Om Babalola

Open intramedullary nailing for segmental long bone fractures: An effective alternative in a resource-restricted environment

Background: Closed, locked intramedullary nailing has been accepted as the gold standard in the care of femoral fractures, with reported union rates as high as 98-100%. Closed, locked intramedullary nailing often requires expensive equipment which is a challenge in developing countries. Segmental long bone fractures are often a result of high-energy trauma and hence often associated with a lot of injuries to the surrounding soft tissues. This consequently results in higher rates of delayed or nonunion. This study was proposed to review the outcome of management of segmental fractures with locked intramedullary nails, using an open method of reduction. Methods: A retrospective analysis was made of data obtained from all segmental long bone fractures treated with intramedullary nailing over a 1-year period. Records were retrieved from the folders of patients operated on from January 2011 to December 2011. Patients were followed up for a minimum of 1 year after the surgery. Results: We managed a total of 12 segmental long bone fractures in 11 patients. Eight of the 12 fractures were femoral fractures and 10 of the fractures were closed fractures. All but one fracture (91.7%) achieved union within 4 months with no major complications. Conclusions: Open method of locked intramedullary nailing achieves satisfactory results when used for the management of long bone fractures. The method can be used for segmental fractures of the humerus, femur, and tibia, with high union rates. This is particularly useful in low-income societies where the use of intraoperative imaging may be unavailable or unaffordable. It gives patients in such societies, a chance for comparable outcomes in terms of union rates as well as avoidance of major complications. Larger prospective studies will be necessary to conclusively validate the efficacy of this fixation method in this environment.

Transforaminal epidural steroid injections for the treatment of lumbosacral radicular pain in a Nigeria tertiary hospital: observational study

Background: Lumbosacral radicular pain is a common cause of chronic low back pain. Despite published reports of effectiveness of transforaminal epidural steroid for lumbosacral radicular pain, it is underutilised in many tertiary hospitals in sub-Saharan Africa. This study assessed the clinical effects of transforaminal epidural steroid injections in patients with lumbosacral radicular pain at a major tertiary health facility in Nigeria. Methods: This is a prospective observational study carried out between March 2012 and February 2016. Under fluoroscopy, the epidural space was accessed through the neuroforamen using 22G spinal needles in 47 adult patients with lumbosacral radicular pain; and a mixture of 10 mg triamcinolone acetonide and 0.25% plain bupivacaine (2 mLs per level) was injected. Pain intensity and functional impairment were assessed with the Numeric Pain Rating Scale (NPRS) and the Oswestry Disability Index (ODI) scores respectively at three and six months. Results: The pain and ODI scores at baseline and at six months’ follow-up improved significantly; 8.49 ± 1.28 vs. 3.6 ± 1.5 (p = 0.002) and 45.1 ± 11.5 vs. 32.4 ± 11.5 (p = 0.001) respectively. Conclusion: Transforaminal epidural steroid injections provided significant pain relief and improved function in patients with lumbar radicular pain due to intervertebral disc herniations.

PA 02-5-2551 Epidemiology of injuries at a teaching hospital in nigeria: a 15-year review

Injuries constitute a large proportion of the emergency surgical patient load in most hospitals. It constitutes a major public health threat and is the leading cause of death in persons aged between 1 and 44 years, accounting for up to 72% of deaths in some age groups (e.g. 15–24 years). The effect of injury as a public health burden is particularly felt in low and middle-income countries that experience 90% of the global mortality from injury. In 2010, 5.1 million deaths resulted from injuries surpassing the cumulative mortality from the more prominent public health concerns in LMICs (HIV-AIDS, malaria, and tuberculosis at 3.8 million deaths). Over a 15 year period from February 2000 to January 2015, all patients that presented to the surgical emergency of a University Teaching Hospital were enrolled into a prospective observational study to observe the patterns of presentation and epidemiology. Data was collected at presentation and analysis was done at the end of the 15 year period. A total of 17,0677 patients were admitted via the surgical emergency ward over the period. Most of the patients were young adults (47.1%) with an average age at presentation of 32.38 (s.d 19.2). 11 779 patients (69%) presented to the hospital following trauma while the remaining 31% presented with other surgical emergencies. Road traffic crashes accounted for the vast majority of the injuries (59.6%) while falls and assaults accounted for 9.8% and 7.2% respectively. Occupational injuries and sports injuries were relatively rare, accounting for only 1.2% and 0.4% of cases respectively. Injuries constitute a large proportion of the emergency surgical health care demands in this environment. Road traffic injuries continue to account for majority of injuries presenting to the hospitals with young adult males being the main victims.

Clinical Outcomes after Open Locked Intramedullary Nailing of Closed Femoral Shaft Fractures for Adult Patients in a Nigerian Hospital

Background: Femoral shaft fractures are common injuries in adults. Closed locked intramedullary nailing is the recommended treatment for femoral shaft fractures due to its high union rate. Objective: The objective of this study is to determine the outcome of management of closed femoral shaft fractures in adult patients, using open locked intramedullary nailing. Patients and Methods: This is a prospective study which was carried out on all adult patients aged 16 years and above who presented within 2 weeks of sustaining closed femoral shaft fractures to the accident and emergency unit of a University Teaching Hospital in Nigeria from January 2013 to December 2013. Pathological fractures were excluded from the study. The procedure was carried out using standard techniques, and each patient was followed up for a minimum of 1 year. Results: Forty-three patients were recruited into the study. They had a mean age of 36.9 ± 11.7 years, with a male to female ratio of 2.9:1. The most common cause of closed femoral shaft fractures was road traffic crashes (95.3%), with motorcycle-related injuries found to be the highest type (56.1%). The rate of union in the study was 95.3%. The average time to radiological union was 14.0 ± 1.2 weeks while the mean time to painless full weight bearing was 14.2 ± 1.2 weeks. Among the complications encountered were broken nails (4.7%), infection, loosening of the distal screw, and limb length discrepancy (2.3% each). Using Thoresens criteria, excellent results were obtained in 93% and poor results in 4.7% of patients. Conclusion: Open locked intramedullary nailing gives excellent clinical outcomes with high union and low complication rates in the management of closed femoral shaft fractures in adult patients.

Colonoscopic examination of rectal bleeding in children: a report of two cases.

Rectal bleeding in children is a frightening and cause of great concern, and of parental anxiety. In this report, we present the value of colonoscopy to unravel the diagnostic conundrum often associated with rectal bleeding in children.