ABSTRACT
Background: Worldwide, lower extremity gangrene in children is rare. In orthopaedic practice in developing countries, a frequent cause of extremity gangrene is the practice of traditional bone setting. Aim of the study was to document lower extremity gangrene in children resulting from the care of traditional bone setters’ as seen in a tertiary health institution.Methods: A prospective study of children presenting with lower extremity gangrene from the care of traditional bone setters at the University of Port Harcourt Teaching Hospital from January 2006 to December 2018. Data obtained included the patients socio-demographics and relevant information related to the diagnosis. Data was analysed with SPSS version 20.Results: Eighteen children with lower extremity gangrene were seen. Their ages ranged from 10 days to 132 months. There was a female preponderance. Their parents mostly had primary and secondary levels of education and majority were married. The most common diagnosis was tibiofibular fractures followed by congenital clubfoot. Trauma-related injuries were mostly from falls. Duration before presentation ranged from 7 to 28 days. Majority had massage, splinting and bandaging from the bone setter. Most common associated complication at presentation was sepsis. All had provisional amputation. Most common amputation was below knee. Most had stump refashioning within 15 days. One had split skin grafting. There was one mortality. Duration of hospital stay ranged from 3 to 65 days.Conclusions: Children at any age can develop lower extremity gangrene from traditional bone setters’ care. This is an avoidable and preventable sequelae of care. Parental health education is necessary to discourage their patronizing traditional bone setters.
ABSTRACT
Background: Removal of an intramedullary nail would require the extraction system of the inserted nail to be available. Sometimes the system is not available, and an alternative system would have to be utilised. Aim of the study was to document the removal of interlocked nails using bolts in the absence of appropriate fitting extraction system.Methods: A prospective study of consecutive patients seen by the authors between September 2016 and September 2018 in private clinics in Port Harcourt where the authors were invited to remove intramedullary nails. Bolts fitted to the proximal tips of the nails were utilized. With the aid of plier applied to the bolts and mallet, the nails were extracted. The patients’ socio-demographic and information relevant to the injury were obtained. Data was analysed using SPSS version 23.Results: Fifteen patients were seen. Ages ranged from 29 to 72 years, consisting of 10 males and five females. The tibia was affected in six and the femur in nine. There were five united tibial fractures and one non-united tibial fracture, six united femoral fractures and three non-united femoral fractures. Indication for removal was mostly patients’ request. Duration of surgery ranged from 1 to 4 hours. All the nails were extracted. Complications included broken nail, heterotopic calcification, bony overgrowth/ ingrowth/ongrowth around the nail and interlocking screws. There was no mortality.Conclusions: In the absence of conventional intramedullary nail extraction system, appropriate size bolts can be applied to the threaded proximal tip of nails and used for nail extraction.
ABSTRACT
Background: Ring entrapment is uncommon in our environment. It is necessary to remove entrapped rings and the removal techniques could be either destructive or non-destructive. The aim of this study is to present a non-destructive method of entrapped ring removal.Methods: A prospective study of patients who presented to the University of Port Harcourt Teaching Hospital, Port Harcourt between 1st October 2007 and 30th September 2018, with entrapped finger ring(s). The authors developed a non-destructive technique of entrapped ring removal utilizing 1.5-2.5 mm electric cables. The cables are passed under the ring and looped over it. The surgeon and his first assistant applies traction towards the distal aspect of the finger through the cables while moving the cables from side to side around the finger, with the second assistant maintaining a counter-traction. Data obtained was analyzed using IBM’s Statistical Package for Social Sciences (SPSS) version 23.Results: During the period, there were 25 patients who had entrapped ring(s) in their fingers. Mean age was 22.92±9.33 years. There were 10 males and 15 females. Mean duration of ring entrapment was 5.72±4.57 days. Mean duration of ring removal was 63.6±46.58 seconds. Abrasion was the most common complication following initial removal attempts as well as this technique. The entrapped rings were all successfully removed.Conclusion: The electric cable technique is a simple, inexpensive and readily available method of entrapped ring removal.