Kehinde S. Oluwadiya

Pediatric trauma in sub-Saharan Africa: Challenges in overcoming the scourge.

All over the world, pediatric trauma has emerged as an important public health problem. It accounts for the highest mortality in children and young adults in developed countries. Reports from Africa on trauma in the pediatric age group are few and most have been single center experience. In many low-and middle-income countries, the death rates from trauma in the pediatric age group exceed those found in developed countries. Much of this mortality is preventable by developing suitable preventive measures, implementing an effective trauma system and adapting interventions that have been implemented in developed countries that have led to significant reduction in both morbidity and mortality. This review of literature on the subject by pediatric and orthopedic surgeons from different centers in Africa aims to highlight the challenges faced in the care of these patients and proffer solutions to the scourge.

Blistering Digital Dactylitis Complicated by Osteomyelitis and Amputation in an HIV-Positive Infant

HIV infection is rapidly emerging as a predominant cause of morbidity and mortality in children from developing countries. This probably accounts for the many reports that have emanated from resource-limited settings in the last decade. Reports highlighting bone infections and untoward complications in HIV-infected children are rare. This informed our decision to report the case of a 9-month-old HIV-positive Nigerian girl who presented with blistering dactylitis of the right middle finger. Plain radiograph of the right hand showed amputation of the terminal phalanx and changes consistent with osteomyelitis in the middle phalanx of the third finger. The case is discussed with a view of highlighting this rare complication and the challenges associated with management in a resource-limited setting.

Acquired boneless forearm as a complication of traditional bone setting.

An 8-year-old girl sustained closed fracture of the right ulna 10 weeks prior to presentation. She was taken to a traditional bone setter who applied a tight splint. The patient reported pain, but the splint was not removed. A week after application of the splint, a foul odor was detected and removal of the splint showed extensive exposure of the forearm bones. Above elbow amputation was rejected by the patients parents when she was taken to hospital, where she was admitted for 8 weeks by a second traditional bone setter. A trained nurse applied herbal concoctions and dressed the wound daily in anticipation that the skin would cover the exposed bone fragments. She was brought to our hospital for wound dressing so that the skin would cover the exposed bones fragments. Examination revealed a grossly shortened right forearm--by 7 cm compared with her left--extensive exposure of both radius and ulna at the anterior aspect of the forearm, and loss of sensation and movement of the fingers. Radiographs showed sequestrated radius and ulna with involucrum around the olecranon process. Above elbow amputation was offered to the patient but the parents again declined. The forearm bones detached while scrubbing the wound for review and removal of the sequestrated bone. The wound healed within one and a half weeks of dressing, resulting in an acquired boneless forearm.