Nigerian Journal of Orthopaedics and Trauma

Six Years On!

Icha Inalegwu Onche — 2020-08-26

No Abstract.

Factors Influencing the Choice of Orthopaedic Surgery Specialty Amongst Medical undergraduates in Enugu Nigeria

Ndubuisi O.C. Onyemaechi — 2020-08-26

Background: There is need for equitable distribution of specialist workforce in every healthcare system. The composition and pattern of specialists is largely determined by the specialty preferences of medical undergraduates. The preference of orthopaedic surgery specialty by medical
undergraduates has been poor. The study aimed to determine the factors that influenced the choice of orthopaedic surgery.

Methods: A descriptive cross-sectional study was conducted among final year medical undergraduates of College of Medicine, University of Nigeria. A structured selfadministered questionnaire was used to collect information on the socio-demographic profile of the students, the specialty preferences and the factors that influenced their choices.

Result: A total of 152 students were studied. The most preferred first choice specialties were general surgery (19.7%), obstetrics and gynaecology (14.5%), and public health (10.5%). Radiology (1.7%), orthopaedic surgery (2%) and plastic surgery (2%) were among the least preferred specialties. About half of the students (50.6%) of the students preferred surgical specialties to non-surgical specialties. A total of 17 students (11.2%) chose orthopaedic surgery as either first or second choice specialty. The factors that influenced the choice of orthopaedic surgery were personal abilities, personal abilities and career prospects.

Conclusion: There is low level of interest in orthopaedic surgery among our medical undergraduates. Reviewing the undergraduate medical curriculum to increase the period of clerkship in orthopaedic surgery may change this trend.

Keywords: specialty, choices, medical students, Enugu, Nigeria

Early Outcome of Open Locked Intramedullary Sign Nail in Closed Tibial Diaphyseal Fracture

S.N. Ubi — 2020-08-26

Background: Fracture of the tibial shaft is a major cause of morbidity and mortality in patients with lower extremity injuries and it is especially prevalent in the economically active age group 3. The treatment of tibial shaft fracture has always been a focus of interest and has undergone significant evolution over the past century. Currently, interlocking intramedullary nail has emerged as the treatment of choice for tibial shaft fractures. Open locked intramedullary nailing with the aid of an external jig (without the use of an image intensifier) is increasingly being used in
resource poor countries like ours. The study was aimed at evaluating the early outcome of tibial shaft fracture treated by open method of locked intramedullary SIGN nailing.

Patients and Methods: The study was carried out in National Orthopaedic Hospital, Igbobi Lagos (NOHIL) from July 2015 to July 2016. A prospective, interventional study was carried out on skeletally mature patients or age = 18 years, with unilateral closed tibial shaft fractures. Seventy six patients, who met the inclusion criteria and completed a minimum of 24 weeks of follow up, participated in the study. A structured questionnaire was used to interview the participants. Data was analysed with regards to the clinical and radiological outcome to evaluate the effectiveness, outcome and morbidity associated with the procedure

Results: The peak age was 25-34 years. Male to female ratio was 2:1. Road traffic accidents were the most common (86.9%) mechanism of injury. Most of the fractures were comminuted (40.8%), the fractures were mostly located in the distal third (32%). The SIGN nail with its external jig
system (without the aid of image intensification) was utilized in all cases. The patients were followed up for 24 weeks. During follow up visits, the state of the wound, limb length discrepancy, malrotation deformity, range of motion of the knee joint and rate of fracture union were assessed. The
mean time to fracture union was 17.5±4.8 weeks. Fracture union was achieved in all the patients though there was delayed union in 15 (20%) cases. There was no incidence of nonunion, malunion, broken implant or screw loosening. Only two patients had superficial wound infection, no patient
had deep wound infection. Eighty four percent of our patients were satisfied with the outcome of treatment, using the Johner and Wruhs' outcome measure.

Conclusion: Open locked intramedullary SIGN nail is a safe and effective treatment modality for closed tibial shaft fractures in developing countries where image intensifiers and fracture tables are not readily available.

Keywords: Tibial Fracture, Locked intramedullary nail, SIGN nail, Johner and Wruhhs outcome measures

Profile of extremity injuries caused by Motorcycle accidents seen at Lagos University Teaching Hospital, Lagos Nigeria

G.O. Enweluzo — 2020-08-26

Background: The increasing use of commercial motorcycle as a mode of transportation in urban cities like Lagos has become an important cause of morbidity and mortality. Injuries of the extremity, especially the lower extremity being the most common nonfatal injury with head injury as the
common cause of mortality. This has led to several states in the country restricting or banning commercial motorcycle operation. The aim of this study was to determine the trend of motorcycle extremity injuries post restriction of commercial motorcycles in Lagos as seen in LUTH.
Materials and Methods: This was a 2-year prospective hospital based study of all patients that presented at the Lagos University Teaching Hospital (LUTH) with motorcycle extremity injury that met the inclusion criteria. It evaluated the pattern of motorcycle extremity injury, determining associated injuries in patients with motorcycle - related extremity injuries and determining the impact of legislation against commercial motorcyclist in Lagos in terms of severity and type of injuries. Also outcome in terms of mortality, duration of hospital stay were assessed.
Results: Out of 2670 patients admitted at the accident and emergency during the period of this study, 570 (21.3%) were road traffic accident victims. Of the victims of RTA, 282 (49.5%) patients sustained motorcycle accident. The male: female (M: F) ratio was 2.8:1. The age ranged from less than 1 year to 75 years with a peak at 30-39years. The total number of extremity injuries was 322. Abrasions were the commonest type of injury accounting for 180(55.9%) of all extremity injuries followed by extremity fractures 110(34.2%). 80 patients had isolated extremity injuries and 202 patients had associated injuries. Head injury 190 (94.1%) was the most frequently associated injury followed closely by blunt chest injury 6(3.0%). None of the patients wore protective helmet. 48 mortalities (17.02%) were recorded and all dead patients had head injury.
Conclusions: Motorcycle extremity injuries still represent a common cause of morbidity despite its restriction in Lagos. Therefore, strict enforcement of the law especially those closely associated with subject safety is advocated so as to reduce morbidity and mortality associated with motorcycle accidents .. restriction in Lagos. Therefore strict enforcement of the law especially those closely associated with subject safety is advocated so as to reduce morbidity associated with motorcycle accident.

Keywords: Motorcycle, Fractures, Head Injury, Extremity injury.

Strict peri-operative antibiotic prophylaxis in surgical fixation of fractures: Experience from a trauma centre in Nigeria

S.E.B. Ibeanusi — 2020-08-26

Background: Infection remains one of the most dreaded complications of internal fixation as infection alters the natural history and outcome of fracture care. Therefore, antimicrobial prophylaxis for orthopaedic surgeries has become the standard of care in closed fracture surgery as it has been shown to reduce the incidence of SSIs especially when antibiotics is combined with other aseptic protocols during surgeries. However, in most developing countries, this guideline is often not strictly adhered.
Aim: This study aimed at reviewing the experience from strict implementation of short course peri-operative antibiotic protocol for fracture fixation in a trauma centre in Nigeria.
Method: Prospectively collected data of subsets of patients that presented with closed fractures treated by surgical fixation from 1st January 2008 to 31st December 2012 after commencement of the implementation of the peri-operative antibiotic policy in the regional trauma centre in Port Harcourt Nigeria was analysed and presented.
Result: One thousand one hundred and fifty-four cases (75.4%) involved males while 377 (24.6%) of the cases affected females giving a male to female ratio of 3.1:1. A significant proportion of the fractures were treated by intramedullary nailing 664 (43.4%) followed by fixation using plate and screws 422 (27.6%). Seventy-eight (5.1%) of the fractures were treated by external fixation, Six hundred and ninety-three (45.3%) of the patients were hospitalised for less than one week and 1171 of the patients (76.5%) of the patients had been discharged from admission as at two weeks following admission. A significant proportion of the fractures had shown evidence of radiological union as at 12 weeks post surgery 1030 (67.3%).
The main complications observed following treatment of the fractures were infections 65 (4.2%), Malunion 44 (2.9%), Non-union 34 (2.2%). The organisms cultured as causative agents of the infections was Staphylococcus aureus 22 (33.8%), Pseudomonas 11 (16.9%), Escherichia coli 7 (10.8%). Others were mixed organisms 25 (38.5%).
Conclusion: Peri-operative antibiotic prophylaxis is the standard of care for fracture fixation surgeries particularly in those requiring an implant. Whereas antibiotic prophylaxis helps to reduce postoperative infections, it should be an adjunct and should not replace essential aseptic protocols
and precautions required for clean surgeries.

Keywords: Prophylaxis, Antibiotics, Surgical site infections, Closed fractures.

Megaprostheses in Orthopaedic Practice-indications, Prospects and Challenges

I. Amupitan — 2020-08-26

Introduction: In the case of primary malignant tumors, extensive metastatic disease, major trauma or end-stage revision arthroplasty, the orthopaedic surgeon often has to deal with the need to reconstruct large skeletal defects, or replace bone of low quality. In recent past as part of our therapeutic armamentaria, this was frequently impossible.

Methods: This was a prospective descriptive study of consecutive patient who presented to the Daisyland orthopaedic hospital Jos since 2016 and had joint replacement using Mega prostheses.

Results: Seven patients had Arthroplasty using Megaprosthesis of which all of them where females. Their mean age was 70.7(±9.8) years, the mean hospital stay was 5.7(±1.2) days and they were all discharged home on full weight bearing.