Tophaceous gout: a case of bilateral carpal tunnel syndrome

Gouty tenosynovitis may present as infection, tendon rupture, nerve compression and/or digital stiffness. We report a case of tophaceous gout which presented as bilateral carpal tunnel syndrome (AU)

Resistance training and the elderly: an effective alternative for the osteoarthritic patient - abstract

The aim of this prospective study of 20 patients with moderate or severe osteoarthritis was to determine the effectiveness of a one-year regime of aerobics and strength training. In all patients mobility and social life were significantly limited due to pain and stiffness in the joints. Bedridden patients with contractures of the hips and knees were excluded from the study. Muscle strength, flexibility, balance, level of pain and quality of life were measured before, and after 6 weeks, 3 months, 6 months and 1 year of the regime. Each patient served as his/her own control and for the group as a whole. The results showed that with progressive training there were significant gains in strength, flexibility and aerobic capacity (not highlighted in this study). These gains correlated with the decrease in pain and stiffness and the improvement in the quality of life for these patients. This study clearly illustrated that resistance training is a necessary adjunct in the management of patients with osteoarthritis. In many Caribbean countries, this form of treatment may be a cost-effective alternative to the expensive joint replacement programme in the management of patients with disabling osteoarthritis (AU)

Fibrodysplasia ossificans progressiva: report of a case in Trinidad and Tobago

A case of fibrodysplasia ossificans progressiva is herein reported in a 27-year-old black woman. This is a very rare condition, the first reported from Trinidad and Tobago. (AU)

Musculo-skeletal sport injuries in Trinidad & Tobago - abstract

It is well-known fact that exercise is an essential activity in order to maintain a healthy life style. However, the benefits of exercise may be minimized if the risk of injury is high. This 2-year retrospective study analyzed the risk of injury from sporting events in our community. One thousand, nine hundred and eighty-six elective and emergency referrals in our Orthopaedic Unit over this period were studied. Of 1,410 emergency referrals 846 (60 percent) were musculo-skeletal injuries resulting from sporting activities. Among 576 clinic referrals 192 (33 percent) were musculo-skeletal sporting injuries. The risk of injury was found to be 60 percent. Most of the injuries (50 percent) resulted from soccer and occurred in the over 35 years age group. A significant number of these injuries (25 percent) were of such severity as to cause hospitalization and job absence for over 3 weeks. Contributory risk factors found were age, physical fitness, alcohol abuse, the presence of chronic injury, inappropriate footwear, inadequate protective geat and non-compliance with the rules and regulations of the sport (AU)

Sudden death in athletes in Trinidad and Tobago

Sudden death related to exercise activity is a well-recognised clinical syndrome. Although the incidence is low, it is always an agonizing experience to all concerned when a young, relatively healthy individual dies suddenly. Over the last four years, we have had six proven cases of sudden death in athletics. The cause varied from congenital to acquired pathology of the heart, and there was one case of heat stroke. From this study, we were able to analyse some of the risk factors and, from a review of the literature, we are able to determine (1) the feasibility of a screening programme, and (2) the design of such a programme as would be suitable for our environment. (AU)

Anterior dislocation of the shoulder: a local study - abstract

Anterior dislocation of the shoulder joint is still a common injury following trauma. In this study, we encountered 130 cases over a two-year period. Only cases of first dislocation were included, and patients with epilepsy and neurological deficit were excluded. All were treated by closed reduction and a supervised pro-epilepsy and neurological deficit were excluded. All were treated by closed reduction and a supervised programme of physiotherapy after immobilization and were followed up for 2 years. The type of immobilization varied from collar and cuff for 2-3 weeks (60 patients), collar and cuff for 4-6 weeks (40 patients) and body bandage for 4 - 6 weeks (30 patients). There were 18 (14 percent) females and the 3 main cause of dislocation were sports injurues (78 percent), interpersonal conflicts and road traffic accidents (14 percent) and home injuries (6 percent). The rate of recurrence was not related to the period or type of immobilization and was 15.6 percent in the 18 - 30 years age group after 2 years which is much lower than other reported studies. We believe that a supervised period of physiotherapy following a short period of immobilization after closed reduction reduced the risk of recurrence (AU)

Sudden death in athletes in Trinidad and Tobago - abstract

Sudden death related to excercise activity is a well recognized clinical syndrome. Although the incidence is low, it is always an agonizing experience to all concerned when a young, relatively healthy individual dies suddenly. Over the last 4 years, we have encountered 6 such cases, all males 5 of whom were under 30 years of age. In 4 patients, the cause of death was a congenital heart anomaly, one, the oldest at age 33 years, had an acquired cardiac condition, and the sixth patient died of heat stroke. An adequate pre-excercise screening tool for recreational and middle-aged athletes appears to be the `Preparation for Activity Readiness Questionnaire' (PAR-Q), and in the younger athlete who may be at increased risk for medical problems, it has been suggested that specific cardiac investigations should be considered. To minimize the occurrence of heat stroke in long distance runners in Trinidad and Tobago, a programme of education among athletes and race organizers has been implemented, supplemented by a set of guidelines provided to all athletes and their clubs (AU)

Gas gangrene following compound fractures

The authors report on the management of 4 cases of gangrene. These cases are presented to remind clinicians of the possibility of this complication following compound injuries. Two cases were treated with hyperbaric oxygen. The importance of keen index of suspicion in the early diagnosis of gas gangrene together with the use of hyperbaric oxygen in cases of spreading myositis negates the need for mutilating surgery. (AU)

Arthroscopy: an initial experience

Diagnostic arthroscopy is a useful adjunct to clinical and radiological examinations in assessing internal derangements of the knee. This series of fifty cases shows an average diagnostic accuracy of approximately 90-92 percent. This accuracy varied from 85 percent in the early stages to 98 percent in the later cases. We have found this procedure to be of significant value in assessing acute sports injuries of the knee joint, allowing early treatment and full rehabilitation of the athletes. (AU)

Proximal femoral fractures in the elderly factors affecting the mortality rate - abstract

The average life span of people within the Caribbean region has increased significantly over the last 3 decades. This has resulted in an increase in the incidence of proximal femoral fractures. Published series show a mortality rate ranging from 6.5 percent to 60.5 percent The rate is affected by the type of management. It is low in cases that have operative fracture fixation within the 1st week after admission and high in cases treated conservatively. In our series of 51 cases, over a 2-year period, there were 41 females and 10 males, aged 53 to 100 yrs. (mean 84 yrs.). The overall mortality rate was 28 percent. Twenty-one cases had surgery. The time from admission to surgery was 4 to 30 days (mean 13 days). The post-operative hospital stay averaged 13 days. In this group that had internal fixation of the fracture, the mortality rate was 14 percent for those patients who were operated on within 10 days of injury of the mortality rate was 6 percent. The mortality rate for those cases treated conservatively was 55 percent. Thirty-five per cent of the patients developed decubitus ulceration over the buttocks, scapular and heel regions; 40 percent developed urinary tract infection. We suggest that the benefits of surgery far outweigh the complications of prolonged conservative management. Not only does early internal fixation of the fracture with early ambulation reduce the mortality rate, it also results in a significant cost saving when compared with treatment by prolonged traction (AU)

Myocutaneous flaps and the West Indian general surgeon - abstract

Although myocutaneous flaps are not yet widely used in the West Indies, their use has facilitated reconstructive surgery in difficult cases. Because many of our patients present with advanced disease and since multidisciplinary teams are usually unavailable, these reliable flaps could be very valuable. From November 1983 to 1987, we have performed 30 flaps in 29 cases. There were 18 rectus abdominis flaps for primary (9) or recurrent (8) breast cancer, or necrotising fascitis (1); in this group, there was 1 partial (10 percent) loss and 1 total loss of the graft. Seven gastrocnemius grafts were done for tibial non-union (3), osteomyelitis (2) or traumatic soft tissue loss (2); there were 4 latissimus dorsi, and 1 trapezius, grafts. Primary healing was achieved in all the cases except the two abdominal flaps. Unlike the traditionally used tubed-skin flap, the musculo-cutaneous flap can be performed at one operation. The excellent vascularity also helps the graft to withstand radiotherapy and resist infection. Thus, use of a myocutaneous flap permits wide resection of tumour or generous debridement of infected tissue with immediate reconstruction in one stage. Its high success rate, with primary healing, makes it an extremely valuable tool in the armamentarium of the West Indian general surgeon (AU)

Heat injuries in Trinidadian long distance runners - abstract

Long distance running in hot environmental conditions is plagued by many medical problems, heat injuries being the commonest and most severe. During the period October 1985 - October 1987, we have studied 12 running events of 10 km or more, in which a total of 5,624 athletes participated. There was 450 cases of heat injury (8 percent) with 1 death from heat stroke. The number and severity of the injuries were directly proportional to the effective temperature. All the injuries occurred when the temperature was 85§F - 96§F and the relative humidity waas above 75 percent. There was also a direct relationship with the level of training (miles per week) and injury. The number of injuries was higher in those races where the Sports Medicine Association was not involved in the organisation (13 percent). We have drawn up guidelines which are available from the authors. They include recommended starting times, water and shower availability and the provision of medical facilities. There should be an improvement of race organisation, extensive competitor education and updating of the knowledge of medical personnel involved in these events (AU)

Idiopathic scoliosis in a Jamaican population - abstract

This two-year retrospective study analyses the results of operative treatment of patients with idiopathic scoliosis, using the Harrington Instrumentation. The series consists of 63 consecutive cases, 50 boys and 13 girls. The average age at presentation was 16 years and the curves varied from 42§ to 86§. Most of the curves affected the dorso-lumbar vertebrae and the majority were convex to the right; 10 percent of the cases showed clinical evidence of neurofibromatosis and 15 percent had a marfanoid appearance with no systemic evidence of Marfan's syndrome. Seven cases were treated pre-operatively with a Risser's turnbuckle cast. Operative treatment consisted of correction of the major cure with a Harrington distraction rod and posterior fusion. On-lay bone graft was done using bone obtained from the spinous processes of the vertebrae. No additional bone was used. Post-operatively, all patients were nursed free on a Stryker frame for fourteen days. After this, an underarm plater jacket was applied. This was worn for three months. Patients were discharged after the jacket was applied and were allowed to attend school. Only restricted activities were allowed then. Full activities were allowed after the jacket was removed. The average correction obtained was 33 percent and the mean loss of correction after one year was 4§. The complications were varied and consisted of minor wound sepsis, temporary neurological deficit in two cases, intestinal obstruction in one case and pseudo-arthrosis in one cases. The scoliosis programme in Jamaica has contributed significantly to the improvement in the quality of life of affected patients. The emphasis now is on early detection and institution of early conservative management (AU)

The use of Perkin's traction without external splintage in the treatment of femoral shaft fractures - abstract

This study was done to show that external splintage in Plaster casts was unnecessary in the conservative management of femoral shaft fractures and that early mobilization and rehabilitation are possible in our environment. Skin traction was used in the young children initially and they were later mobilized to full weight-bearing. In the older children and adults, skeletal traction with a tibial Steinmann's pin was used. They were later mobilized on crutches after a short period of knee flexion exercises on a split bed. There were sixty-two patients. In the 5-11 year age group, all the nine patients achieved full weight-bearing after five weeks. In the 11-17 year age group, all the eight patients were mobilized on crutches with partial weight-bearing after five weeks and were fully weight-bearing after ten weeks. In the 17-30-year age group, nineteen of the 21 patients were mobilized on crutches (non-weight-bearing) after six weeks and were fully weight-bearing after twelve weeks. In the 30-50 year age group, twenty-two of the 24 patients were on traction for an average of 6.5 weeks and were then mobilized on crutches, non-weight-bearing. They were full weight-bearing after twelve weeks. There were one death and two re-fractures. One patient needed an open reduction and internal fixation for muscle interposition. complications were minor and consisted of mild pin tract infections and mild decrease in full knee flexion. The result of this study demonstrate that traction and early mobilization are successful (AU)

Fasciocutaneous flaps for lower extremity salvage - abstract

Compound injuries to the lower limb with substantial soft tissue loss are traditionally resurfaced with distant jump flaps, cross-leg flaps or local random flaps. They have a high incidence of flap necrosis, limited flap size, and involve prolonged immobilization and multiple procedures. The use of muscle flaps has a better prognosis but are technically difficult: they detach functioning muscle and require expensive equipment. Fasciocutaneous flaps offer a solution as they provide soft tissue padding, have a rich vascular supply, are simple to perform with an avascular plane of dissection, lead to less contour defect and do not require rigid plaster immobilisation postoperatively. Over the past 12 months, we have used fasciocutaneous flaps in seven cases with exposed tibiae due to compound fractures and in an eighth case with an exposed calcaneus. Two of the patients had local transposition flaps while five had cross-leg flap, probably due to rinking of the flap postoperatively; the flap was sufficient to allow for excision and advancement. The immobilisation and length of hospital stay were significantly reduced. The value of the fasciocutaneous flap as a simple, safe method of providing well-vascularised, soft tissue coverage of defects of the leg has been demonstrated (AU)

Extrapelvic enodometriosis presenting as unusual swellings of the buttock and thigh

We present the first case of extrapelvic endometriosis (EPE) presenting as combined swellings of the thigh and buttock in 28-year-old nulliparous woman. The diagnosis was aided by the history of cyclical symptoms, needle aspirate, ultrasonography and computed tomography scan and was confirmed by histological analysis of the exercised specimens. Of note, laparoscopy showed the pelvis to be free of gross disease. Surgical excision combined with hormonal suppression therapy proved adequate treatment in preventing recurrence as well as the complications of wound implantation. (AU)