Foot and ankle abnormalities among a cohort of Nigerian school children: an epidemiological study.

PURPOSE: Foot and ankle problems in children are a common cause for paediatric orthopaedic referrals. There is a variation in the reported epidemiology of foot and ankle abnormalities across the globe. The prevalence in our locality was unknown. The objective of this study was to determine the prevalence pattern of foot and ankle problems in our locality as well as compare with patterns from other geographical locations to determine the presence or otherwise, of differences among varying populations. METHODS: One thousand seven hundred and fifty-eight Nigerian primary school children aged between five and 13 years were clinically evaluated, checking for weight, height and calculation of BMI. The heel axis angle and hallux angle were measured clinically while determination of flatfeet or high arched feet was made from analysis of foot imprints. RESULTS: Hindfoot valgus was the commonest abnormality of the foot and ankle in this population with a prevalence of 34.2% and predominantly in females and older children, while hallux valgus and a high arched foot were the least common abnormalities at 0.6 and 0.7% prevalence rates, respectively. We found no statistically significant relationship between BMI and hindfoot valgus. CONCLUSION: Hindfoot valgus is the commonest foot and ankle abnormality among primary school children in our locality.

Prevalence of pin tract infection: the role of combined silver sulphadiazine and chlorhexidine dressing.

OBJECTIVE: Infection at the pin tract is a common complication of external fixation. This study was done to compare the rate of pin site infection following combined 1% silver sulphadiazine and 5 % chlorbexidine dressing with 5% chlorhexidine dressing alone. METHOD: This was a prospective controlled study which compared the results of pin site dressing using a combination of chlorhexidine and silver sulphadiazine cream (Study group) with dressing using chlorhexidine alone. Eligible patients had external fixation in the treatment of open fractures or orthopaedic conditions. Pin-tract infection was deemed to be present iferythema, cellulitis or purulent discharge occurred around a pin site. We did not distinguish between deep and superficial infection. RESULTS: The study group had one hundred and seventy pin sites while the control group had one hundred and sixty-four pin sites. Thirty-eight patients, in whom thirty-seven uniplanar external fixators and one Ilizarov ring fixator were used, made up both groups. Three patients (7.9%) had pin tract infection in the study group while nine patients (23.7%) had pin tract infection in the control group. CONCLUSION: There was a significantly lower prevalence of pin-tract infection amongst patients whose external fixation pins were dressed with 1% silver sulphadiazine and 5% chlorhexidine than in those dressed with chlorhexidine alone (P = 0.03). Therefore, we advocate the use of a combination of silver sulphadiazine and chlorhexidine for pin site dressing.

The level of fibula osteotomy and incidence of peroneal nerve palsy in proximal tibial osteotomy.

OBJECTIVES: The level of fibular osteotomy has a role in the incidence of peroneal nerve palsy (PNP). This study aims to compare the prevalence of PNP among patients who had fibular osteotomy at two different levels. MATERIALS AND METHODS: Sixty-nine limbs in fifty-two patients had valgus osteotomy of the proximal tibia and fibular osteotomy at two different levels - the proximal half (Group 1) and distal half (Group 2). The results of these were compared. RESULTS: The incidence of peroneal nerve palsy was 23.6 and 3.2% in Groups 1 and 2, respectively (P < 0.025). CONCLUSION: This study supports the choice of the distal half for fibular osteotomy.

Prevalence of Pin Tract Infection: The Role of Combined Silver Sulphadiazine and Chlorhexidine Dressing

Infection at the pin tract is a common complication of external fixation. This study was done to compare the rate of pin site infection following combined 1silver sulphadiazine and 5chlorhexidine dressing with 5chlorhexidine dressing alone. This was a prospective controlled study which compared the results of pin site dressing using a combination of chlorhexidine and silver sulphadiazine cream(Study group)with dressing using chlorhexidine alone. Eligible patients had external fixation in the treatment of open fractures or orthopaedic conditions. Pintract infectionwas deemed to be present if erythema; cellulitis or purulent discharge occurred around a pin site. We did not distinguish between deep and superficial infection. The study group had one hundred and seventy pin sites while the control group had one hundred and sixty-four pin sites. Thirty-eight patients; in whom thirty-seven uniplanar external fixators and one Ilizarov ring fixator were used; made up both groups. Three patients (7.9) had pin tract infection in the study group while nine patients (23.7) had pin tract infection in the control group. Therewas a significantly lower prevalence of pin-tract infection amongst patientswhose external fixation pins were dressed with 1silver sulphadiazine and 5chlorhexidine than in those dressed with chlorhexidine alone (P=0.03). Therefore; we advocate the use of a combination of silver sulphadiazine and chlorhexidine for pin site dressing

Multiple digital gangrene arising from traditional therapy: a case report.

BACKGROUND: Traditional medicine has being advocated as an alternative to Orthodox medicine in Nigeria despite, its reported adverse effects. OBJECTIVE: To report an unusual complication of traditional therapy. METHODS: A 20-year-old house-wife who was bitten by a crawling insect presented to a hospital with complaints of swollen body and pain in three digits. After clinical evaluation and investigations, she had both medical and surgical intervention. RESULTS: Two weeks following an insect bite, the patient noticed periorbital and bilateral leg swellings. She sought help from a traditional medicine practitioner who incised and tied the affected digits for three days. He repeated the cycle thrice. She had generalized oedema, massive proteinuria, hypoalbuminaemia, hypercholesterolaemia features consistent with a diagnosis of nephritic syndrome. There was gangrene of the left middle finger and both index toes. Oedema responded to diuretics, lisinopril and low salt diet. She had surgery for the gangrenous digits. CONCLUSION: Development of gangrene is an unusual finding in nephrotic syndrome. It occurred in this case as an aftermath of traditional medical intervention. This report reiterates the danger of this form of medical practice and the need for measures to protect the populace to be put in place.

Multiple digital grengrene arising from traditional therapy: a case report.

BACKGROUND: Traditional medicine has being advocated as an alternative to Orthodox medicine in Nigeria despite, its reported adverse effects. OBJECTIVE: To report an unusual complication of traditional therapy. METHODS: A 20-year-old house-wife who was bitten by a crawling insect presented to a hospital with complaints of swollen body and pain in three digits. After clinical evaluation and investigations, she had both medical and surgical intervention. RESULTS: Two weeks following an insect bite, the patient noticed periorbital and bilateral leg swellings. She sought help from a traditional medicine practitioner who incised and tied the affected digits for three days. He repeated the cycle thrice. She had generalized oedema, massive proteinuria, hypoalbuminaemia, hypercholesterolaemia features consistent with a diagnosis of nephritic syndrome. There was gangrene of the left middle finger and both index toes. Oedema responded to diuretics, lisinopril and low salt diet. She had surgery for the gangrenous digits. CONCLUSION: Development of gangrene is an unusual finding in nephrotic syndrome. It occurred in this case as an aftermath of traditional medical intervention. This report reiterates the danger of this form of medical practice and the need for measures to protect the populace to be put in place.