Ea Orimolade

Femoral bifurcation with ipsilateral tibia hemimelia: Early outcome of ablation and prosthetic fitting

Femoral bifurcation and tibia hemimelia are rare anomalies. Hereby, we present a case report of a 2-year-old boy who first presented in our orthopedic clinic as a 12-day-old neonate, with a grossly deformed right lower limb from a combination of complete tibia hemimelia and ipsilateral femoral bifurcation. Excision of femoral exostosis, knee disarticulation and prosthetic fitting gives satisfactory early outcome.

Esmarch tourniquet in orthopaedic surgery

A bloodless field is important in many orthopaedic operations necessitating the use of a pneumatic tourniquet or Esmarch bandage. The outcome of the use of an Esmarch bandage for exsanguination and as a tourniquet in 112 consecutive patients who had elective orthopaedic operations on 131 limbs was evaluated. The setting was at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, from March 2003 to February 2005. The mean age of the patients was 25.7 + standard deviation years (range 1-70 years). The duration of tourniquet application ranged from 20 min to 2 h 35 min. Four limbs (3.1%) developed acute compartment syndrome; four (3.1%) had tourniquet paralysis with ulnar nerve involvement in three limbs. All limbs regained full neurological function following physiotherapy. There was wound infection in two limbs (1.5%). In spite of its drawbacks, the Esmarch bandage is still useful for exsanguination and as a tourniquet in orthopaedic surgery where there is no pneumatic tourniquet.

External jig in the placement of distal interlocking screws

Background: Placement of distal locking screws is a challenge to many surgeons involved in interlocking nails. Objectives: The aim of this study is to evaluate the accuracy of external jig as a target arm for distal locking screw insertion. Methods: 85 consecutive patients with 90 fractures treated with SIGN interlocking nails were prospectively studied. We report the assessment of the accuracy of insertion of distal locking screws with the use of SIGN external jigs. The patients demographic data and fracture characteristics were documented. Two distal screws are usually inserted. However, in very difficult cases, one distal screw may be inserted. In all cases there was no access to intra operative radiograph. Results: There were 85 patients and 90 fractures. There were 57 males and 28 females giving a ratio of M:F 2:1. The mean±SD age of the patients was 41.19±16.28 years and the range was 18-85 years. The two bones studied were femur 62.3% and tibia 37.8%. Retrograde (52.2%) was the commonest surgical approach used for femur. The main indication for SIGN interlocking surgery was recent fracture 77.8%. Open reduction 97.8% was the commonest method of reduction used. The mean±SD bone union time was 3.58±0.56 months and range 3-5 months. Distal screw insertion was successful (2 screws) in 93.3% and partial success (1 screw) in 6.7%. At first attempt 96.7% of distal screws were inserted while 3.3% distal screws were inserted at 2nd attempt (2nd visit to theatre). The main complication was screw loosing seen in 3.3%. Conclusion: External jig as a target arm is effective for the placement of distal locking screw. Keywords: External jig; Target arm; Distal screws; Interlocking nails.