ABSTRACT
Background: The elderly constitute an important part of the general population. Worldwide the population of the elderly has increased over the years. This paper documents the pattern of orthopaedic injuries in the elderly in Umuahia; Nigeria. Methods: A retrospective study of all injuries in patients aged 60years and above seen at the Federal Medical Centre; Umuahia from 1st July; 1996 to 30th June; 1999 utilizing data from the patients' case notes; casualty and ward registers are well as the theatre registers. Extracted data was analyzed using descriptive statistics. Results: Of the 102 patients seen; only 62 patients' records were retrievable. There were 38 males and 24 females giving a male: female ratio of 1.6:1. Their average age was 68.7 years. Over 60were in the 60-69 years age bracket. Most of the injuries occurred in the rural setting. The most common aetiology was road traffic accidents(54.8) followed by falls (21.0). Most patients (69.4) presented within 7 days of injury with 27.4receiving some form of treatment before presentation. The most common body region affected was the lower limb followed by the upper limb. Fractures were the most common injury type. The most common comorbidity was hypertension followed by arthritis and diabetes mellitus. The average duration of hospital stay was 20.7 days. No mortality was recorded. While 45.2were discharged on recovery; 22.6discharged against medical advice. Conclusion: Trauma-related injuries in the elderly are not uncommon and road traffic accident was the most common aetiology. Efforts should be made to prevent these injuries
Subject(s)
Aged , Nigeria , Orthopedics , Wounds and InjuriesABSTRACT
Background: The accurate diagnosis of acute appendicitis (AP) in a patient is valuable to the busy clinician. Decision making in cases of AP poses a clinical challenge especially in developing countries where advanced radiological investigations are not readily available and do not appear cost effective; clinical parameters remain the mainstay of diagnosis. Time and resources wasted on surgical intervention; with the added risks of surgery and anaesthesia; only to discover that this was unnecessary remains a big challenge. This prospective study was carried out to assess the accuracy of the Bengezi and Al-Fallouji modified Alvarado score in presumptive diagnosis of AP and its effect on the negative appendicectomy rate (NAR) at the University of Port Harcourt Teaching Hospital. Methods: A retrospective study of the NAR of this hospital between June 2000 and May 2002 was carried out. All consecutive patients (128) who presented with presumptive diagnosis of AP between June 2003 and May 2004 were scored using the Bengezi and Al-Fallouji modified Alvarado scoring system and correlated with histological diagnosis. Patients discharged without surgery based on score; were reviewed in the outpatient's clinic for one month to ascertain that they did not need surgical intervention. The NAR for all appendicectomies performed by surgeons for presumptive diagnosis of AP without scoring between June 2004 and May 2005 was determined as control. Validity of the scoring system was assessed by calculating sensitivity; specificity; positiveand negative predictive values. Results: A total of 128 patients were scored. Forty patients with scores less than 4 after eight hours observations and re-evaluation at the Accident and Emergency were discharged without surgery. Eighty eight patients had appendicectomies as treatment for scores 5- 10. There were 39 males and 49 females. In eighty patients; the appendix was histologically inflammed and 8 were normal; giving a NAR of 9.09. High sensitivity of 92.93and specificity of 92.93were recorded in the study. The NAR of the retrospective study was 26.4and 19.05for the control group operated without scoring