Mortality Pattern in Surgical Wards in Northwestern Nigeria: A Single-Center Study.

BACKGROUND: Surgical pathologies contribute to a huge portion of the global burden of diseases. Surgical needs therefore remain high and is projected to increase even further in the near future with increasing life expectancy and comorbidities, given the projection that 16% of the world's population will be older than 65 years by 2050. The outcome of patients with surgical pathologies could be influenced by several factors. Key amongst them is the quality of care. Mortality as an outcome is one metric that could be used to assess the quality of surgical care in a health facility, hence this study with the objective of determining the pattern of inpatient mortality in our surgical wards and suggesting possible ways of addressing identified gaps in their care delivery, which may also improve the care in other centers. PATIENTS AND METHODS: A retrospective cohort study of surgical inpatients' mortality in the surgical wards of Ahmadu Bello university teaching hospital from January 1st 2016 to December 31st 2019. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.0, and presented as descriptive statistics. RESULTS: A total of 8862 admissions were made into the surgical wards, with 655 deaths, giving a crude mortality rate of 7.4%. Most of the deaths occurred in patients in the 46-60 years age group (217, 33.1%). Malignancy was the commonest surgical condition, 294 (48.7%, n=604). This was followed by trauma-related conditions, 96 (15.9%, n=604). Civil gunshot injury admissions showed an upward trend from 19 in 2017, with an exponential rise to 45 in 2019. CONCLUSION: Although malignancy- related deaths predominated amongst our surgical inpatients, the incidences of deaths from road traffic and burns injuries, as well as septic surgical conditions are also worrisomely high. There is a rise in civil gunshot- related injury admissions and deaths.

CONTEXTE: Les pathologies chirurgicales contribuent à une part énorme du fardeau mondial des maladies. Les besoins chirurgicaux restent donc élevés et devraient encore augmenter dans un avenir proche avec l'augmentation de l'espérance de vie et des comorbidités que 16 % de la population mondiale aura plus de 65 ans en 2050. L'issue des patients atteints de pathologies chirurgicales peut être influencé par plusieurs facteurs. Parmi ceux-ci, la qualité des soins. La mortalité en tant que résultat est une mesure qui pourrait être utilisée pour évaluer la qualité des soins chirurgicaux dans un établissement de santé. Cette étude a pour objectif de déterminer le modèle de mortalité des patients hospitalisés dans nos services de chirurgie et de suggérer des solutions possibles de remédier aux les lacunes identifiées dans leur prestation de soins, ce qui pourrait également améliorer les soins dans d'autres centres. PATIENTS ET MÉTHODES: Une étude de cohorte rétrospective de la mortalité des patients hospitalisés en chirurgie dans les services de chirurgie de l'hôpital universitaire d'Ahmadu Bello Ahmadu Bello, du 1er janvier 2016 au 31 décembre 2019. Les données ont été analysées en utilisant la version 20.0 du progiciel de statistiques pour les Sciences (SPSS) et présentées sous forme de statistiques descriptives. RÉSULTATS: Un total de 8862 admissions ont été faites dans les services de chirurgie, avec 655 décès., soit un taux de mortalité brut de 7,4 %. La plupart des décès sont survenus chez des patients de la tranche d'âge 46-60 ans (217, 33.1%). La malignité était l'affection chirurgicale la plus fréquente, 294 (48.7%, n=604). Elle était suivie par les affections liées à un traumatisme, 96 (15.9%, n=604). Les admissions civiles pour blessure par balle ont connu une tendance à la hausse, passant de 19 en 2017, avec une augmentation exponentielle à 45 en 2019. CONCLUSION: Bien que les décès liés à la malignité aient prédominé prédominaient parmi nos patients hospitalisés en chirurgie, l'incidence des décès dus aux de la circulation routière et des brûlures, ainsi que des états chirurgicaux septiques sont également inquiétantes. Il y a une augmentation des admissions et des décès liés à des blessures civiles par balle. Mots-clés: Mortalité chirurgicale, Décès liés à un traumatisme, Décès liés à une arme à feu.

Challenges in the Management of Supracondylar Humeral Fractures in Children in Resource-Constrained Settings.

Upper limb fractures are quite common in children accounting for about 90% of all paediatric fractures. They are more common in males than in females. The supracondylar humeral fracture variety is one of the most common, requiring operative intervention. It is known to be associated with complications such as neurovascular injuries as well as elbow stiffness and cubitus varus. The management of the fracture in the absence of basic suitable imaging facilities poses great challenges to the orthopaedic surgeon.

Les fractures des membres supérieurs sont assez courantes chez les enfants et représentent environ 90 % de toutes les fractures pédiatriques. Ils sont plus fréquents chez les hommes que chez les femmes. La fracture supracondylienne de l'humérus est l'une des plus fréquentes, nécessitant une intervention chirurgicale. Il est connu pour être associé à des complications telles que des lésions neurovasculaires ainsi qu'une raideur du coude et un cubitus varus. La gestion de la fracture en l'absence d'installations d'imagerie de base appropriées pose de grands défis au chirurgien orthopédiste. Mots-clés: Fracture supracondylienne, broche de Kirschener, technique du fil latéral et croisé, paralysie du nerf ulnaire, cubitus varus.

Burden of Chronic Musculoskeletal Disorders amongst Patients Attending Orthopaedic Outpatients Clinic of a Tertiary Hospital, North-Western Nigeria.

BACKGROUND: Musculoskeletal disorders often pose significant limitation to activities of daily living due to pain or disability. These disorders often arise as a result of the normal aging process, but most have some predisposing factors that are lifestyle-related, especially in younger people as a result of repeated mal- posturing/ misuse of parts of the body in the course of their jobs or recreations. These disorders cause more functional limitations in the older adult population than any other group of disorders. Thus, with increasing aging of most populations of the world, it is expected that the burden of these disorders will continue to rise. There is paucity of epidemiological data on this subject and no published study showing the ease of affordability of treatment for these conditions in Nigeria, hence this study. PATIENTS AND METHODS: A cross -sectional study of patients with chronic musculoskeletal conditions attending the orthopaedic outpatient clinic of Ahmadu Bello university Teaching Hospital between 1st July 2019 and 31st December 2019, involving physical interview of new patients and review of case notes of old patients seen within the period. Statistical analysis was done with the Statistical Package for the Social Sciences (SPSS) version 20.0, and descriptive statistics were employed to summarize data. Pearson Chi- square test was used to examine for association between age, occupational ergonomic factors and chronic musculoskeletal conditions. RESULTS: Forty-six percent of the outpatients suffered from chronic musculoskeletal disorders. Chronic low back pain accounted for the greatest burden (64.9%), followed by osteoarthritis of the weight bearing joints (27%), chronic neck pain (4.8%) and rheumatoid arthritis (2.8%). 51.8% of the patients with chronic low back pain, 64.5% of chronic neck pain and 68.5% of osteoarthritis were in the middle-age group. Occupational ergonomic factors as an entity was a significant risk factor identified in almost all the conditions except rheumatoid arthritis (P = 0.0001). Only 121(18.7%) of the patients enjoyed health insurance, while majority do not. Also, 56.0% of the patients had the means of footing the cost of their treatment (either by way of health insurance coverage or out-of-pocket payment). CONCLUSION: The burden of chronic musculoskeletal disorders is high in our region. There is a need for the government to organize ergonomic educational programs through seminars and workshops as part of public health education, and a wider, well funded health insurance policy that covers both the formal and informal sectors and the full extent of the management of these chronic disorders to make such care accessible to all.

CONTEXTE: Les troubles musculo-squelettiques posent souvent des limitations importantes aux activités de la vie quotidienne en raison de la douleur ou d'un handicap. Ces troubles surviennent souvent à la suite du processus normal de vieillissement, mais la plupart présentent des facteurs prédisposants liés au mode de vie, en particulier chez les jeunes, à la suite d'une mauvaise posture / d'une mauvaise utilisation répétée de certaines parties du corps au cours de leur travail. ou des loisirs. Ces troubles entraînent plus de limitations fonctionnelles chez les personnes âgées que tout autre groupe de troubles. Ainsi, avec le vieillissement croissant de la plupart des populations du monde, on s'attend à ce que le fardeau de ces troubles continue d'augmenter. Il y a peu de données épidémiologiques sur ce sujet et aucune étude publiée montrant la facilité du traitement abordable pour ces conditions au Nigéria, d'où cette étude. PATIENTS ET MÉTHODES: Une étude transversale de patients atteints de troubles musculo-squelettiques chroniques fréquentant la clinique ambulatoire orthopédique de l'hôpital universitaire Ahmadu Bello entre le 1er juillet 2019 et le 31 décembre 2019, impliquant un entretien physique de nouveaux patients et un examen des notes de cas d'anciens patients vus dans la période. L'analyse statistique a été effectuée avec le progiciel statistique pour les sciences sociales (SPSS) version 20.0, et des statistiques descriptives ont été utilisées pour résumer les données. Le test du Chi-carré de Pearson a été utilisé pour examiner l'association entre l'âge, les facteurs ergonomiques professionnels et les affections musculo-squelettiques chroniques. RÉSULTATS: Quarante-six pour cent des patients ambulatoires souffraient de troubles musculo-squelettiques chroniques. La lombalgie chronique représentait le plus gros fardeau (64,9%), suivie de l'arthrose des articulations portantes (27%), de la cervicalgie chronique (4,8%) et de la polyarthrite rhumatoïde (2,8%). 51,8% des patients souffrant de lombalgie chronique, 64,5% de cervicalgie chronique et 68,5% d'arthrose appartenaient au groupe d'âge moyen. Les facteurs ergonomiques professionnels en tant qu'entité constituaient un facteur de risque significatif identifié dans presque toutes les affections à l'exception de la polyarthrite rhumatoïde (P = 0,0001). Seuls 121 (18,7%) des patients bénéficiaient d'une assurance maladie, alors que la majorité n'en bénéficiaient pas. De plus, 56,0% des patients avaient les moyens de prendre en charge le coût de leur traitement (soit par une couverture d'assurance maladie, soit par un paiement direct). CONCLUSION: Le fardeau des troubles musculo-squelettiques chroniques est élevé dans notre région. Il est nécessaire que le gouvernement organise des programmes éducatifs ergonomiques par le biais de séminaires et d'ateliers dans le cadre de l'éducation à la santé publique, et d'une politique d'assurance maladie plus large et bien financée qui couvre à la fois les secteurs formel et informel et toute l'étendue de la gestion de ces maladies chroniques. troubles pour rendre ces soins accessibles à tous. MOTS CLÉS: Clinique orthopédique, Appareil locomoteur chronique troubles, fardeau, assurance maladie.

Induced Membrane Technique of Masquelet; A Viable Option in Treatment of Post-Trauma Segmental Bone Loss: A Case Report.

In trauma and orthopaedic practice, the management of segmental bone loss constitutes a major challenge to the surgeon. Several methods have been employed in bone reconstruction with varying objectives depending on the size of the defect in question. A gap of not more than 2cm may benefit from acute docking and fixation, 4cm gap can be managed by non-vascularized structural or non-structural graft with fixation. Gaps of more than 4cm can be managed by numerous options which include allograft, vascularized structural graft and distraction osteogenesis with either linear rail system (LRS) or Ilizarov device. Masquelet technique of induced membrane formation is used to bridge a gap of more than 5cm and up to 25cm using bone cement as a spacer in first stage and use of autologous cancellous bone graft in the second stage.

En traumatologie et en orthopédie, la prise en charge de la perte osseuse segmentaire constitue un défi majeur pour la chirurgien. Plusieurs méthodes ont été employées dans la reconstruction d'os avec des objectifs variables en fonction de la taille du défaut en question. Un écart de pas plus de 2 cm peut en bénéficier de l'amarrage et de la fixation aigus, un écart de 4 cm peut être géré par structurelle non vascularisée ou greffe non structurelle avec fixation. Les espaces de plus de 4 cm peuvent être gérés par de nombreux options qui incluent allogreffe, greffe structurelle vascularisée et ostéogenèse par distraction avec l'un ou l'autre des systèmes de rails linéaires (LRS) ou appareil Ilizarov. Technique de Masquelet d'induit la formation de la membrane est utilisée pour combler un espace de plus de 5 cm et jusqu'à 25 cm en utilisant du ciment osseux comme espaceur dans la première étape et l'utilisation d'une greffe d'os spongieux autologue dans la deuxième étape. Mots clés: Défaut osseux segmentaire, ostéogenèse par distraction, technique de membrane induite, espaceur de ciment osseux.

Giant Cell Tumour of Distal Left Tibia: A Case Report.

Giant cell tumours of bone are relatively uncommon, accounting for about 5% of all primary bone tumours. They are generally classified as benign bone tumours. However, some of them might be locally aggressive. The peak incidence is between second and fourth decades of life. They are commonly found at the epiphyseal and, occasionally, metaphyseal zones of long bones such as radius, femur and tibia. They most often present as painless swellings; however, pain may be experienced as a result of pressure on the surrounding soft tissues. The relevant diagnostic investigations that help in establishing the diagnosis include plain x-rays, Magnetic resonance imaging (MRI), CT and tissue biopsy for histological confirmation. Traditionally, surgery is the mainstay of treatment of the disease. Other modalities include radiation, tumour embolization and injectable drugs for surgically inaccessible or recurrent cases.

Trauma Mortality in The Emergency Department of a Tertiary Hospital in a Low-Income Country: It's Time To Walk The Talks.

BACKGROUND: Trauma in developing countries has assumed an epidemic proportion and is now a public health problem. This is largely due to the rising incidence of road traffic crashes (RTC), increasing urbanization, industrialization and armed conflicts including terrorism fuelled by political, ethnic and religious factors in most developing countries. Unfortunately, this public health menace has not gotten the attention it deserves from the governments of the low-income countries, global non-governmental organisations and the mass media compared to the infectious diseases. METHODS: This was a 2-year retrospective cohort study of trauma patients who presented to our emergency department and died within 72 hours of admission. RESULTS: Within the period, a total of 6,858 patients, consisting of 2,228 trauma patients were admitted into our emergency department. Out of the trauma admissions, 256 patients died; giving a mortality rate of 11.5%. However, only 237 of the dead patients' case files could be reviewed. There were 195 (82.3%) males and 42 (17.7%) females. Majority of the deaths were in the age group 31 years - 45 years, with a mean age of 33.6 years. Road traffic crash was the most common cause of trauma deaths, 194 (81.9%); followed by flame burn, 15 (6.3%). Traumatic brain injury with or without other associated lesser injuries was the predominant diagnosis at presentation, 157 (66.2%). Most of the patients presented within 4 hours of their injuries, 136 (57.4%). Majority of the patients were brought to hospital by other road users, 133 (56.1%); and commercial bus was the commonest mode of transportation of the patients to the hospital, 102 (43.1%). CONCLUSION: The trauma mortality rate in our emergency department calls for urgent intervention measures. Critical amongst them is the need for establishment of a trauma system with an efficient pre-hospital emergency medical service component in our region.

Peripheral Gangrene and Extremity Amputations - Painful Preventable Sequelae of Meningococcal Septicaemia: Case Series Reports.

Extremity gangrene is a fairly common pathology, which complicates systemic vascular and endocrine diseases. Most often, it is encountered in diseases like uncontrolled Diabetes Mellitus, presenting as diabetic foot gangrene, severe peripheral arteriosclerosis with gangrene of the extremity complicating severe uncontrolled systemic hypertension and meningococcal septicaemia with peripheral gangrene. It also occurs in some cases of snake bite as well as frost bite (in regions with extreme cold weather conditions). Some of them present as monolateral extremity gangrene. However, others present as bilateral symmetrical peripheral gangrene (SPG) characterized by bilateral extremity ischaemia resulting in gangrene in which there is no major vascular occlusive disease. There is disseminated intravascular coagulation with the gangrene being considered as a cutaneous marker and some of the patients that survive ultimately require amputation of the affected limb(s) in the severe cases. The mild cases end up losing some of the digits or just exfoliation of the dead cutaneous layer. The effects are generally more severe in the lower limbs than in upper limbs. Notable among these are some of those complicating meningococcal sepsis resulting from peripheral intravascular coagulation. We present here, five patients who presented with varying degrees of peripheral gangrene during an epidemic of meningitis and the treatments that were carried out depending on the severity of their cases.

Trauma intensive care in a terror-ravaged, resource-constrained setting: Are we prepared for the emerging challenge?

INTRODUCTION: Trauma in developing countries has been on the increase, a situation perpetuated by rising road traffic collisions, terrorism and firearms proliferation. Some of the victims of trauma are left with life threatening conditions requiring urgent surgical intervention and/or intensive care. The objectives of this study were to determine the pattern of major trauma needing intensive care in the region, and to determine the outcome of major trauma admitted to intensive care unit. METHODS: A six-year retrospective cohort study of trauma patients needing intensive care, set in the Intensive Care Unit of Ahmadu Bello University Teaching Hospital, Zaria, North-West Nigeria. Subjects were major trauma patients admitted into the intensive care unit of the institution, identified via an admission register kept in the unit. The main outcomes measured were length of stay and mortality. RESULTS: Trauma admissions represented 25.1% of the all intensive care admissions. Severe traumatic brain injury accounted for 32.1% of the trauma admissions, while burns accounted for 23.2%. Of the injuries, 15.5% were sustained in bomb blasts, and 8.3% were firearm injuries. The majority of the patients stayed for no more than seven days from admission. Burns patients had the worst outcomes, with 82.1% mortality. CONCLUSION: Major trauma contributes significantly to local intensive care admissions, with terrorism- related trauma now an emerging challenging cause of major trauma in our region. The observed poor outcomes in this study are a reflection of the quality of available intensive care, and lends credence to the concept of appropriately resourced, specialised intensive care units for optimisation of care.

Anaesthetic requirement in spinal cord injured patients undergoing operation below the level of cord injury.

BACKGROUND: Anaesthesia in spinal cord injured (SCI) can be hazardous. In complete injuries above T6, the abnormal state of the respiratory and the cardiovascular systems pose special problems. The objective of this study therefore was to evaluate the anaesthetic requirements in patients with complete SCI undergoing operation below the level of the cord lesion. PATIENTS AND METHOD: The medical records and the operation notes of all patients with complete SCI who underwent surgical operations between January 2001 and December 2005 were reviewed. Information about their demographics, level of injury, indications for operation, type of operation done and the type anaesthesia used were collated. The choice anaesthesia was guarded by the proximity of operation site to the level of cord transaction and by patient's preference. The pre-operative and intra-operative blood pressure, pulse rate and respiratory rate were used to monitor cardiovascular and respiratory responses. RESULTS: They were twenty-eight, all male except one. The age range was 13-67 years with an average of32 years. The level of cord lesion varied. The thoracic spine was most involved followed by the cervical spine. The most common indication for operation was pressure sore. The anesthetic requirement varied, and ranged from general anesthesia (GA) to no anaesthesia at all. Three broad groups were observed: no anaesthesia; sedation with diazepam; and general anaesthesia. There was no remarkable change in the blood pressure readings in the three groups. However, three patients who had GA and whose operation sites were in the twilight zone had remarkable changes in the pulse and respiratory rates. CONCLUSION: Even though spinal patients are insensate below the level of their injury, significant proportions that need operation below the level of cord lesion require anaesthesia.