Neglected simultaneous bilateral asymmetric traumatic hip dislocation in a young male managed by closed reduction manoeuvres in a resource-limited setting: A case report.

Background: Asymmetric bilateral hip dislocations are rare, representing approximately 0.01 %-0.02 % of all joint dislocations. The treatment of neglected hip dislocations is difficult or impossible by closed reduction manoeuvres. This is a report of an unusual clinical entity of neglected simultaneous bilateral asymmetric traumatic hip dislocations in a young male, managed by closed reduction manoeuvres. Case presentation: This is the case of a 29-years-old male who presented with neglected simultaneous bilateral asymmetric traumatic hip dislocations 5 weeks post injury. His condition was managed by closed reduction manoeuvres due to financial constraints. Under spinal anaesthesia, the left hip was successfully reduced. Due to an associated posterior acetabular wall fracture, the presence of osteo-chondral fragments and labral lesions, adequate reduction of the right hip was not achieved. The functional Harris Hip Score (HHS) of the left hip improved on every subsequent follow-up visits at the clinic from 70 at day 45 to 86 at day 90. The HHS of the right hip was poor at day 45 but however increased to 90 after total hip replacement was done. Conclusions: This is an unusual case of neglected simultaneous bilateral asymmetric traumatic hip dislocations in a young male, managed by closed reduction manoeuvres. Closed reduction of such injury is difficult and seldom successful with uncertain long term functional outcome.

Functional outcome of unstable pelvic fractures treated in a level III hospital in a developing country: a 10-year prospective observational study.

BACKGROUND: Unstable pelvic fractures are severe and life-threatening injuries with high morbi-mortality rates. Management of these fractures is a major challenge in orthopaedic practice in limited resource communities. The aim of this study is to evaluate the functional outcome of unstable pelvic fractures managed in a hospital with limited diagnostic and therapeutic facilities. METHODOLOGY: This was a hospital-based prospective observational study carried out from 1st of January 2009 to 31st of December 2018 at the Limbe Regional Hospital, a level III health institution in the South-West region of Cameroon. RESULTS: A total of 68 patients were included in the study. The ages ranged from 18 to 80 years with a mean age of 39 ± 5 years. The average follow-up duration at the latest visit was 36 months (range 3-84 months). There were 59 cases that were evaluated. The overall average Majeed score was fair. Poor outcomes were noted in patients aged 60 years and above, those with co-morbidities, and those managed conservatively. CONCLUSION: Although the functional outcomes following unstable pelvic fractures have improved with modernised diagnostic and therapeutic modalities, it is not the case in poor resource settings where the lack of these modalities makes the management challenging, consequently affecting the functional outcome.

The effect of subsidized malaria treatment among under-five children in the Buea Health District, Cameroon.

INTRODUCTION: Access to free diagnoses and treatments has been shown to be a major determinant in malaria control. The Cameroon government launched in 2011 and 2014 the exemption of the under-fives' simple and severe malaria treatment policy to increase access to health care and reduce inequality, so as to reduce the mortality related to malaria among the under-fives. This study assessed the effect of providing free malaria treatment in the Buea health district. METHODS: This retrospective and cross sectional study was carried out in the Buea health district. Aggregated monthly data from (2008-2010) before and (2012-2014) after the implementation of free malaria treatment was compared, to assess the attributable outcomes of free treatment. A semi-structure questionnaire was also used to assess barriers faced in providing free malaria treatment services by health care workers. Data was collected using a semi-structure questionnaire and a data review summary sheet. The data was analysed using Epi-Info 7, Excel and SPSS (Statistical Package for the Social Sciences) version 20.0 for Windows. All statistical tests were performed at 95% confidence interval (significance level of 0.05). RESULTS: Increase utilisation of health care; as general and malaria related consultations (by 5.7% (p=0.001) witnessed an increase after the implementation of free malaria treatment services. Severe malaria hospitalisation also increased, indicating that most caregivers used the health facility when complications had already set in, which could have led to no significant reduction in mortality due to malaria among under-five children (4.4%, p=0.533). CONCLUSION: Utilisation of health care increased; as consultation and morbidity rate increased after the implementation of free malaria treatment services. Communication strategy should therefore be strengthened so as to better disseminate information, so as to enhance the effectiveness of the program. There is the need to make a large-scale study to assess the impact of subsidized malaria treatment.

Treatment of the diabetic foot - to amputate or not?

BACKGROUND: Diabetic foot infections are a frequent clinical problem. About 50% of patients with diabetic foot infections who have foot amputations die within five years. Properly managed most can be cured, but many patients needlessly undergo amputations because of improper diagnostic and therapeutic approaches. DISCUSSION: The article debates the pros and cons of amputation of the diabetic foot. The thesis is that if the guidelines on the management of the diabetic foot are followed primary amputation is only necessary for the unsalvageable diabetic foot. This approach would reduce the incidence of lower limb amputations in diabetic patients. SUMMARY: We favour the argument that a structured clinical and vascular assessment would help clinical decision- making as to which patients to hospitalize, which to send for imaging, or for whom to recommend surgical interventions. Endovascular procedures are the future in the treatment of diabetic arterial disease and hence the diabetic foot.

Emergency primary repair of grade V bladder neck injury complicating pelvic fracture.

We report a case of a grade V bladder injury complicating an open-book pelvic fracture following a road traffic accident. The bladder neck injury was primarily repaired in the emergency setting of a poor-resourced area with successful outcome. The dangers of urinary extravasation are still to be considered of importance and we advocate and encourage immediate/emergency open intervention although it remains controversial to say the least in a lesser resourced healthcare set up.