practice by patients in our society. This case is being reported to highlight the occurrence of this rare orthopaedic emergency.

Acute bilaterial anterior shoulder dislocation following domestic assault

A rare case of acute bilateral anterior shoulder dislocation in an elderly woman is presented. This injury resulted from domestic physical assault by her daughter in-law. Patient defaulted after initial treatment - a common practice by patients in our society. This case is being reported to highlight the occurrence of this rare orthopaedic emergency

Review of Seventy consecutive cases of limb injuries in calabar the role of motorcyclists

Background: Limb injuries are common. The aims of this study were to evaluate the pattern of limb injuries seen at the University of Calabar Teaching Hospital (UCTH); Calabar and the role ofmotorcyclists in their causation. Methodology: Prospective study from 1st January; 2005. Seventy consecutive patients with limb injuries presenting at the accident and emergencyunit of UCTH were evaluated. Results: The seventy patients who entered the study presented between 1st January 2005 and 31st May 2005. They sustained eighty five (85) limb injuries.Ages ranged from 4.5years to 68years with mean of 30years. Male to female ratio was 2.7:1. Road Traffic Accident (RTA) was the commonest cause of injury accounting for 76.8of cases withmotorcycle accidents constituting 52.8of these. Fracture was the most common injury accounting for 54 cases (63.5). Fracture of the tibia and fibula (combined) was the most common fracture (37.0). Head injury was the most common associated injury (66.7). Conclusion: Motorcycle accidents are important causes of limb injuries. Appropriate measures to reduce incidence of road traffic accidents would significantly curtail the rate of occurrence of limb injuries