Examining the adequacy of preoperative informed consent in a developing country: Challenges in the era of surgical specialisation.

Preoperative informed consent is a legal and ethical requirement that ensures patients understand a procedure, its associated risks and benefits, alternative treatment options, and potential complications to make an informed decision about their care. This cross-sectional study evaluated the informed consent process for major orthopaedic surgeries at a tertiary hospital in Nigeria. A self-administered questionnaire was used to collect data from 120 adult participants. Results showed that many patients do not read the consent form before signing it, and surgeons do not adequately explain the alternatives to surgery, potential risks, and available anaesthetic options. Higher-educated patients are more likely to read the consent form. Surgeons performed well in explaining the nature of the condition and prognosis, the procedure's potential benefits, and answering patients' questions. The study emphasises the need to improve the informed consent process to ensure patients understand and can make rational decisions about their healthcare.

Factors Affecting the Acquisition of Basic Surgical Skills among Surgery Interns in Teaching Hospitals in Southeast, Nigeria.

Background: Upon graduation from medical school, doctors in Nigeria undergo a compulsory internship program which includes rotation through four core specialties: Internal medicine, Obstetrics and Gynaecology, Paediatrics and Surgery. Interns are expected to acquire basic surgical skills during their rotation in surgery. Objectives: To identify the factors that affect the acquisition of basic surgical skills by surgery interns (house officers) during their one-year internship program in teaching hospitals in Southeast Nigeria. Materials and Methods: A total of 73 surgery interns were sampled using a descriptive cross-sectional, epidemiological survey that employed self-administered Google forms. The semi-structured questionnaire was electronically distributed to interns currently in surgery rotations in their internship program in South-east, Nigeria. The data was analyzed using IBM's Statistical Package for Social Sciences (SPSS) version 22 and presented in tables and charts. Consent was obtained from all respondents and measures were put in place to limit different forms of bias. Results: The most important factors that negatively affected the acquisition of surgical skills by interns were fatigue from overwork (55.4%), poor mentorship (47.3%) and inadequate skill training courses (44.6%). There were no statistically significant correlations amongst the factors that affected the acquisition of basic surgical skills by house officers. Conclusion: Some of the major limitations to acquisition of surgical skills by house officers that have undergone the surgery rotation were identified to be the workload, poor mentorship and inadequate structured skill training courses. Recommendation: Provision of better work conditions to limit work fatigue and improve learning. The training of house officers undergoing their surgery rotation should be supplemented by periodic assessment and mentorship programs by senior doctor to improve the acquisition of basic surgical skills by house officers.

Early outcome after the use of the triceps fascia flap in interposition elbow arthroplasty: a novel method in the treatment of post-traumatic elbow stiffness.

BACKGROUND: Post-traumatic elbow stiffness (PTES) results in severe interference with the activities of daily living (ADL), affecting mainly young people. Total elbow arthroplasty (TEA) is relatively contraindicated in the young patient and arthrodesis is poorly tolerated. Interposition elbow arthroplasty (IEA) improves the range of motion (ROM) buying time for future reconstructive surgery. While the fascia lata remains the most common material used in IEA, the triceps fascia is a native vascularized tissue, and it does not require a separate incision to harvest. To our knowledge, there are no published studies on the use of this technique of IEA. METHOD: Sixteen patients with post-traumatic elbow stiffness had IEA with the triceps fascia between January 2009 and January 2017. The ROM was assessed pre-operatively and post-operatively at the 6th and the 24th week. The researchers also evaluated the functional outcome with the Mayo Elbow Performance Score (MEPS) at the 24th week. The data were analysed with the software IBM SPSS Version 20. RESULTS: Nine males and seven females had IEA with the triceps fascia. The mean age of the subjects was 22.8 years (SD = 6.39). The median duration of the stiffness was eight months (range: 2-168 months). Fall was the most frequent cause of post-traumatic elbow stiffness, and the non-dominant side was more frequently involved. Fourteen patients had an intervention at the native bone setters before presentation to the hospital. The mean elbow ROM increased from 16.4° pre-operatively to 97.2° at the 24th week (p < 0.001), while the mean MEPS improved from 42.5° pre-operatively to 81.2° post-operatively (p < 0.001). CONCLUSION: The triceps fascia flap provides an excellent alternative to the fascia lata for IEA without the complications of the donor site morbidity.

A comparison of the use and non-use of closed suction wound drainage in open reduction and internal fixation of femoral shaft fractures.

PURPOSE: The aim of this study was to determine if the routine use of closed suction wound drainage is justified following open reduction and internal fixation (ORIF) of femoral shaft fractures. METHOD: This was a prospective comparative study of two study groups: those with post-operative closed suction drainage (WCSD) and those not with closed suction drainage (NWCSD). RESULTS: Fifty-six patients, twenty-eight each for the two cohorts, were recruited for this study. Five patients (17.9%) in the WCSD group and only one patient (3.6%) in NWCSD group had surgical site infection (p = 0.20). Four patients (14.3%) in the WCSD group and nine (32.1%) in NWCSD group had wound dressing reinforcements (p = 0.21). CONCLUSION: There was generally no statistically significant difference in the incidence of wound infections, strike through bloodstain with wound dressing reinforcement and duration of hospital stay in patients with and without closed suction wound drainage after ORIF of femoral shaft fractures. The duration of the injury may however influence the decision to use or not use wound drain after surgery.