Quality of Life and Life after Amputation among Amputees in Lagos, Nigeria.

Background: Amputation is a life-changing surgical procedure that can cause significant disruptions in the quality of life of an individual. Objectives: This study aimed to evaluate the quality of life of patients with limb amputations in Lagos. Materials and Methods: This was a cross-sectional study carried out among amputees recruited from two tertiary institutions and roadsides in Lagos state. A structured interviewer-administered questionnaire was used to collect data on demography, medical history, and postamputation health status. Also, a short form (SF-12V2) health questionnaire was used to assess their quality of life. Results: Two hundred and fifty-four (254) subjects with extremity amputation, aged 18-75 years with a mean age of 47.82 ± 11.53 years were studied. The male-to-female ratio was 1.4:1. The commonest age group of the amputees was 45-60 years (52%). The commonest indication for amputation was diabetic gangrene (126 [49.6%]) and trauma (90 [35.4%]). Postamputation, 98 (38%) were employed, and 117 (75%) of those unemployed resorted to begging as a means of livelihood. While 57 (22.4%) used prostheses frequently, 68 (26%) did not want prostheses as they supposed that it negatively affected their begging business. Female amputees have a statistically significantly better quality of life than males in the physical (r = 0.03) and mental components (r = 0.04). Conclusions: A proper rehabilitation program, the use of prostheses, and adequate employment opportunities would improve the quality of life of amputees.

New method to estimate femoral head size from the trochanteric length of the femur.

INTRODUCTION: Preoperative planning is an important step before any joint replacement surgery. In developing countries standardised radiographs and planning tools might not be available but nevertheless hemiarthroplasties are performed in certain trauma cases. An equation should be devised to allow a preoperative estimation of the expected femoral head size dimensions in those situations. MATERIALS AND METHODS: 35 lower limbs of human cadavers were studied. The estimated femoral head (EFH) size of each femur was obtained by measuring the trochanteric length (TL) (in cm) and using the equation 'EFH = 16 + (0.7 × TL)'. The hip joint was dissected, and the actual size of the femoral head (AFH) was measured on the specimen. RESULTS: There was a correlation between the EFH and AFH (p = 0.0001). Accepting a range of ±3 mm the femoral head size was predicted correctly in 31 hips (89%), for ±4 mm in 33 hips (94%) and for ±5 mm in 35 hips (100%), respectively. CONCLUSIONS: A simple tape measurement and the equation Femoral head size = {16 + (0.7 × Trochanteric Length)} ±5 mm gives a rather reliable guess for the expected femoral head size. It might be useful as pre-operative planning tool if no standardised radiographs are available.

Presentation and management outcomes of pelvic fractures: a single institutional review

Background: Pelvic fractures are orthopaedic emergencies associated with polytrauma. These fractures have gradually increased in recent times as a result of increasing high speed and complex road traffic accidents. Objective: To describe the presentation and management outcome of patients that were managed in our institution for pelvic fractures over the study period. Methodology: We retrospectively reviewed the hospital records of patients who were admitted and treated in our hospital with pelvic injuries from February 2012 to January 2015. Results: Majority 122 (75.8%) of the patients in this study were aged below 40 years. These fractures were mostly caused by road traffic accidents. Most 116 (71.9%) of our patients had Tile class A and B fractures. Polytrauma seen in 41.6% of the patients was the most common associated injury seen with pelvic fractures. The mean Injury Severity Score (ISS) 31.4 shows that these patients were mostly severely injured patients. The fatality rate in this study was 16.12%. These mortality were higher for patients with Tile class C than B injury and no death was recorded for class A injuries. Conclusion: Majority of the patients were less than 40 years and Road Traffic Accident is the commonest aetiology. Many were successfully managed conservatively particularly those with stable and partially stable injuries. Functional outcome is generally good

Spectrum of musculo-skeletal disorders in sickle cell disease in Lagos, Nigeria.

BACKGROUND: Sickle cell anemia (SCA) is a common genetic disease in Nigeria. Past studies from West Africa focused on isolated aspects of its medical and surgical presentations. To the best of our knowledge, the musculo-skeletal presentations amongst Nigerians with SCA have not been documented in a single all encompassing study. This work aims to prospectively document the musculo-skeletal disease burden among SCA patients. METHODS: In a prospective study of 318 consecutive patients with genotype-confirmed SCA at the Lagos University Teaching Hospital (LUTH), the musculo-skeletal pathologies, anatomic sites, grade of disease, age at presentation and management outcome were recorded over a one-year period. Data obtained were analyzed using Epi-Info software version 6.0. Data are presented as frequencies (%) and mean values (SD) as appropriate. RESULTS: The HbSS genotype occurred in 296 (93.0%), while 22 (7.0%) were HbSC. 100 (31.4%) patients with average presenting haemoglobin concentration of 8.2 g/100 ml in the study group, presented with 131 musculo-skeletal pathologies in 118 anatomic sites. Osteomyelitis 31 (31%) and septic arthritis 19 (19%) were most commonly observed in children less than 10 years. Skin ulcers and avascular necrosis (AVN) occurred predominantly in the older age groups, with frequencies of 13 (13.0%) and 26 (26.0%) respectively. 20 (71.5%) of diagnosed cases of AVN presented with radiological grade 4 disease. The lower limbs were involved in 84 (71.1%) of sites affected. Lesions involving the spine were rare 11 (0.9%). Multiple presentations occurred in 89 (28.0%) of patients; 62 (69.7%) of which were children below 10 years. CONCLUSIONS: Musculo-skeletal complications are common features of sickle cell anaemia seen in 31.4%. Infectious aetiologies predominate with long bones and joints of lower limbs more commonly affected by osteomyelitis and septic arthritis. Healthcare providers managing SCA should be aware of the potential morbidity and mortality of these conditions to ensure early diagnosis and adequate management.