Forequarter Amputation at Muhimbili Orthopaedic Institute:Indications and Outcome

Amputation through the scapulo-thoracic articulations is a radical surgical procedure. Although it is rarely performed; it remains a valuable surgical option for malignancy and severe injuries around the shoulder joint. In this review we present five cases of Fore Quarter Amputation done at Muhimbili Orthopaedic Institute between 2006 - 2010 with emphasis on the indication;outcome and its significance in developing countries

The Incidence and Treatment Outcome of Open Fractures of the Extremities at Muhimbili Orthopaedic Institute

A retrospective study of patients with open fractures admitted to Muhimbili Orthopaedic Institute between January 1999 to December 2001 (3 years) was done to determine the incidence; mechanism of injury; demographic pattern; and treatment outcome. A total of 507 patients with open fractures were admitted during this period; giving an incidence rate of 5.72. Among these 85.8were male. Road traffic accidents accounted for 55of the cases as a cause; followed by interpersonal violence (11.2) and falls from heights (11). Tibia and fibula were the commonest injured bones (54) followed by radius and ulna 15and the femur 11. Grade III open fractures accounted for 55.1of all fractures while out of these 7.5were crush injuries and 3.2had traumatic amputation of one of the extremities. Surgical debridement and external fixation was the most frequently used mode of treatment (42.6) while surgical debridement and POP mobilization was used in 28.4of the patients. Almost 29of the patients sustained various complications. Amputations including traumatic amputations accounted for 11; chronic osteomyelitis accounting for 7. Six patients (1.2) died due to tetanus. This study shows early proper surgical debridement and frequent use of external fixators reduces the rate of complications from open fractures

Late Open Intramedullary Kuntscger Nailing of Femoral Shaft Fractures

One hundred and three femoral shaft fractures treated by open intramedullary Kuntscher nailing between July 1998 and June 2001 were studied retrospectively. Their ages ranged between 9 and 70 years of age with a mean age 30.6 years; males accounting for 82.5. Most of the injuries (72.8) resulted from road traffic accidents. All were operated late after failure of traction with time between injury and surgery ranging from one week to 16 weeks; with a mean duration of 7 weeks. The commonest complication was reduced knee flexion; with 16 (16) of the patients having a knee flexion of less than 1000 six weeks after surgery. Osteomyelitis occurred in 3 patients (2.9) but all had full recovery after control of the infection. Fatigue fracture of nails (implant failure) requiring renailing occurred in 7 patients (6.8). These results support the continued use of open intramedullary Kuntscher nailing of femoral shaft fractures in developing countries where the necessary infrastructure and expertise required for closed interlocking intramedullary nailing is not available