La chirurgie ambulatoire en orthopédie et traumatologie: expériences du Centre Hospitalier Universitaire Morafeno Toamasina / mbulatory surgery in orthopedics and traumatology: experiences of the University Hospital Morafeno Toamasin

Introduction : Plus qu'un défi ou un enjeu, la chirurgie ambulatoire, constitue pour les pays en voies de développement une opportunité d'accroître l'accès aux soins. Elle est un concept d'organisation centrée sur le malade, basée sur la sélection des patients et des actes chirurgicaux afin d'assurer une qualité et une sécurité maximale de soins. Objectifs : Partager les résultats de notre expérience sur la chirurgie ambulatoire en orthopédie traumatologie et de déterminer les difficultés rencontrées lors de sa mise en place. Matériels et Méthodes: Il s'agit d'une étude prospective, descriptive et observationnelle allant de janvier 2018 au janvier 2019 (12 mois) réalisée au CHU Morafeno Toamasina. Résultats: Au total, 108 patients ont été retenus. Les interventions réglées étaient réalisées chez 82,40% des patients contre 17,59% d'urgences traumatologiques. L'âge moyen des patients était de 32 ans ± 8,6 ans avec une prédominance masculine (sex ratio:3,9) . Le type d'intervention réalisé était dominé par les ablations de matériels d'ostéosynthèses avec un taux de 25,92%, suivies des tentatives de réduction orthopédique de fractures dans 22,22 % des cas. Le type d'anesthésie la plus pratiquée était l'anesthésie locorégionale (52,77%). Les évènements en postopératoire étaient dominés par l'insomnie (4,62%), la céphalée (2,77 %), les nausées et vomissements (5,55%) et les hématomes (3,70%). Soixante-douze virgule deux pour cent des patients déclaraient satisfaits de leur prise en charge. Conclusion: Le développement extensif de la chirurgie ambulatoire est basé sur la sélection des patients à qui l'on propose ce type de prise en charge. Elle présente un enjeu majeur en matière de restructuration et d'amélioration de l'offre de soins en chirurgie orthopédique et traumatologie

Mortalité en Orthopédie-Traumatologie: aspects épidémiologiques et facteurs de risques / Epidemiological aspects and risk factors of orthopedics-trauma mortality

Contexte. La mortalité est un indicateur de performance de la qualité de soins dans un hôpital. L'objectif de cette étude était de décrire les aspects épidémiologiques, et d'identifi er les facteurs de risques infl uençant la mortalité dans le service Méthodes. Cette étude rétrospective descriptive et analytique a été réalisée entre janvier 2013 et décembre 2020. Elle a concerné les patients àgés de plus de 15 ans pris en charge dans le service et décédés en hospitalisation, en réanimation ou au bloc opératoire. Les données étudiées étaient d'ordre épidémiologique, thérapeutique et caractéristique du décès. L'analyse statistique a été réalisée à l'aide du test de Khi2 au seuil de signifi cation situé à 5% (P< 0,05 ) pour déterminer les probables facteurs de mortalité. Les facteurs étudiés étaient,l'âge, le sexe, les comorbidités, l'Injury Severity Score (ISS) de Baker, le score de l' American Society of Anesthesiologists (ASA,) la cause du décès et la période du décès. Résultats. Il a été observé 144 décès sur un total de 4728 patients admis, soit un taux de mortalité de 3%. L'âge moyen était 59,5 ± 20,1 ans (17-95) avec un médian de 64,5 ans . Les patients âgés de plus de 60 ans représentaient 54,2% (n=78).Il y'avait 78 hommes (54,2%) et 66 femmes (45,8%). Le diabète de type 2 non équilibré (n=85;59%) et La gangrène diabétique du membre inférieur (n=70;48,6%) prédominaient. Les principales causes du décès étaient le choc septique et l'anémie. Les facteurs de risques trouvés étaient : le sexe masculin, le score ISS sévère, la période de décès la nuit, le choc septique et l'anémie. Conclusion. Le taux de mortalité était de 3%.Les principalescauses du décès étaient le choc septique et l'anémie.Les facteurs de risques trouvés étaient, le sexe masculin, le score ISS (>25), la période du décès la nuit, le choc septique et l'anémie.

Aspects thérapeutiques et évolutifs des fractures diaphysaires de jambe au Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona Madagascar / Therapeutic and evolutive aspects of diaphyseal leg fractures at the Joseph Ravoahangy University Hospital Center Andrianavalona Madagascar

La prise en charge d'une fracture de jambe est fonction de la classification de la lésion, du plateau technique et de l'expérience du chirurgien. Le but de notre travail est de déterminer les aspects thérapeutique et évolutif des fractures diaphysaires de la jambe prises en charge au Service de Traumatologie du Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona (CHU-JRA) Madagascar. Il s'agissait d'une étude descriptive de 74 patients hospitalisés dans le Service en 2017. Il y a une discrète prédominance des fractures ouvertes (52,7%) dont 41,01% étaient classés type II selon Gustilo Anderson. Les fractures concernaient les deux os dans 79,7%. Le traitement était orthopédique dans 74,7 % par un appareil plâtré cruro-pedieux précédé ou non d'une traction trans-calcanéenne. Parmi ceux qui ont été opérés, 47,4% ont bénéficié d'un enclouage centromédullaire type Kuntcher, 31,58% d'un fixateur externe et 21,02% d'une amputation transtibiale. L'évolution a été favorable dans 87,7%. Les complications étaient dominées par les infections (5,46%), lésions vasculo-nerveuses (4,09%) et les cals vicieux (1,36%). Le séjour hospitalier moyen étaient de 14 jours (1-86 jours). La prise en charge des fractures de jambe reste un challenge pour les chirurgiens dans les pays en voie de développement. L'optimisation de cette prise en charge passe par l'amélioration de l'accès aux soins et l'ajustement de la logistique hospitalière.

The management of a leg fracture depends on the classification of the lesion, the technical platform and the experience of the surgeon. The aim of our study is to determine the therapeutic and evolutive aspects of diaphyseal fractures of the leg treated at the Traumatology Department of the Joseph Ravoahangy Andrianavalona University Hospital Center (CHU-JRA) Madagascar. This was a descriptive study of 74 patients hospitalized in the Department in 2017. There is a slight predominance of open fractures (52.7%) of which 41.01% were classified as type II according to Gustilo Anderson. Fractures involved both bones in 79.7%. Treatment was orthopedic in 74.7% with a cruro-pedial cast, preceded or not by trans-calcaneal traction. Of those who underwent surgery, 47.4% received a Kuntcher intramedullary nailing, 31.58% an external fixator and 21.02% a transtibial amputation. The evolution was favorable in 87.7%. Complications were dominated by infections (5.46%), vascular nerve damage (4.09%) and malunion (1.36%). The average hospital stay was 14 days (1-86 days). The management of leg fractures remains a challenge for surgeons in developing countries. Optimizing this care involves improving access to care and adjusting hospital logistics

Comparison of the duration and quality of epidural analgesia between plain bupivacaine alone and plain bupivacaine with tramadol in lower limb orthopaedic surgeries

Background: This study was aimed at comparing the duration and quality of epidural analgesia between plain bupivacaine alone with plain bupivacaine and tramadol in lower limb orthopaedic surgeries. Method: This was a prospective randomized double blinded control study involving 74 ASA I and II patients scheduled for elective lower limb orthopaedic surgeries. Group A (n=37) received 19mls of 0.5% epidural plain bupivacaine with 1 ml of water for injection, while group B received 19mls of 0.5% epidural plain bupivacaine with 1ml (50mg) of preservative freetramadol. The duration of analgesia was from the time of epidural block to the time of rescue analgesia. While, the quality of block was measured with Visual Analogue Scale (VAS) and Bromage scale. Results: Thestudy ages were between 16-60years,consisting of 22(60%) male and 15(40%) female in group A, while in group B 20 (54%) were male and 17(46%) female. It showed the mean duration of analgesia were 189.05±21.92min and 254.19±32.78min in group A and B respectively with p <0.01.The intra-operative VAS scores between the two groups did not show any significant difference between study groups (P> 0.05).The differences of grades of motor block and maximum sensory block height were not statistically significant (P=0.26) among the study groups. Conclusion: The addition of 50mg (1ml) of tramadol to plain bupivacaine epidurally prolonged the duration of analgesia and improved the quality of analgesia when compared to the use of bupivacaine alone

Timing of prophylactic antibiotic administration in an orthopedic hospital in a developing country

Background: Appropriate timing of administration is crucial to the effectiveness of prophylactic antibiotics in preventing surgical site infection. Poor adherence to perioperative antibiotic prophylaxis recommendations has been documented from developed countries; but there is a paucity of data on this subject from Nigeria. The aim of this study was to assess the timeliness of administration of the first dose of prophylactic antibiotics in orthopedic surgery. Materials and Methods: In this observational study in an orthopedic practice; administration of antibiotics in operations done over a 6-month period was investigated. The main outcome measure was timing of antibiotic administration in relation to skin incision and tourniquet application. Optimum timing was de fined as prophylactic antibiotic administration 15-60 min before skin incision or tourniquet application. Univariate analysis was performed using CDC-Epi Info TM Version 3.5.1 (August 2008). Results: There were 102 procedures out of which 95 (93.1) were performed without a tourniquet.Of these 95 procedures; antibiotics were given before skin incision in 53 (55.8) procedures and administration was optimum onlyin 16 (16.8) procedures. The median induction-incision interval was 19 min (range: 3-45 min). Conclusion: Timing of perioperative antibiotic administration was inadequate. Routine administration at induction of anesthesia may promote optimum timing and can be considered as in any practice where no written perioperative antibiotic protocol exists

Traitement orthopedique des fractures deplacees du quart inferieur du radius chez l'enfant

But : rapporter les resultats du traitement orthopedique en fonction des analyses radiologiques et fonctionnelles. Patients et methode : etude prospective sur les fractures deplacees du quart inferieur du radius au CHU de Nancy (France) de janvier 2003 a aout 2004. La reduction etait faite sous anesthesie generale et l'immobilisation brachio-antebrachio-palmaire. Les mesures radiologiques ont ete : les angulations radiales de face et profil; la translation radiale a J1; J7; J14; J45 et au recul maximum ainsi que l'angle de flexion du poignet dans le platre. Resultats : vingt-sept fractures deplacees du quart inferieur du radius ont ete suivis dont 22 avaient repondu parfaitement aux criteres de l'etude tandis que 5 translations radiales ont etes notees. 11 deplacements secondaires (41) ont ete notes a six semaines du deplatrage dont 6 bascules posterieures de 12 a 26 o; 2 bascules anterieures de 5o et 28o; 3 inclinaisons radiales de 20 a 30o. Les translations radiales n'ont pas ete deplacees secondairement. Selon les criteres de Clarke; nos reductions ont ete anatomiques malgre de nombreux deplacements secondaires. Les translations radiales initiales n'ont pas ete deplacees secondairement. Nous n'avons pas note l'influence de l'hyperflexion palmaire; se pose alors la question du moulage platre. Conclusion : le traitement orthopedique a ete marque par un taux eleve de deplacements secondaires. Mais le remodelage radiologique et les resultats fonctionnels ont ete parfaits au recul maximum. Notre attitude actuelle est d'immobiliser en supination et en legere flexion palmaire tout en veillant a un bon moulage du platre

Risk Factors Associated with Distal Humeral Fractures: A Radiological Study of Nigerians Admitted at National Orthopedic Hospital; Igbobi; Lagos State; Nigeria

Aim: This study is aimed at investigating the possible risk factors associated with distal humeral fractures among Nigerians. Materials and Methods: The study was carried out retrospectively at the Department of Medical Records; National Orthopedic Hospital; Igbobi; Lagos State; Nigeria using Plain films of X-ray from a total number of 144 patients of ages from birth to 100 years (0-100 years); comprising of 88 males and 56 females. Results: It reveals that the age group 1-10 years were affected more than other age groups. This study also shows that fall is the main cause of distal humeral fractures (68.7) followed by road traffic accidents (27.8). The predominance of fracture of the left humerus in this study was statistically significant. Conclusion: Since distal humeral fracture is an issue of harsh economic consequences; various measures should be taken by all the parties involved so as to address the menace

Risk Factors for Surgical Site Infections Following Clean Orthopaedic Operations

Background: Surgical site infections can follow clean orthopaedic operations and can cause serious morbidity; mortality and increased resource utilization. Despite this; there are few studies on risk factors for surgical site infections in the Nigerian orthopaedic literature. We conducted a prospective study to determine the host and environmental risk factors for surgical site infections following clean orthopaedic operations.Materials and Methods: Consecutive patients who satisfied the inclusion criteria and were to undergo clean orthopaedic operations performed at the National Orthopaedic Hospital; Igbobi; Lagos from January 2007 to July 2008 were included. Patient's biodata; duration of preoperative hospitalization and other risk factors were analyzed. The risk factors for surgical site infection were determined with Chi square test.Results: The overall rate of surgical site infection during the 18 months of the study was 9.9 (12 of 121). Independent risk factors for this were: Prolonged duration of preoperative hospital stay greater than 13 days (21 infection rate); increasing age greater than 60 years (31 infection rate); and use of implants and drains (only one un-drained wound was infected).Conclusion and Recommendations: Patient's age; duration of preoperative hospitalization; type of surgery (implant or non-implant); and use of drains were the most significant risk factors affecting surgical site infection. It is recommended that preoperative hospital stay should be as short as possible and extra care/precautions taken when working on the elderly; using implants or requiring drainage

A Comparision of Clinical Diagnosis and Knee Arthroscopy Findings at Mulago Hospital

Background: Many patients present to the orthopaedic surgeon with complaints of knee pain. In many such cases making a diagnosis based on clinical examination is often difficulty and frequently inaccurate. This study sought to document the common findings at knee arthroscopy and how they compare with clinical impressions. Methods: A cross-sectional study of 34 patients undergoing diagnostic knee arthroscopy with undetermined diagnosis was conducted at Mulago Hospital. The preoperative clinical provisional diagnosis and the findings at arthroscopy were documented; compared and analysed. Results: The commonest clinical diagnosis was medial meniscal tear (21); while the most frequentinding at arthroscopy was osteochondral lesions (27). The highest correlations between clinical impressions and arthroscopic findings were in ACL tears and osteoarthritis. The overall accuracy of clinical examination was 87.2.Conclusion: Clinical examination is a useful tool in diagnosing knee pathologies. In Mulago; the accuracy of the clinical impressions as proved at arthroscopy is high

HIV Infection among Orthopedic In-Patients at Dil Chora Referral Hospital; Ethiopia

Back ground: In Health care centers receiving HIV positive patients the risk of occupational exposure is of special concern to Health Care Workers (HCW's). Exposure to infected blood and body fluids due to needle stick injuries present greatest over all risk to medical personnel although in surgery `Cuts' during operations are additional hazard. The objective of the study was to determine the Incidence of HIV infection among patients admitted to orthopedic ward in Dil chora referral Hospital. Methods: Between may 2007 and May 2009; and After pre test counseling the incidence of HIV infection was determined For all patients admitted to our orthopedic ward using `Rapid tests' as out-lined by Ethiopian Nutrition and Health Research Institute(ENHRI) guide lines. The patients were again counseled before being given their test results. All the data was ecorded by the sole Author. Results: A total of 731;525 male (72); 206 Females (28) were admitted during the two yearstudy period. Out of these 28 patients (3.8) were found to be infected by HIV; 17 (2.3) were males; and 11 (1.5) were females and the majority(96) were between the age of 15-54 Years.The reason for admission among the HIV positive patients were Trauma in 20(71); infections in 6 (21) and other diagnosis of musculoskeletal disorders in 2(7).Non-operative treatment was given for 16 (57) and operative treatment for 12 (43) of the HIV infected patients.Conclusion: Implementation of universal Safety precautions (USP) for prevention of nosocomial infection is recommended

Orthopaedic Outreach Program in Uganda: A Strategy to Improve Inequality in Service Delivery between Rural and Urban Communities

Background: Musculoskeletal diseases are on the increase worldwide. Greater than 80of Ugandans live in rural areas; facing formidable barriers to specialized care. In 1991 the Orthopedics Outreach Program (OOP) was initiated as a plausible solution to the inequity of orthopedic care between the urban and rural disadvantaged populations. This investigation was conducted to evaluate the output; effectiveness; and barriers to access; of the OOP over 13 years. Methods: This was a retrospective analysis to quantify surgical output and effectiveness of the OOP using the outreach record and a cross-sectional analysis to assess access and efficacy of the program. Semi-structured and key informant interviews targeted to key actors involved in the OOP were conducted to provide a qualitative assessment of the program. Results: Sixty seven outreach visits were completed; 6;653 patients seen; and 1;071 surgeries performed; at a total cost of US$12;701.00. The cost per patient seen was US$1.91 and US$11.86 per surgery performed. Poverty was uniformly cited as barrier to access; others were; transportation; and lack of awareness. There was unanimous opinion on the worthiness and effectiveness of the OOP; but many operational issues and constraints were cited. Conclusion: The OOP may provide a short and medium term solution to equity and access for orthopedic care in Uganda. There is need to quantify the burden of specific orthopedics conditions. A follow-up analysis assessing operational efficacy and output from 2004 to date; under the African Medical and Research Foundation (AMREF) and Ministry of Health funding is recommended

Non-Steroidal Anti Inflammatory Drugs Usage in Orthopaedics and Trauma Practice A Guide and Review

Background: Non steroidal anti-inflammatory drugs NSAIDs) are a group of heterogeneous compounds with nti inflammatory; analgesic and often times anti pyretic roperties. They are weak organic acids and are the most commonly used drugs in Orthopaedic/Trauma practice. hey provide mild to moderate pain relief. SAID share common therapeutic and side effects irrespective of the class or group to which an individual rug may belong. These side effects are many and varied nd constitute a major concern in their usage since most f them are life threatening. Th SAIDs are also one of the most commonly abused rugs. The abuses stem mostly from poor prescription abit by the health professionals. he poor prescription habit by the professionals and aissez-a-faire attitude to NSAID Usage informed the need this review which addresses the issues; controversies and preventive strategies to reduce the complications in Orthopedics/Trauma practice. Methods: Literature on the subject was reviewed extensively using manual library internet search. Publications from local and international Journals spanning a period of over thirty years were reviewed. The internet search was done using pubmed and ortholink search engines. Results: NSAIDs act locally at the site of origin of pain by inhibiting the cyclooxygenase enzymes and induce no change in mood and dependency. The inhibition of the Cox enzymes can be reversible or irreversible and leads to inhibition of prostaglandin synthesis. All the therapeutic and most of the side effects of NSAIDs result from the inhibition of the cyclooxygenase pathway. Thus the Cox-2 selective inhibitors have lesser side effects than the non selective Cox inhibitors; though there is recent evidence linking them with adverse cardiovascular events. There is paucity of information in literature on the guidelines of the prescription/usage of NSAIDs; and the preventive strategies in orthopedics and traumatology. Conclusion: NSAIDs are the most commonly prescribed group of drugs in orthopedics and trauma practice. They constitute a great asset to any Doctor who deals with pains associated with inflammation which they relief quite effectively. NSAID Usage is froth with significant life threatening complications. A high index of suspicion of the possibility of occurrence of these complications; adherence to proper prescription guidelines and preventive strategies; change of the laissez-a-faire attitude of the professionals to NSAID prescription and appropriate monitoring of the patients on the drugs are paramount in improving their safety profiles. Orthopedic and Trauma surgeons need to be aware of the serious side effects and the role of preventive strategies in the use of NSAIDs

Orthopaedic infuries in the elderly: Federal Medical Center, Umuahia experience

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

Major Limb Trauma in Eastern Ethiopia

Background: Disability following road traffic accident is expected to increase dramatically in developing countries resulting in a decline in the size of the labour force. Adolescents and young adults are at the greatest risk of limb injury resulting from road traffic accidents. The objective of the study was to identify patterns of major limb trauma based on the definition given by the WHO scientific group. Methods: This audit was conducted by the author who recorded the relevant findings on every patient that was referred to the orthopaedic department between October 1st 2004 and April 31st 2007. Results: The results of a two and a half year audit (2004 -2007) made in the Eastern Ethiopia are reported. During this period a total of 1487 patients were managed in our orthopaedic department; of whom 1248 had suffered major limb trauma. Of these 1012 were males (68) and 475 females (32) giving a ratio of approximately 2 to 1. The majority 883 (70) were between the age of 15 and 54 years. Fractures formed the largest group 1044 (83); followed by amputation 68 (6); open wounds 58 (5); dislocation 52 (4); crush injuries 10 (0.8) and eurovascular injuries 16 (1). There were no cases of burns to the extremities in the study period. The commonest causes of injury were road traffic accident (RTA's) 533 (43); a fall in 444 (35); machine and tools in 246 (20). Suggestions are made as how best to reduce the size of this problem

Results of Open Wound Technique in the Treatment of Post-Sequestrectomy Dead Space

BACKGROUND AND METHOD. Severe chronic osteomyelitis with variable outcomes is still common among children in developing nations. There has been no consensus on the optimal method of treatment. We therefore prospectively evaluated the rates of wound healing and recurrence following open wound treatment of post-sequestrectomy dead spaces in 30 patients with haematogenous chronic osteomyelitis of the tibial shaft at the King Orthopaedic Clinic; Ekpoma; Edo State; Nigeria; between January 2001 and December 2005. Thirty similar patients whose post-sequestrectomy dead spaces were treated by closed wound technique formed the control group. Both groups were subjected to standard methods of perioperative management. Saucerisation; sequestrectomy and curettage were the cornerstones of surgical therapy. The wounds were primarily either left open (study group) or closed (control group). The rates of wound healing and recurrence were used to assess the outcome of treatment. The chi-squaretest was used for statistical analysis. RESULT. The median age was 13 years; with a range of 6 - 60 years. Staphylococcus aureus was the organism most commonly associated with chronic osteomyelitis. Rates of wound healing and recurrence in the study group were significantly better than in the control group (p0.05); eventhough it took a relatively longer period to achieve healing with the open method of treatment. The follow-up period ranged from 1 to 5 years; with a median of 2 years.CONCLUSION. We observed that the results of the open method of treating post-sequestrectomy dead spaces were good; and we advocate its use in resource-poor settings

Patients' Perception of Traditional Bone Setting in Calabar

Background: Patients with orthopaedic injuries patronize traditional bonesetters in our communities. This study was undertaken to find out and document the reasons and factors responsible for this patronage; who made the choice; the role of healthworkers; patients' perception of the practice and if their experience will encourage or discourage them from patronizing traditional bone setting in future. We also compared the cost between orthodox and traditional bone setting for close humeral and femoral fractures. Methods: A prospective study of patients in three traditional bone setting centres in Calabar . A pre-tested questionnaire requesting information on age; sex; educational level; type of injury; reasons for choice of traditional bone setting was administered. Other details included who decided on traditional treatment; perception of outcome; and the option of choice in the event of a future injury. Results: There were 98 patients with 106 injuries. The male: female ratio was 66:32 (2.1:1) and age range was 9 months to 60 years. There were 76 fractures in 68 patients; 28 dislocations and 2 brachial plexus injuries. Traditional bone setting was chosen in 50 patients (51.0) because traditional bonesetters were believed to be more skillful than orthodox orthopaedic practitioners; 32 patients (32.7) thought it was cheaper; 12 patients (12.2) believed orthodox orthopaedic practitioners have no empathy towards their patients and 4 patients (4.1) had no health facility in their locality. In 68 patients (69.4) the locus of decision was external; in 22 patients (22.4) internal and 8 patients (8.2) were encouraged by a healthworker. Complications including pain; mal/nonunion; joint stiffness and contractures occurred in 60 patients (61.2). Treatment outcome was adjudged satisfactory by 48 patients (49.0); fair by 40 patients (40.8) and unsatisfactory by 10 patients (10.2). Traditional bone setting for the management of humeral and femoral fractures was more expensive than orthodox management. Conclusion: Traditional bone setting is popular for varied reasons. The freedom to advertise may have helped to woo a public already biased towards traditional bone setting by cultural attachment. A paradigm shift is necessary to reverse the trend

An Audit of Anaesthetic Record Charts in the Orthopaedic Theatre of a Nigerian Teaching Hospital

Objective: The anaesthetic record is an essential part of a patient's record; providing useful information for the management of the patient. It is of medico-legal importance and can be used for quality assurance and researchpurposes. An analysis of anaesthetic record charts from a satellite operating theatre of the University of Port-Harcourt Teaching Hospital (UPTH) was undertaken to determine their legibility; correctness and completeness. Method: A retrospective analysis of the anaesthetic record charts from March 2003 to February 2004 of the orthopaedic theatre of the UPTH was undertaken. Results : A total of 232 anaesthetic record charts were analyzed. All entries were manually-written. Of these; 141 (60.9) were filled by anaesthetic registrars; the rest were filled by senior registrars 85 (36.5) and consultants 6 (2.6). One hundred and twenty-one charts (52.2) were legible; completely and correctly filled; but 47.8were incompletely filled; and 47.7had at least an illegible parameter. Conclusion: It is concluded from this analysis that the standard of anaesthetic record-keeping needs to be improved and consideration given to the use of computer-generated records which will eliminate the problems of illegible records

Prise en charge des fractures associées des membres et de la face. Notre experience au CHU de Treicheville (Abidjan)

Trente six (36) dossiers de patients présentant unefracture concomitante des membres et de la face ontété revus de façon rétrospective. Il s'agissait de 26hommes et 10 femmes âgés en moyenne de 32,91 ans(extrêmes 03 à 70 ans) tous admis au CHU de Treichvilleentre janvier 1998 et octobre 2003.Les accidents dela voie publique représentaient l'étiologie la plusfréquente (77,8%). Le membre inférieur était intéressédans 69,44% des cas et les lésions maxillo-faciales selocalisaient à l'étage inférieur dans 61,11%. Lesassociations lésionnelles fréquentes étaient lesfractures mandibulaires associées aux fractures dufémur (13,88%). Les sièges des fractures étaient divers etaucune association n'était significativement pré-pondérante pour expliquer des circonstancesétiopathogéniques particulières.Les moyens thérapeutiques utilisés dans les deuxspécialités ont été dominés par les traitementsorthopédiques. En définitive, 36,11% des patients ontété pris en charge dans le même temps opératoire,séparément et de façon différée pour 63,89% destraumatisés.L'évolution a été simple chez 29 patients, soit80,6% avec une consolidation acquise pour toutesles lésions fracturaires. Des complications ont étéobservées et se résumaient en 5 sepsis superficielset une nécrose commissurale. Une séquelle a typede raideur du poignet a été constaté.Au sein d'une même structure hospitalière la priseen charge des fractures maxillo faciales et desmembres doit obéir à une concertation préalable entreles spécialités afin de permettre un traitement rapideet complet des lésions