Clinical measurement of angular profile of the knee and correlation with intermalleolar distance in children in Enugu metropolis.

BACKGROUND: Angular deformities of the lower limbs are commonly encountered deformities in pediatric orthopedic clinics. The values of the tibiofemoral angle undergoes changes as the child grows and these changes are self-limiting. The aim of the study is to establish the normal variation of knee angles of children between 2 and 12 years of age in Enugu metropolis and to establish any correlation between the knee angles and the intermalleolar distances (IMDs). SUBJECTS AND METHODS: This study was done on 630 school children in Enugu metropolis between the age groups of 2 and 12 years. Multistage sampling was used in the study. The tibiofemoral angles and intermalleolar/intercondylar distances were measured. RESULTS: The maximum tibiofemoral angle from this study was 7.6° ± 2.4° and the age corresponding to this value was 4 years. Only 23 subjects (3.5%) had varus knee angle. The values of the mean tibiofemoral angle and IMDs plateaued from 8 to 12 years. There was a significant positive correlation between average knee angle and IMD (r = 0.785, P < 0.001). CONCLUSION: The physiological changes in the knee angle (tibiofemoral) follow a similar pattern as established in the literature and there was positive correlation between IMD and the tibiofemoral angle.

Musculoskeletal complications of sickle cell disease in Enugu, Nigeria.

BACKGROUND: Sickle cell disease (SCD) is one of the most important haemoglobinopathies. It is an autosomal recessive genetic condition in which a defective form of haemoglobin, haemoglobin S (HbS) results from a single amino acid substitution. The amino acid valine replaces glutamic acid at position 6 in the beta globin gene. Musculoskeletal complications are often observed in the evolution of this disease and are common causes of morbidity and disability in these patients. The objective of this study is to describe the pattern and presentation of musculoskeletal complications in sickle cell disease at the National Orthopaedic Hospital Enugu Nigeria. METHOD: a retrospective review of the patients with musculoskeletal complications who are genotype-confirmed sicklers who were treated in our hospital from January 1993 to December 2007 was carried out. The data collected included age, sex, complications, anatomic site, grade of disease, treatment, outcome of management and follow up. Patients with incomplete data were excluded from the study. RESULTS: Twenty seven patients with musculoskeletal complications of SCD were treated within the study period. Two patients were excluded from the study because of incomplete data. Twenty-five patients with 44 complications were analyzed. The age range was between 7 years to 30 years with a mean age of 19.2 years. Fifty six percent of patients were males. Malleolar ulcers were the commonest complications. This was followed by avascular necrosis (AVN) of the femoral head and osteomyelitis. Septic arthritis and osteomyelitis were most common in children less than 10 years while avascular necrosis and malleolar ulcers occurred more commonly in patients more than 15 years. Majority of the malleolar ulcers were treated by split skin grafting. Seventy five percent of the femoral head avascular necrosis was treated conservatively CONCLUSION: Musculoskeletal complications are common causes of morbidity and disability in sickle cell disease. Malleolar ulcers were the commonest musculoskeletal complications. The predominant presentation in children below the age of 10 years is osteomyelitis and septic arthritis while AVN and malleolar ulcers occurred mostly in adolescents.

Implant associated surgical site infection in orthopaedics: a regional hospital experience.

BACKGROUND: Post operative surgical site infection following implant surgery is a major problem in orthopedic surgical practice. Infection occurring after internal fixation of a fracture is a devastating complication and may be difficult to treat. The frequency of occurrence of surgical site infection has decreased with improvements in aseptic technique. The objectives of the study are to determine the incidence of surgical site infection following orthopaedic related implant surgeries and to indentify the predisposing factors. METHODS: The study was a prospective study conducted at the National orthopedic hospital, Enugu. Wound surveillance was carried out for the 97 patients included in this study for a period of 6 months postoperatively. The diagnosis of surgical site infection was in accordance with the CDC's guideline for prevention of surgical site infection published in 1999. RESULTS: The study included 61 males and 36 females giving a ratio of 1.7:1. The study population was aged 7 to 83 years with a mean age of 38.7 +/- 18.3 years. The infection rate was found to be 9.3% with staphylococcus aureus as the most common causative organism in 55.6% of cases. Two of the nine infected cases required implant removal. Significant factor was a theatre population of more than 6 persons. CONCLUSION: Surgical site infection following implant surgery is relatively common in our environment with staphylococcus aureus as the major causative organism. Increased theatre populations increase the risk of implant associated surgical site infection.

Concerns, attitudes, and practices of orthopaedic surgeons towards management of patients with HIV/AIDS in Nigeria.

The increasing number of people living with HIV/AIDS is causing concern among surgeons over risk of occupationally acquired HIV infection. This may influence their attitude to such patients. The purpose of this study was to develop a cross-sectional survey of orthopaedic surgeons to assess their concerns, attitudes, and practices towards management of HIV-positive patients in Nigeria. All respondents were males, 55 (73.3%) of them indicated concern over the risk of occupational acquisition of HIV infection and 37 (49.3%) had examined or operated on at least one HIV/AIDS patient. Sixty (79.9%) were willing to be tested for HIV and 51 (67.9%) were previously tested. Fifty-seven (75.9%) would order preoperative HIV screening of high risk patients, and 67 (89.3%) would operate on HIV-positive patients. Most orthopaedic surgeons in Nigeria would operate on HIV-positive patients.

The efficacy and toleration of celecoxib (Celebrex) in the treatment of osteoarthritis in Nigeria: a multicentre study.

BACKGROUND: Non-selective, non-steroidal anti-inflammatory drugs (NSAIDs) are effective in terms of pain relief and improving function in osteoarthritis. The advent of cyclooxygenase-2 (Cox-2) specific inhibitor, celecoxib, in the treatment of osteoarthritis has shown similar efficacy in relieving pain in osteoarthritis with low incidence of GI (Gastrointestinal) symptoms. OBJECTIVE: To determine the efficacy and toleration of celecoxib in treatment of osteoarthritis in Nigerian population. METHODS: Eighty patients were recruited from six tertiary health institutions scattered over Nigeria. A fixed dose of 200 mg celecoxib was administered daily with patient seen on the second and six weeks after commencement of study. Efficacy of the drug and safety were assessed during the study. RESULTS: The patients had a mean age of 57.8 years with a standard deviation of 13.3 year. The mean weight was 74.7 +/- 14.9kg while the female sex constituted the majority (73.8%) of the patients. Using the physician global assessment of osteoarthritis instrument, 36.3% of the patients were rated as having poor arthritis score at baseline. This value reduced to 2.6% at second visit and 0.00% at end of the study respectively. There was no significant difference between the vital signs, haematological indices, renal and hepatic function at baseline and the final visit. There was no case of serious adverse effect. CONCLUSION: The study showed statistically significant improvements in the symptoms of osteoarthristis following the administration of Celecoxib 200mg daily for six weeks.