Can treatment of posterior malleolus fractures with tibio-fibular instability be usefully addressed by Bartonicek classification?

INTRODUCTION: Ankle fractures account for 4% of all fractures and treatment of those involving the Posterior Malleolus remains controversial. Clinical and radiological outcomes in a cohort of patients with Posterior Malleolus fractures conservatively treated were retrospectively evaluated; furthermore, a treatment algorithm was suggested. METHODS: Patients were divided according to Bartonícek classification. The clinical evaluation was made with OMAS/AOFAS scores; the radiological evaluation with Van Dijk classification for post-traumatic arthritis. RESULTS: Clinical outcome worsened with the severity of Bartonícek classification, but early degenerative changes were not correlated neither to the clinical outcome nor to the injury pattern. Clinical and radiological outcomes depended on the damage of the syndesmosis as articular step-offs and tibio-fibular notch involvement. DISCUSSION: We recommend conservative treatment for Bartonícek type I, type II and type III fractures, the latter when undisplaced and without tibial plafond depression. We suggest surgical treatment for type IV and displaced type III fractures.

A new approach to local DCO in ankle fracture dislocations: external fixation with diaphyseal unicortical screws applied by local anaesthesia.

PURPOSE: Ankle fracture dislocations represent a great threat for soft tissue viability and articular instability. The use of a temporary ankle bridging ExFix plays a fundamental role in the local damage control orthopaedics while waiting for definitive synthesis. METHODS: For this prospective research, we have developed a full application protocol of innovative diaphyseal monocortical screws fixator (Unyco-OrthofixTM) exclusively under local anaesthesia. Rigid selection criteria allowed us to collect nine patients during a period of almost 2 years. VAS score was analysed for the feasibility of the procedure, and a thorough radiologic evaluation was performed. RESULTS: Results pointed out that the calcaneus pin insertion (VAS: 3.44) followed by the local anaesthetics injection (VAS: 3.22) was the most painful, without precluding to continue the procedure; fracture temporary stability was achieved in all the cases. CONCLUSIONS: The procedure of monocortical diaphyseal application in bridging external fixation is comparable to the conventional transcalcaneal traction maintaining the advantage in terms of speediness, independence from anaesthetists and feasibility within few minutes from hospital admittance even in patients under anticoagulants therapy, but increasing the stability of the reduction and improving the quality of nursing (so-called portable traction).

Complete avulsion of the globe and the optic nerve: a case report.

Blunt trauma to the globe may cause rupture or avulsion of the globe with its attendant consequences. Traumatic avulsion of the globe and optic nerve are rare because of the protection offered by the bony socket and the resistance of the globe due to its pressure and the thickness of the nerve tissues. However, there are a few documented cases of avulsion of the globe and optic nerve in the literature. We report a case of traumatic avulsion of the left globe in a 38-year-old female Nigerian. Primary enucleation of the avulsed globe with insertion of orbital prosthesis was done.

A preformed antibiotic-loaded spacer for treatment for septic arthritis of the shoulder.

BACKGROUND: Total shoulder arthroplasty infections are rare, depending on the use of antibiotic prophylaxis, the local blood supply, the axial load gradient and the proximal location of the shoulder. The purpose of this study was to evaluate the results of treatment for infections in total shoulder arthroplasty and septic arthritis using a preformed antibiotic-loaded spacer. MATERIALS AND METHODS: Seven shoulders in as many patients were treated for infected arthroplasty or septic arthritis without previous surgery. A preformed antibiotic-loaded spacer was always applied. Patients were evaluated at the final follow-up with the Constant Score (CS), the Secec Elbow Score (SES), and the American Shoulder and Elbow Society Score (ASESS). RESULTS: The mean follow-up was 40, 71 months after spacer implant. Infection was always confirmed preoperatively by the leukocyte and neutrophil counts in the aspirated synovial fluid, and intra-operative biopsy and pathologic analysis. Positive bacterial cultures were found in 5 cases: 3 MRSA and 2 Staphylococcus epidermidis. The mean SES increased from 34.43 before spacer implant to 77.29 at final follow-up, ASESS ranged from 14.86 to 21.14, and CS from 40.28 to 79.14. CONCLUSION: A preformed antibiotic-loaded spacer is intended to release gentamicin alone, but we can consider adding vancomycin to increase antibiotic spectrum. An early diagnosis and an immediate treatment can prevent a persistent infection and severe soft-tissue damage. The use of a preformed antibiotic spacer allows maintaining joint function at the intermediate stage in two-stage treatment.

Acrylic bone cement: current concept review.

Acrylic bone cement has had for years an important role in orthopedic surgery. Polymethylmethacrylate (PMMA) has been extended from the ophthalmological and dental fields to orthopedics, as acrylic cement used for fixation of prosthetic implants, for remodeling osteoporotic, neoplastic and vertebral fractures repair. The PMMA bone cement is a good carrier for sustained antibiotic release in the site of infection. Joint prostheses chronic infection requires surgical removal of the implant, in order to eradicate the infection process. This can be performed in the same surgical time (one-stage procedure) or in two separate steps (two-stage procedure, which involves the use of an antibiotic-loaded cement spacer). The mechanical and functional characteristics of the spacers allow a good joint range of motion, weight-bearing in selected cases and a sustained release of antibiotic at the site of infection. The improvement of fixation devices in recent years was not accompanied by the improvement of elderly bone quality. Some studies have tested the use of PMMA bone cement or calcium phosphate as augmentation support of internal fixation of these fractures. Over the past 20 years, experimental study of acrylic biomaterials (bone cement, bioglass ceramic, cement additives, absorbable cement, antibiotic spacers) has been of particular importance, offering numerous models and projects.

Three-dimensional matrix-induced autologous chondrocytes implantation for osteochondral lesions of the talus: midterm results.

Introduction. We evaluate the midterm results of thirty patients who underwent autologous chondrocytes implantation for talus osteochondral lesions treatment. Materials and Methods. From 2002 to 2009, 30 ankles with a mean lesion size of 2,36 cm(2) were treated. We evaluated patients using American Orthopaedic Foot and Ankle Surgery and Coughlin score, Van Dijk scale, recovering time, and Musculoskeletal Outcomes Data Evaluation and Management System. Results. The mean AOFAS score varied from 36.9 to 83.9 at follow-up. Average of Van Dijk scale was 141.1. Coughlin score was excellent/good in 24 patients. MOCART score varied from 6.3 to 3.8. Discussion. This matrix is easy to handle conformable to the lesion and apply by arthroscopy. No correlation between MRI imaging and clinical results is found. Conclusions. Our results, compared with those reported in literature with other surgical procedures, show no superiority evidence for our technique compared to the others regarding the size of the lesions.

Audiometric findings in Waardenburg's syndrome amongst the institutionalised deaf/blind in Kaduna-Nigeria.

INTRODUCTION: Waardenburg's syndrome (WS) is a rare inherited disorder of congenital hearing loss and Pigmentary disturbances of the eyes, hair, skin and neural crest derivatives. MATERIALS & METHODS: 620 students in a deaf/blind school were examined and four had WS with a frequency of 0.65%. 2 males and 2 females with WS and age ranges between 10-19yrs {mean 15.75yrs.} All 4 subjects had complete blue irides, white forelock and sensorineural hearing loss, and thus met the diagnostic criteria. They were then subjected to Audiometric assessment. RESULTS: Otoscopy was essentially normal but Audiometry revealed sensorineural hearing loss [SNHL] in all the subjects ranging from severe to profound with one subject being stone deaf. CONCLUSION: WS is a rare disorder in our environment although it may be under reported. Two ofthe subjects benefited from amplification and were given hearing Aids. Provision of early amplification cannot be over emphasized.

Real-life experience study of the safety and efficacy of travoprost 0.004% / timoptol 0.50% fixed combination ophthalmic solution in intraocular pressure control.

PURPOSE: To evaluate the safety and efficacy of timolol 0.5%/travoprost 0.004% combination (duotrav) as observed in primary open-angle glaucoma (POAG), ocular hypertension (OHT) and normal tension glaucoma (NTG) in real-life conditions. MATERIALS AND METHODS: Patients with uncontrolled intraocular pressure (IOP) on other medication and no contraindication to ß-blockers were switched to duotrav in 56 eyes of 28 patients. The drop in IOP was the primary outcome measured. RESULTS: Switch to duotrav provided an additional IOP reduction after 3-month follow-up that was statistically significant for those on latanoprost (P=0.02857), bimatoprost (P =0.04978) and travoprost (P =0.0078). Patients on latanotrost had an additional 25.9% drop 3 months after switching to duotrav while those on bimatoprost and travatan had 18.04% and 17.59% drop, respectively, after the switch. It was effective in lowering the IOP to clinically significant levels of ≤ 18.5 mmHg in POAG, NTG and OHT (12.5-17.9% drop), but not in chronic angle closure glaucoma. CONCLUSION: Duotrav was well-tolerated and produced significant additional IOP reduction when switched from other anti-glaucoma drugs in patients with uncontrolled glaucoma. It also achieved IOP of ≤ 18.5 mmHg in glaucoma patients.

Ophthalmologic abnormalities among deaf students in Kaduna, Northern Nigeria.

BACKGROUND: The association between deafness and ocular problems is well established; however the nature and prevalence of these problems are diverse across the globe. OBJECTIVE: The aim of this study is to determine the nature and prevalence of ophthalmologic abnormalities in deaf students and offer treatment to those with remediable conditions. METHOD: Six hundred and twenty deaf students aged between 5 and 38 years were examined in a school for the deaf. RESULTS: One hundred and thirty (20.9%) had some form of ophthalmologic abnormality. Some had anterior segment abnormalities such as corneal opacities (0.5%) and allergic conjunctivitis (3.4%) while others had posterior segment abnormalities like optic atrophy (0.3%), Waardenburg syndrome (0.6%) and Ushers syndrome (0.6%). Refractive error was the most common (7.9%). CONCLUSION: Since these deaf students use their sight to compensate for the deafness, routine ophthalmologic examination should be carried out on them so that ophthalmologic abnormalities are detected early and treatment offered for remediable diseases.

Ocular disorders in children in Zaria children's school.

BACKGROUND: The main causes of blindness in children change over time. The prevalence and pattern of eye diseases in children were studied in northern Nigeria 6 years ago. This study like the previous one was a school eye health screening conducted in Zaria children school located at the centre of Zaria, a city in northern Nigeria. AIMS AND OBJECTIVES: to determine the current prevalence and pattern of eye diseases affecting school children in Zaria. This is to serve as a current template for planning eye care for children in Zaria and environs. MATERIALS AND METHODS: a cross sectional study of 327 children who completed a pre-designed school eye screening format was conducted. Consent was obtained from the school authority and the parents before the screening exercise. It involved assessment of visual acuity, anterior and posterior segment examination and colour vision testing. Intraocular pressure measurement and refraction were done for those with indications. RESULT: A total of 327 children were examined, out of which 45.6% (n=149) were males and 54.4% (n=178) were females. M: F=1:1.2. Age range 5-17 yrs with mean of 9.6 ± 3.1(SD). The commonest causes of eye disorders were refractive errors 8.0% (n=26), allergic conjunctivitis 7.3 % (n=24), glaucoma suspects 3.7% (n=12) and colour deficiency 1.5%(n=5). CONCLUSION: The major causes of childhood eye disorders were uncorrected refractive errors and allergic conjunctivitis. The predominance of uncorrected refractive error is similar to what is obtainable in other parts of the world especially in the urban areas.

Survey of Medical Specialists on their Attitudes to and Resources for Health Research in Nigeria

Aim: To study the views of medical specialists on their attitude to and the resources for health research in Nigeria and draw appropriate policy implications. Materials and Methods: Structured questionnaires were distributed to consenting 90 randomly selected medical specialists practising in six Nigerian tertiary health institutions. Participants' background information; importance attached to research; motivations for conducting research; funding; ethical oversight; literature search; and statistical support were probed. The coded responses were stored and analyzed using the statistical SPSS software. Results: Fifty-one out of the 90 questionnaires distributed were returned; giving a response rate of 63.3. Research function was rated third by 64.7of the respondents after hospital service (72.5) and teaching (66.0). Advancement of knowledge was the strongest motivating factor for conducting research (78.4). Securing funding (94) and finding time (80) were their major constraints. Only a minority of the respondents; 20and 14; respectfully; positively rated the quality and promptness of the decisions of their institutions' ethical organs in the highest category. Most of their literature search was conducted on the internet (96.1) and they stored and analyzed their research data with commonly available statistical software. Conclusion: Our study respondents regarded research highly but were severely constrained in conducting research by lack of access to sources of funding from within and outside Nigeria and finding time from core hospital functions. We recommend periodic (re)training in research particularly on how to apply for research grants and giving some protected research time for Nigerian medical specialists in order to boost their research function

Ocular disorders in children in Zaria children's school

BACKGROUND:The main causes of blindness in children change over time. The prevalence and pattern of eye diseases in children were studied in northern Nigeria 6 years ago. This study like the previous one was a school eye health screening conducted in Zaria children school located at the centre of Zaria, a city in northern Nigeria.AIMS AND OBJECTIVES:to determine the current prevalence and pattern of eye diseases affecting school children in Zaria. This is to serve as a current template for planning eye care for children in Zaria and environs.MATERIALS AND METHODS:a cross sectional study of 327 children who completed a pre-designed school eye screening format was conducted. Consent was obtained from the school authority and the parents before the screening exercise. It involved assessment of visual acuity, anterior and posterior segment examination and colour vision testing. Intraocular pressure measurement and refraction were done for those with indications.RESULT :A total of 327 children were examined, out of which 45.6% (n=149) were males and 54.4% (n=178) were females. M: F=1:1.2. Age range 5-17 yrs with mean of 9.6 ± 3.1(SD). The commonest causes of eye disorders were refractive errors 8.0% (n=26), allergic conjunctivitis 7.3 % (n=24), glaucoma suspects 3.7% (n=12) and colour deficiency 1.5%(n=5).CONCLUSION :The major causes of childhood eye disorders were uncorrected refractive errors and allergic conjunctivitis. The predominance of uncorrected refractive error is similar to what is obtainable in other parts of the world especially in the urban areas

Audiometric findings in Waardenburg's syndrome amongst the institutionalised deaf/ blind in Kaduna-Nigeria.

INTRODUCTION: Waardenburg's syndrome is a rare inherited disorder of congenital hearing loss and Pigmentary disturbances of the eyes, hair, skin and neural crest derivatives. METHODOLOGY: 620 students in a deaf/blind school were examined end four had Waardenburg's syndrome with a frequency of 0.65%. 2 males and 2 females with Waardenburg's syndrome and age ranges between 1019 years (mean 15.75 years) All 4 subjects had complete blue irides, white forelock and sensorineural hearing loss, and thus met the diagnostic criteria. They were then subjected to Audiometric assessment. RESULTS: Otoscopy was essentially normal but Audiometry revealed sensorineural hearing loss [SNHL] in all the subjects ranging from severe to profound with one subject being stone deaf. CONCLUSION: Waardenburg's syndrome is a rare disorder in our environment although it may be under reported. Two of the subjects benefited from amplification and were given hearing Aids. Provision of early amplification cannot be over emphasized.

Involutional Lower Eyelid Entropion: Combined Wheeler's and Wedge Resection of Tarsal Plate

BACKGROUND: Involutional entropion; a common eyelid condition; has different methods of surgical correction and attendant variable recurrence rates; depending to a large degree on the method used. OBJECTIVE: To describe and evaluate a modified technique of entropion repair where the Wheeler's method is combined with wedge resection of the tarsal plate. METHODS: This was a chart review study of 49 patients who had the modified technique carried out to correct their involutional entropion. The technique essentially involves dissecting and separating the lower lid pre-tarsal orbicularis muscle from the tarsal plate; resecting a down-base triangular wedge of the tarsus followed by shortening the orbicularis and anchoring it to the tarsal plate superiorly. RESULTS: Over the three and a half-year review period; 54 eyelids of 49 patients underwent the procedure to correct their lower eyelid entropion. Of these; 28(57) were females and 21(43) males with a mean age of 73.5 years. The mean follow up period was 30.3 months. One (1.9) recurrence was recorded in all the cases during the follow-up period. Complications were minimal. CONCLUSION: The combined Wheeler and wedge resection of the tarsal plate produces very good post-operative results and can be used in primary involutional entropion or as the procedure of choice if an initial different surgical technique used fails

Efficacy of garcinia Kola 0.5 aqueous eye drops in patients with primary open-angle glaucoma or ocular hypertension

PURPOSE:To evaluate the intraocular pressure (IOP) lowering efficacy of Garcinia kola 0.5% aqueous solution eye drops in patients with newly diagnosed primary open-angle glaucoma or ocular hypertension (POAG/OH).MATERIALS AND METHODS: A randomized, double-masked, multicenter, active-controlled prospective study. Patients who met the inclusion criteria were randomly assigned in equal numbers to receive Timolol 0.5% eye drops as a control medication (A = Group 1 eyes) or Garcinia kola 0.5% eye drops as the study medication (B = Group 2 eyes). All drops were instilled at 6 am and 6 pm daily. Goldman applanation tonometry was performed at 9 am, 12 pm and 3 pm at baseline, week-6, week-12 and week-24 visits. Voluntary and actively elicited reports of adverse events were documented. The mean change in IOP over 24 weeks was the primary outcome measure. Both groups were compared for statistically significant differences at all visits. A P < 0.05 was considered statistically significant.RESULTS:A total of 178 patients were randomly assigned to G. kola and Timolol groups. At baseline there were no differences in mean IOP between groups, based on age, sex, or diagnosis. At the end of the study period (24(th) week), the mean (+/- SD) reduction in IOP was 12.93 +/- 2.3 mmHg (47.8% +/- 0.8% reduction) in G. Kola group and 13.09 +/- 2.8 mm Hg (48.2% +/- 1.03% reduction) in the Timolol group (P > 0.05). Adverse events were mild in nature with no statistically significant differences between groups (P > 0.05).CONCLUSIONS:Garcinia kola ophthalmic solution significantly reduces IOP as compared to baseline. The IOP lowering effect of both treatments was equivalent

Audiometric Findings in Waardenburg's Syndrome amongst the Institutionalised Deaf Blind in Kaduna-Nigeria

Introduction:Waardenburg's syndrome is a rare inherited disorder of congenital hearing loss and Pigmentary disturbances of the eyes; hair; skin and neural crest derivatives. Methodology: 620 students in a deaf/blind school were examined and four had Waardenburg's syndrome with a frequency of 0.65. 2 males and 2 females with Waardenburg's syndrome and age ranges between 10-19years (mean 15.75years) All 4 subjects had complete blue irides; white forelock and sensorineural hearing loss; and thus met the diagnostic criteria. They were then subjected to Audiometric assessment. Results: Otoscopy was essentially normal but Audiometry revealed sensorineural hearing loss [SNHL] in all the subjects ranging from severe to profound with one subject being stone deaf. Conclusion: Waardenburg's syndrome is a rare disorder in our environment although it may be under reported.Two of the subjects benefited from amplification and were given hearing Aids. Provision of early amplification cannot be over emphasized

Conjunctival impression cytology and biochemical assessment of vitamin A status in Nigerian children.

The study was part of a national survey designed as cross-sectional population survey to estimate the prevalence of Vitamin A deficiency in Nigeria. A multistage cluster random sampling technique was used to select about 163 children between 6 and 71 months of age in 2 health zones of Nigeria, for assessment of their vitamin A status. Conjunctival Impression Cytology (CIC) was compared with biochemical method by estimating serum level of vitamin A using the reverse phase high pressure liquid chromatography (HPLC). Conjunctival impressions were taken from both temporal bulbar conjunctivae of 483 children using the disc applicator. CIC showed significant association with low serum retinol (0.70 umol/l) levels. Children with abnormal CIC had 2.6 times the risk of having low serum retinol levels compared with those with normal CIC (OR = 2.6, 95% C.I = 1.03-6.67). When CIC was classified as normal and abnormal at cut off points of retinol at 0.70 and 0.35 umol/l, the sensitivity of CIC remained low, while the specificity remained high. Although our study did not demonstrate valuable use of CIC as a screening tool under field conditions in a tropical environment like Nigeria, our impression is that, if the technique is further refined and evaluated, there is a high potential for its use in developing countries, because of its simplicity, practicability and non-invasiveness.

Risk factors for optic nerve disease in communities mesoendemic for savannah onchocerciasis, Kaduna State, Nigeria.

Ophthalmic examinations on 6831 individuals aged 5 years or more, living in 34 guinea savannah communities mesoendemic for onchocerciasis, in Kaduna State, Nigeria, revealed a relatively high prevalence (9%) of optic nerve disease (OND). Further investigations were performed to determine what proportion of this burden of OND might be due to onchocercal infection. Information on history of cerebro-spinal meningitis (CSM), past use of diethylcarbamazine (DEC) and chloroquine, consumption of cassava and locally produced alcohol was collected for all individuals by questioning. In addition, a nested case-control study of 81 cases of OND and 136 age and sex-matched controls was performed to investigate whether syphilis or a variety of other neurological disorders were responsible for a substantial proportion of cases of OND. Our data suggest that in this population, onchocercal infection is the single most important cause of OND and may account for 50% of all cases. Some 13% of cases were associated with signs suggestive of glaucoma. DEC use might be responsible for up to 30% of all OND. We found no evidence to suggest that any of the following are important causes of OND in the communities studied: CSM, syphilis, neurological syndromes such as polyneuropathy or other generalized neurological disease, consumption of raw cassava, consumption of locally prepared alcohol.

An outbreak of acute haemorrhagic conjunctivitis in Kaduna, Nigeria.

Clinical studies were carried out on two groups of patients with acute haemorrhagic conjunctivitis (AHC) during an epidemic in 1985 in Northern Nigeria. Group 1 consisted of 99 students attending a girls' boarding school, group 2 of 200 patients selected randomly from 1000 examined at the local clinic. Moderate to severe hyperaemia and papillary responses were present in the palpebral conjunctiva of all patients, and 234 (66%) had subconjunctival haemorrhages. Transient superficial punctate keratitis was noted in over 60% of patients. A transient flare suggestive of a low grade iritis was seen in five patients. No neurological disorders were noted. Serological studies were carried out on patients from group 2. Fifteen paired and 20 single serum samples were titrated against adenovirus type 4 (Ad-4) and enterovirus type 70 (EV-70). Two pairs of sera showed a 4-fold rise in antibody levels to EV-70, whereas the antibody titres to EV-70 in the rest of the sera ranged from 1:20 (no antibody) to 1:160. None of the paired serum samples showed a 4-fold rise in antibody levels to adenovirus. The results of clinical studies and serological findings support EV-70 as a probable cause of AHC in Nigeria.