Outcome of road traffic injuries received in the emergency room of a teaching hospital, Southeast Nigeria.

Road traffic injuries (RTI) are a rapidly growing public health problem in developing countries. This study was aimed at assessing the early outcome of RTIs received in our hospital emergency room. Understanding this will help to achieve optimum injury outcome. A prospective study was conducted on all patients presenting with RTIs to the emergency room of the Ebonyi University Teaching Hospital, Abakaliki, from 1 March 2007 to 29 February 2008. Out of 363 patients: 72.45% were treated in the emergency unit and discharged; 12.7% left against medical advice; 10.9% were admitted to the ward; and 4.7% died. Self-discharge against medical advice was significantly related to the type of injury (78.3% had fracture/dislocation) and gender (P = 0.001). The patronage of traditional bone setters, because of cultural belief that they have supernatural ability to treat fractures, was the major reason given by those who left against medical advice. The morbidity and mortality rate was significantly related to the road type (P = 0.005 - a higher rate was observed for RTIs received on intercity roads than intracity ones) and the type of crash (P = 0.03 - more than half from head on collisions). Although the mortality rate was within the expected range, the preventable death rate was high, and the majority of deaths occurred within the 'golden hour' . Improvement in pre-hospital and emergency room care of patients with RTIs, as well as public awareness of the availability and efficacy of orthodox orthopaedic trauma care, are needed in the developing countries.

Oesophageal replacement in adult Nigerians with corrosive oesophageal strictures.

Literature dealing with the management of undilatable oesophageal strictures in Africa is either scanty or non-existent. This report reviews 73 cases of adult undilatable corrosive strictures treated by oesophageal replacement at the University of Nigeria Teaching Hospital (UNTH) Enugu over a 5-year period (March 1986 to February 1991). Almost all the cases were suicidal or parasuicidal. All the patients had colon transplants; the right colon was used in 68 patients while the left colon was used in five patients. The age range was 13 to 48 years with a mean of 26 years. There were 65 males and 8 females. Four patients died in the postoperative period, earlier on in our surgical experience, a mortality of 5%. Of the 69 survivors, 62 patients (90%) experienced no dysphagia after 6-9 months of follow-up. Four patients (6%) swallowed with some difficulty while three patients who could not swallow at all 6 months after surgery underwent further surgery, the strictured upper part of the transplants being replaced with myocutaneous tube grafts after which two patients were able to swallow. Major postoperative complications were proximal anastomotic leak 49% (34 patients) of survivors, wound sepsis 25% (17 patients), tension pneumothorax 7% (five patients), colon graft necrosis 4% (three patients), and Ascaris upper intestinal obstruction 4% (three patients). The short and medium term results after colon transplant for oesophageal corrosive strictures are good. Our experience emphasizes the fact that these patients are from the very low social class, usually ignorant and most default at the follow-up clinics, once they start swallowing.(ABSTRACT TRUNCATED AT 250 WORDS)

Osteosarcoma seen at the National Orthopaedic Hospital; Enugu - A retrospective review of 20 cases

A case study of 20 primary osteosarcoma seen at National Orthopaedic Hospital; Enugu for a period of ten years (June 1; 1978 to June 1; 1988) was done. The tumor was found to be the commonest bone tumor constituting 40of the malignant bone tumors seen at the hospital. Ninety per cent of the tumors occurred in the long bones; with 60occurring in the region of the knee. 15occurred in the upper limb while 85in the lower limb. Greater percentage of patients seen were lost to follow-up after one year and only six deaths were recorded. Treatment mostly was ablative surgery and adjuvant chemo-therapy

Fractures of the femur - a report of two hundred consecutive cases

Femoral fracture is quite a disabling injury and one of the most difficult to treat. Developing countries like ours have their own logistic problems that might affect the ultimate results. Ignorance and poverty have resulted in late presentations with resultant complications. Large series of femoral fractures treated over a ten year period at National Orthopaedic Hospital; Enugu has been reviewed. Of the two hundred cases seen 48.5was due to Road Traffic Accidents which mainly occurred during period of festivities. 41.5of the patients had already been to the traditional bone setters