So Ogunlade

Mandibular defect reconstruction with nonvascularized iliac crest bone graft

CONTEXT Reconstruction of mandibular defect is a challenge to the head and neck surgeon because of associated functional and esthetic problems. Our experience with the use of nonvascularized iliac crest bone graft is hereby reported. AIM The aim was to report our experience with the use of nonvascularized iliac crest bone for mandibular defect reconstruction at University College Hospital, Ibadan. Nigeria. SETTINGS AND DESIGN A retrospective descriptive study was performed. MATERIALS AND METHODS Cases of mandibular reconstruction with iliac crest bone graft between January 2001 and December 2007 were included in this study. Grafts were secured with either a stainless steel wire or a titanium plate. Preoperative diagnosis, postoperative follow-up records including investigations, diagnosis of graft infection and subsequent treatment modalities were extracted from the available records. STATISTICAL ANALYSIS USED Descriptive variables were analyzed with SPSS version 14. RESULTS A total of 47 patients had mandibular defect reconstruction with nonvascularized iliac crest block bone during the study period. Thirty-eight patients had graft secured with transosseous wire [NVIBw] while 9 had a titanium plate [NVIBp]. The male:female ratio was 26:21 while the mean age of the patients was 24.6±4.25 years. Ten patients (21.3%) developed persistent graft infection during the postoperative period. All cases of infection occurred in patients who had transosseous wiring and analysis showed that 60% of the infected grafts revealed mixed microbial isolates containing Klebsiela spp, Pseudomonas Aeurogenosa, and E coli. Six (60%) of the infected grafts were removed as a result of unabated infection while 4 (40%) were successfully treated by exploration and pus drainage. CONCLUSIONS Nonvascularized iliac crest bone graft provides an affordable and less technical choice for mandibular reconstruction with minimal complications in a resource-limited economy.

The lumbosacral radiographs in the initial screening of low back pain - Is one view enough?

BACKGROUND Radiological imaging is mandatory, when investigating patients with low back pain (LBP). A minimum of three plain radiographic views of lumbosacral spine are routinely requested for by the attending clinicians. OBJECTIVE This study is therefore carried out to determine if only one view will be sufficient in the initial screening of patients with low back pain. MATERIALS AND METHODS The antero-posterior (AP) and lateral plain radiographs of patients referred to the radiology department on account of low back pains in an eighteen month period (June 2007 to November 2008) were reported by two certified radiologists. The findings were subjected to statistical analysis. The Kappa agreement for the two independent reports was between 0.602 and 0.908. RESULTS The radiographs for 638 patients were reviewed. 365 (57.2%) were females and 273 (42.8%) were males. The age ranged from 20 years to 85 years with a mean of 56.4 years. Within the age group of 20-69 years, females were found to significantly present earlier than men with LBP (P< 0.041). The AP view had a significantly higher rate of reported normal findings that the lateral view (P<0.000). Osteophytic outgrowth was the commonest finding in both views although the rate of detection was higher on the lateral view, as with the other abnormal findings. CONCLUSION This study shows that the lateral radiographs show significantly more findings than AP on plain radiographs. It is therefore recommended that lateral radiograph is adequate in the initial screening of patients with low back pain.

Septic Arthritis of The Hip Joint presenting as Acute Abdomen

Septic arthritis of the hip joint in two children, originally thought to be cases of acute abdomen is presented. In one case, the discovery of extra-peritoneal purulent fluid at surgery, obviated the need for laparotomy and in the other, the true nature of the disease became apparent one week after laparotomy. These cases illustrate the maxim that any painful movement of the hip joint with associated unexplained fever should raise suspicion of septic arthritis. The close relationship of the hip joint to the pelvis sometimes confuses hip diseases with pelvic pathologies. Key Words: Septic arthritis, acute abdomen, pathological dislocation Nigerian Journal of Paediatrics 2003; 30: 67-70.