Surgical Resident Doctor's Perspective of their Training in the Southeast Region of Nigeria

There are several problems militating against satisfactory residency training in Nigeria. These problems may not be effectively identified and resolved if the opinion of the trainee doctors is ignored. Objectives: To review surgical residents' perspectives of their training program in South-eastern Nigeria; with the aim of suggesting evidence-based innovative changes to enable the programs meet global trends and standards. Materials and Methods: A total of 90 semi-structured and pre-tested questionnaires were evenly distributed (30 per hospital) to the surgical residents at three tertiary healthcare facilities in South-eastern Nigeria. Information sought included sociodemographic variables; level in the residency training; rating of program and different aspects; learning environments/opportunities; and suggestions on ways to improve either part or overall program. Results: Analysis of 56 properly completed questionnaires (response rate=62.2) shows that the respondents were aged 29 to 53 years [mean(SD) = 35.3(1.7)]; mostly males (91.1) and junior residents (75). A significant majority of residents (47 or 83.8) rated the surgical residency training in their respective centers as inadequate. Grand rounds were roundly criticized as having misplaced objectives and tending toward fault-finding by Consultants. Suggested interventions for improvement included enhanced supervision/mentoring/teaching by senior colleagues; inclusion of didactic lecture sessions; research trainings; and foreign postings. Conclusion: There exist gaps between expectations of surgical residents and the training offered. These create needed support for an evidenced-based review of surgical residency training program to enable it meet the aspirations of trainees and the ever-changing trend in Medicine. More studies on surgical residents covering other regions of Nigeria; and including the trainers (Consultants); will be of immense value

Management of penetrating spinal cord injuries in a non spinal centre: experience at Enugu, Nigeria

BACKGROUND:Penetrating injuries of the spinal cord are among the most dangerous of injuries. They are often associated with injuries to other vital organs of the body, which may demand priority attention. The objectives of this study were to determine the pattern of the penetrating spinal cord injuries and to evaluate outcome of treatment in our setting.METHODS:This is a retrospective study of all penetrating spinal cord injuries seen at the National Orthopaedic Hospital, Enugu over a fifteen-year period (April 1990 March 2005). Information about the demographics aetiology, level of injury, associated injuries, time of presentation, duration of hospitalization and outcome of treatment were retrieved from patients case notes. Data were analyzed using SPSS for windows version 11.RESULT: There were 22 patients, 13 males and 9 females, giving a M:F ratio of 1.7:1. Gunshot injury was the most common aetiological factor. The thoracic spine {9 (41%)} was most often involved. Chest and abdominal injuries were common associated injuries in 5 cases. The circumstances of the injury were mostly armed robbery attack {13 (59%)}. On admission the neurological status was Frankel grade A in 20(91%) cases. Period of hospitalization ranged from 1 week to 36 weeks with a mean of 11 weeks. Pressure sore was the most common complication that delayed rehabilitation. Five (23%) patients with injury at cervical level died from respiratory failure.CONCLUSION:Penetrating spinal cord injuries are relatively rare and demand extra care. Early recognition of associated injuries, minimal wound excision and antibiotic therapy give good result

Operative Management of Congenital Talipes Equinovarus Deformity: Experience and Reason

Background: Congenital talipes equinovarus is the most common congenital anomaly of the foot and ankle. The prevalence of this condition in our environment is not known due to dearth of medical literature on the subject. The aim of this study was to determine the outcome of our operative management of resistant talipes equinovarus by elongation of tendo-Achilles and posteromedial soft tissue release. Methods: We present a retrospective review of congenital talipes equinovarus treated by Elongation of tendo Achilles (ETA) and Posterior Medial Release(PMR) at National Orthopaedic Hospital Enugu over a 6- year period (January1995- December 2000). Results: There were 63(68) males and 30(32) females with mean age of 2.06 years at presentation (range 1/12-18years). There was positive family history in 6(7) patients. More than half of the patients 63(68) came without any formal referral. The mode of delivery was spontaneous vaginal delivery in 81(87) and the first child appears to be more affected 22(24). The deformities on presentation varied from talipes equinovarus 50(54) to frank equinus in 3(3) and fifty-four (58) were bilateral. Sixty- three (68) had initial treatment ranging from serial casting in 46(50) to massage by traditional bonesetter in 2(2) and the average duration of this initial treatment was 20weeks (range 2-106weeks). The average age at surgery was 2.5years (range 3/12-24 years). All patients received postoperative cast for an average of 13 weeks. The commonest post- operative complication was medial wound breakdown. The average duration of follow-up was 30 weeks (range3weeks-3years). Some patients were lost to follow-up immediately the cast was removed. As at last visit 90were walking pain-free and do not require special shoe. The commonest residual deformity as at last visit was forefoot adduction in 17(18) patients. Conclusion: Elongation of tendo-Achilles and posteromedial soft tissue release are common operative procedures for CTEV. The short-term result of these procedures appears very good in our environment. However; the long-term result cannot be effectively analyzed due to high rate of loss to follow-up