Induced Membrane Technique of Masquelet; A Viable Option in Treatment of Post-Trauma Segmental Bone Loss: A Case Report.

In trauma and orthopaedic practice, the management of segmental bone loss constitutes a major challenge to the surgeon. Several methods have been employed in bone reconstruction with varying objectives depending on the size of the defect in question. A gap of not more than 2cm may benefit from acute docking and fixation, 4cm gap can be managed by non-vascularized structural or non-structural graft with fixation. Gaps of more than 4cm can be managed by numerous options which include allograft, vascularized structural graft and distraction osteogenesis with either linear rail system (LRS) or Ilizarov device. Masquelet technique of induced membrane formation is used to bridge a gap of more than 5cm and up to 25cm using bone cement as a spacer in first stage and use of autologous cancellous bone graft in the second stage.

En traumatologie et en orthopédie, la prise en charge de la perte osseuse segmentaire constitue un défi majeur pour la chirurgien. Plusieurs méthodes ont été employées dans la reconstruction d'os avec des objectifs variables en fonction de la taille du défaut en question. Un écart de pas plus de 2 cm peut en bénéficier de l'amarrage et de la fixation aigus, un écart de 4 cm peut être géré par structurelle non vascularisée ou greffe non structurelle avec fixation. Les espaces de plus de 4 cm peuvent être gérés par de nombreux options qui incluent allogreffe, greffe structurelle vascularisée et ostéogenèse par distraction avec l'un ou l'autre des systèmes de rails linéaires (LRS) ou appareil Ilizarov. Technique de Masquelet d'induit la formation de la membrane est utilisée pour combler un espace de plus de 5 cm et jusqu'à 25 cm en utilisant du ciment osseux comme espaceur dans la première étape et l'utilisation d'une greffe d'os spongieux autologue dans la deuxième étape. Mots clés: Défaut osseux segmentaire, ostéogenèse par distraction, technique de membrane induite, espaceur de ciment osseux.

Peripheral Gangrene and Extremity Amputations - Painful Preventable Sequelae of Meningococcal Septicaemia: Case Series Reports.

Extremity gangrene is a fairly common pathology, which complicates systemic vascular and endocrine diseases. Most often, it is encountered in diseases like uncontrolled Diabetes Mellitus, presenting as diabetic foot gangrene, severe peripheral arteriosclerosis with gangrene of the extremity complicating severe uncontrolled systemic hypertension and meningococcal septicaemia with peripheral gangrene. It also occurs in some cases of snake bite as well as frost bite (in regions with extreme cold weather conditions). Some of them present as monolateral extremity gangrene. However, others present as bilateral symmetrical peripheral gangrene (SPG) characterized by bilateral extremity ischaemia resulting in gangrene in which there is no major vascular occlusive disease. There is disseminated intravascular coagulation with the gangrene being considered as a cutaneous marker and some of the patients that survive ultimately require amputation of the affected limb(s) in the severe cases. The mild cases end up losing some of the digits or just exfoliation of the dead cutaneous layer. The effects are generally more severe in the lower limbs than in upper limbs. Notable among these are some of those complicating meningococcal sepsis resulting from peripheral intravascular coagulation. We present here, five patients who presented with varying degrees of peripheral gangrene during an epidemic of meningitis and the treatments that were carried out depending on the severity of their cases.

Open Laminectomy for Lumbar Spinal Canal Stenosis due to Prolapsed Lumbar Intervertebral Discs.

BACKGROUND: Back pain due to prolapsed intervertebral disc accounts for two thirds of all visits to the orthopaedic clinic. The incidence of this disease is increasing with the increased sports activities in the young and due to degeneration in the elderly. Open lumbar microdiscectomy remains the gold standard amongst surgical procedures for herniated discs with or without instrumentation. However, percutaneous/ endoscopic microdiscectomy is gaining popularity. In our environment, high cost and paucity of instrumentation and skills militate against the use of such technique. In the western world, improvement in the mentioned skills and instrumentation and shorter rehabilitation time make minimal access surgeries more appealing than open microdiscectomy in recent times. MATERIALS AND METHODS: Patients with clinical signs and symptoms of spinal canal stenosis secondary to isolated lumbar disc herniation were investigated with plain radiographs and magnetic resonance imaging (MRI). All those with definite canal stenosis as seen on the MRI that were not responsive to conservative therapy or those with rapidly deteriorating clinical outlook without instability were included to have open Laminectomy without instrumentation. Their preoperative and postoperative walking distance, their modified Roland-Morris disability indices, Their pain numeric score (NRS), their anteroposterior distance of the spinal canal at maximal site of stenosis and finally the absence or presence of preoperative and post operative anteroposterior/instability. RESULTS: Twenty patients had open Laminectomy. There was significant improvement in the postoperative pain numeric score, the walking distance, the Roland Morris disability score. There was no evidence of postoperative instability on the plain radiograph. CONCLUSION: Open Laminectomy remains a useful tool in the treatment of patients with lumbar spinal canal stenosis due to prolapsed intervertebral discs.

Fractures in Children Aged 0-12 Years and their Management as seen in North Central Nigeria.

BACKGROUND: Childhood injuries are often associated with fractures, and it is said to account for about 25% of all paediatrics trauma. There is a male preponderance and the peak incidence occurs among primary and secondary school age groups. The occurrence and management of these fractures are influenced by season, geographical location, educational and socio-economic status of the populace as well as time of presentation and availability of suitable facilities for treatment. OBJECTIVES: To analyse the demographic characteristics of the subjects, aetiological factors, fracture distribution, educational and occupational status of their parents, mode of treatment and their outcomes. SUBJECTS AND METHODS: We carried out a prospective study on children 0-12 years of age at the University Teaching Hospital, Zaria, Nigeria, with fractures who consented to the study from January 2013 to December, 2016. Eight-six children were recruited through the Accident and Emergency Department. Diagnosis was made by both clinical and radiological assessment. They were managed by either non-operative or operative modality. Their complications were also managed. Their follow-up was for 12 months. RESULTS: A total of 86 children with 86 fractures were enrolled with mean age of 7 years and male/female ratio of 2:1. The main aetiological factors were road traffic accidents (52.4% from cars, motorcycle and tricycle), followed by falls from heights (40.0%). Forearm bone fractures were the commonest (30.2%). Non-operative modality dominated the management (72.1%). Complication rate was 20.4%. CONCLUSION: Fractures in children have a male prepon-derance with the radius being most commonly involved. Non-operative management was the main modality of treatment.

On the use of drains in orthopedic and trauma.

INTRODUCTION: The use of drains in trauma and Orthopaedic practice has been affected by the concept of evidence based medicine that has become accepted as standard of care for all surgical or medical practice, which questions all care processes that cannot be backed by evidence to be beneficial to the patient. There have been a large number of multi centre meta-analytical studies that found drains to be of little or no benefit in trauma and Orthopaedic operations. Because of these studies, there are few situations where drains are routinely used e.g. Calcaneal fractures in developed countries. Even major procedures like total knee and arthroplasties are being performed without drains. We set to find out whether such evidence can be found in our practice. MATERIALS AND METHODS: Between 2004 and 2012, eighty six patients matched for sex and type of injury and operative procedures to be done were prospectively selected and assigned to use or no use of drains in their operations. Complications like haematoma, drain migration, infection, inadvertent drain stitching were observed in the two groups. RESULTS: Eighty six major orthopaedic operations were studied. There was no evidence of occurrence of complication arising from non use of drains in the undrained group. Those patients whose wounds were drained had no need for drain change thus making the wound care less eventful CONCLUSION: Postoperative wound drains make for neat postoperative period with less tissue swelling. There was no statistically significant differences between the drained and undrained wounds in terms of infection rates, haematoma or seroma formation.

Congenital gangrene of the extremities in a newborn.

Gangrene of the extremities in the newborn is extremely rare at birth. Less than 100 cases have been reported worldwide. Its etiology is obscure in many cases; however, some factors have been associated with it in the newborn, which include vascular injury and embolism. We report a case of a baby with congenital bilateral lower limb gangrene caused by thromboembolic phenomenon from retroplacental hematoma following abruptio placentae and highlight the challenges of managing such condition in resource-poor setting.

The doctrine of informed consent in surgical practice.

Physicians and other professionals in the field of medicine have to perform invasive and non-invasive procedures on patients as part of their duties. There is a legal basis upon which these procedures are done; this is called 'informed consent.' Sociocultural factors have strong influence on the sick role. These factors influence the application of informed consent in Nigeria.

Use of non-vascularized autologous fibula strut graft in the treatment of segmental bone loss.

BACKGROUND: Fractures resulting in segmental bone loss challenge the orthopedic surgeon. Orthopedic surgeons in developed countries have the option of choosing vascularized bone transfers, bone transport, allogenic bone grafts, bone graft substitutes and several other means to treat such conditions. In developing countries where such facilities or expertise may not be readily available, the surgeon has to rely on other techniques of treatment. Non-vascularized fibula strut graft and cancellous bone grafting provides a reliable means of treating such conditions in developing countries. MATERIALS AND METHODS: Over a period of six years all patients with segmental bone loss either from trauma or oncologic resection were included in the study. Data concerning the type of wound, size of gap and skin loss at tumor or fracture were obtained from clinical examination and radiographs. RESULT: Ten patients satisfied the inclusion criteria for the study. The average length of the fibula strut is 7 cm, the longest being 15 cm and the shortest 3 cm long. The average defect length was 6.5 cm. Five patients had Gustillo III B open tibial fractures. One patient had recurrent giant cell tumor of the distal radius and another had a polyostotic bone cyst of the femur, which was later confirmed to be osteosarcoma. Another had non-union of distal tibial fracture with shortening. One other patient had gunshot injury to the femur and was initially managed by skeletal traction. The tenth patient had a comminuted femoral fracture. All trauma patients had measurement of missing segment, tissue envelope assessment, neurological examination, and debridement under general anesthesia with fracture stabilization with external fixators or casts. Graft incorporation was 80% in all treated patients. CONCLUSION: Autologous free, non-vascularized fibula and cancellous graft is a useful addition to the armamentarium of orthopedic surgeon in developing countries attempting to manage segmental bone loss, whether created by trauma or excision of tumors.