Frequency of Osteoporosis in Black Nigerian Women Aged 50 and above with Degenerative Musculoskeletal Diseases and Fractures.

BACKGROUND AND OBJECTIVES: Osteoporosis is a bone disease characterized by reduced bone density (and microarchitecture damage) prevalent in post-menopausal women, who are prone to fragility fractures. There is paucity of data regarding the prevalence of osteoporosis in Nigerian women. This study was carried out to evaluate the frequency of osteoporosis among Nigerian women with degenerative skeletal diseases and fractures who visited our hospital so as to suggest prevention and early treatment in order to reduce the occurrence of fragility fractures. METHODS: Women aged 50 years and older, who visited the hospital with degenerative skeletal diseases and fractures during the study period were recruited. Their ages, diagnosis, Bone Mineral Density (BMD), T-score and interpretation were recorded in an anonymous database. RESULTS: The ages of the 173 patients evaluated ranged between 51 and 89 years, of which 111 (64.1%) were aged between 61 and 80 years. The most common diagnosis was degenerative lumbar spine disease in 37.0% of patients, but only 13.9% had fractures. Knee and hip osteoarthritis (OA) accounted for fewer cases (22.5% and 3.5% respectively). Using WHO criteria for diagnosing osteoporosis, 35 (20.2%) of the patients had osteoporosis, while 82 (47.4%) had low BMD, 52 (30.1%) were normal and 4 (2.3%) had high BMD. CONCLUSIONS: In this study, the frequency of osteoporosis increased with age and was higher among patients with a combination of cervical and lumbar degenerative disease, followed by fractures. We, therefore, recommend routine screening of women aged 50 and above with degenerative spine disease and fractures.

CONTEXTE ET OBJECTIFS: L'ostéoporose est une maladie osseuse caractérisée par une réduction de la densité osseuse (et des dommages à la microarchitecture) fréquente chez les femmes ménopausées, sujettes aux fractures de fragilité. Il y a peu de données sur la prévalence de l'ostéoporose chez les femmes nigérianes. Cette étude a été réalisée pour évaluer la fréquence de l'ostéoporose chez les femmes nigérianes atteintes de maladies dégénératives du squelette et de fractures qui ont visité notre hôpital afin de suggérer une prévention et un traitement précoce afin de réduire la survenue de fractures de fragilité. MÉTHODES: Des femmes âgées de 50 ans et plus, qui ont visité l'hôpital avec des maladies dégénératives du squelette et des fractures au cours de la période d'étude ont été recrutées. Leur âge, leur diagnostic, leur densité minérale osseuse (DMO), leur score T et leur interprétation ont été enregistrés dans une base de données anonyme. RÉSULTATS: L'âge des 173 patients évalués variait entre 51 et 89 ans, dont 111 (64,1%) étaient âgés de 61 à 80 ans. Le diagnostic le plus courant était la maladie dégénérative de la colonne lombaire chez 37,0% des patients, mais seulement 13,9% avaient des fractures. L'arthrose du genou et de la hanche (OA) représentait moins de cas (22,5% et 3,5% respectivement). En utilisant les critères de l'OMS pour le diagnostic de l'ostéoporose, 35 (20,2%) des patients souffraient d'ostéoporose, tandis que 82 (47,4%) avaient une faible DMO, 52 (30,1%) étaient normales et 4 (2,3%) avaient une DMO élevée. CONCLUSIONS: Dans cette étude, la fréquence de l'ostéoporose augmentait avec l'âge et était plus élevée chez les patients présentant une combinaison de maladies dégénératives cervicales et lombaires, suivies de fractures. Nous recommandons donc un dépistage systématique des femmes âgées de 50 ans et plus souffrant de maladie dégénérative de la colonne vertébrale et de fractures. MOTS CLÉS: femmes nigérianes, ostéoporose, densité minérale osseuse, fractures de fragilité.

Ultrasonographic Volumetric Assessment of Achilles Tendons in Unilateral Congenital Clubfoot in Lagos, Nigeria.

PURPOSE: To assess cases of unilateral congenital talipes equinovarus (CTEV) and compare both Achilles tendons using [MSK USS]. METHODS: Twenty-two patients (44 feet) with unilateral CTEV presenting at the clubfoot clinic who met the inclusion criteria were recruited for the study. Biographic data was collected from the patients and both Achilles tendons scanned using high frequency ultrasound scan probe. The length, width, thickness were measured and area of the tendons estimated. RESULTS: The median age of the patients was 32.5days with a male to female ratio of 1.2:1. The right foot was involved in 15 patients while the left was affected in 7 cases giving a ratio 2.1:1. The Achilles tendons in Clubfeet with mean length of 2.44(±0.3) cm were consistently longer than in the normal feet with mean length of 2.25(±0.3) cm. The width, thickness and area of the Achilles tendons in normal feet with mean values of 0.52(±0.01) cm, 0.22(±0.03) cm and 0.030(±0.01) cm2 respectively were consistently more than in clubfeet with mean values of 0.43(±0.1) cm, 0.20(±0.03) cm and 0.020(±0.01) cm2 respectively. The disparity in length between the normal and clubfeet when compared with the Pirani scores of the affected feet revealed no statistically significant difference. This was also noted when the disparity in width, thickness and area of Achilles tendons were similarly compared with Pirani scores. CONCLUSION: The Achilles tendon of unilateral CTEV is longer but thinner and narrower than in the contralateral normal foot. The disparity in sizes of the tendon has no significant correlation with severity of the clubfeet.

EXPERIENCE WITH MANAGING COMPLICATED FRACTURES USING ILIZAROV PRINCIPLE IN LAGOS, NIGERIA.

BACKGROUND: Management of complicated bone fractures in our environment is very challenging. The Ilizarov principle has been found to be a viable management option worldwide, but the use of this method in our environment has been sparsely reported. AIM: To document our use of Ilizarov method to manage patients with complicated long bone fractures and the outcome. DESIGN OF STUDY: Prospective observational study. SETTING: Lagos State University Teaching Hospital, Ikeja, Nigeria. METHODOLOGY: All the patients were treated between June 2009 and December 2012 using the Linear Rail-fixator System (LRS) according to Ilizarov principle. They were followed up for at least two years and data on demography, indications, procedure and outcome were collected and subjected to statistical analysis. RESULTS: Thirty patients whose procedures had been concluded were recruited. The age range was 4 - 57 years with a mean of 38 years ; 17 were male while 13 were female with a male/female ratio of 1.3:1. Specific indications for treatment included infected non-union, failed implant with limb length discrepancy and mal-union. They all had bone defects ranging from 4cm to 12cm and the pre-operative period of morbidity ranged from 2 months to 8 years. Seventeen patients had acute docking and lengthening, 10 had bone transport while 3 had simple limb lengthening. Using the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria, bone outcome was excellent in 7 patients, good in 20 and poor in 3. Functional outcome was excellent in 8, good in 19 and poor in 3. Complications included pin site infection (grades I & II) in 14 patients, knee stiffness in 6 and regenerate fracture in 1. CONCLUSION: Ilizarov surgery is a good method of limb reconstruction in our environment. Our major complications are the high rate of pin site infection and knee stiffness. Good pin site care and early physiotherapy is essential.

Posterior spinal decompression, stabilization and arthrodesis in Nigerian adults: Profile and outcome.

BACKGROUND: The availability of intraoperative fluoroscopy and improved access to varieties of spinal titanium implants has revived posterior spinal stabilization techniques with their distinct advantages. Our aim is to describe the profile of various spine pathologies requiring subaxial posterior spinal decompression, stabilization (using titanium implants), and arthrodesis, and to determine the rate of postoperative complications and factors affecting outcome. MATERIALS AND METHODS: This is a prospective single institution study of consecutive adult patients seen during the study period. Data collected included the patients' demographics, radiological findings, indication for surgery, surgical procedure, operation time, intraoperative blood loss, and postoperative complications. RESULTS: There were 26 patients (15 males and 11 females). Their ages ranged between 24 and 78 years (median = 42 years). The most common indications for surgery were spinal trauma and degenerative spine disease (24 patients). The region that was most commonly stabilized was the lumbar- 12 cases (46.2%). No patients experienced neural or vascular injury as a result of screw position; likewise no patient had screw loosening. There was a case each of superficial surgical site infection and transient cerebrospinal fluid leak but no case of implant failure was encountered. The outcome was significantly associated with the etiology (0.030) of the indication for surgery and preoperative power grade (0.000). CONCLUSION: Spinal trauma and degenerative spine disease are the two most common indications for posterior spinal decompression, stabilization and fusion in our center. It is associated with acceptable postoperative complication rate when done under fluoroscopic guidance. Outcome is related more to the preoperative neurological deficit and etiology of the indication for surgical stabilization.

Ambulance services of lagos state, Nigeria: a six-year (2001-2006) audit.

BACKGROUND: Emergency medical care is designed to overcome the factors most commonly implicated in preventable mortality, such as delays in seeking care, access to health facility, and the provision of adequate care at the facility. The developed world has recognized the importance of organized emergency medical services and has well established systems. The Lagos State Government established the first emergency medical system in Nigeria in 2001. OBJECTIVE: This was to review the activities of the Lagos State Emergency Ambulance Services (LASAMBUS) within the stated period with the hope that our findings can be used to audit the system and make recommendations for further improvement. SUBJECTS, MATERIALS AND METHODS: We reviewed the records of the State Ministry of Health for the data on the activities of LASAMBUS from 2001-2006. The number and types of emergencies that were seen and managed with the associated morbidity and mortality were reviewed. The constraints that were encountered by the LASAMBUS staff were also studied. The data that was obtained was entered into a proforma designed for the study. Analysis of the data was done using the Microsoft Excel software. RESULTS: A total of 32,774 cases comprising 21,977(67.1%) males,10,797(32.9%) females and a male to female (M:F) ratio of 2.04:1, were seen during the study period. Trauma was responsible for 29,500 (90%) of the cases. No mortality was recorded during the transfer of the cases. The records of mortality for the LASAMBUS-transferred cases were not available. CONCLUSION/RECOMMENDATIONS: Trauma cases formed the majority of the cases that were seen with road traffic accident constituting a large proportion of these. Health education focusing on improving driving etiquette of Drivers and injury prevention should intensified. More equipped emergency centres should be established to reduce victims transit and injuryintervention time. Record keeping and documentations should be improved for better assessment of the activities.

Assessing limb ischaemia using Doppler in a patient with diabetes mellitus.

OBJECTIVE: To highlight the usefulness of duplex ultrasonography in assessing the degree of limb ischaemia in patients with peripheral arterial occlusive disease (PAOD). METHODOLOGY: Duplex ultrasonography (B mode, Color flow and spectral Doppler analysis) was used to evaluate the degree of limb ischaemia in an elderly Nigerian woman with diabetes who had clinical features of severe PAOD RESULTS: The patient was found to have moderate and severe limb ischaemia in the right and left lower limbs respectively. She subsequently had a below the knee amputation of the left lower limb. CONCLUSION: Duplex ultrasound is advised as part of the pre-operative evaluation of patients with PAOD, in order to adequately localise the diseased arterial segment and degree of limb ischaemia. However, segmental Doppler pressures with ankle brachial analysis should be utilised as a screening tool in symptomatic patients.

Congenital club foot in a teaching hospital in Lagos, Nigeria.

Congenital club foot has been sparsely reported in literature in Nigeria, although it has been reported as the commonest congenital musculoskeletal abnormality. This study enumerates the point prevalence of this disease in a university teaching hospital in Lagos. Better understanding of the epidemiology in our community should improve awareness, and influence management. Between June 2005 and July 2006, 72 consecutive patients with congenital club feet were seen in the orthopaedic clinic of our Hospital. Demographic data, birth weight, family history, birth facility, maternal age and associated congenital anomalies were recorded and analysed using Statistical Programme for Social Sciences (SPSS) version 15. A total of 72 patients were seen, 28 of whom had bilateral club feet resulting in a total of 100 feet. There were 38 males and 34 females. Only 29% presented in the first month of life and 28% in the second month. Maternal ages ranged between 19 and 38 years and no family history of congenital club foot was given,. Babies delivered outside the orthodox medical system (churches, traditional healers, home etc) constituted 28%. The commonest associated congenital anomalies were tibia hemimelia, hydrocephalus, inguinal hernia and umbilical hernia. A default rate of 28% was observed during treatment. Congenital club foot may not be uncommon in Nigeria. Late presentation and high default rate before correction of the deformity were observed. Establishment of special club foot clinics should reduce the default rate. Training of healthcare workers in maternity units as well as Public awareness should encourage early referral to specialists.

Limb deformities: the Lagos, Nigeria experience

Background: Individuals with various forms and degrees of limb deformities are common on the streets of Lagos; Nigeria. State-sponsored screening and surgical correction of the deformities were carried out in Lagos between June 2004 and May 2006. A report on the pattern of limb deformities is presented. Methods: This was a prospective study of all the patients that were seen and treated during the various screening programmes and operating sessions. Data was stored electronically and analysed using Microsoft Excel software. Results: A total number of 1;321 patients were screened; and 344 satisfied the inclusion criteria for enrolment. They were aged between 9 months and 64 years but only 20were aged 5-years and below. Females constituted 58.2and males 41.8. A total of 513 limbs were surgically corrected. The most frequent deformity and disease entity were bilateral genu varum (45.1) and Blounts disease (48.7); respectively. Proximal tibial wedge corrective osteotomy was the most frequent surgical procedure performed. Most beneficiaries presented late and were discharged within 48-hours of hospital admission. Conclusions: Improved public awareness about the availability of hospital based resources to solve the problem of limb deformity is advocated