Segmental endoprosthesis replacement in a resource-constrained setting.

PURPOSE: Indications for the use of endoprosthesis have continued to expand over the years, especially as an alternative to ablative surgery. This mode of treatment which was initially limited to orthopaedic oncology is now being applied in complex trauma with significant bone loss and end-stage arthroplasty. However, use of endoprosthesis in a resource-constrained setting such as sub-Saharan Africa is limited by various factors. These factors include high cost of endoprosthesis, restricted availability of appropriate equipment and the requisite trained specialists in the field. METHODS: Twelve patients who had segmental endoprosthetic replacement for various aetiologies were studied in this case series. Resection lengths, complications and functional outcomes were noted. RESULTS: The resection length varied between 12 and 27 cm. Using the Henderson classification system, one patient (8.3%) had a Type 1A complication, one had a Type 3A complication (8.3%), and two patients had Type 4A complications (16.6%). Functional outcomes were graded using the MusculoSkeletal Tumour Society scoring system, and scores were good to excellent in ten patients, moderate in one and poor in one patient. CONCLUSION: Early results indicate fair outcomes; however, factors limiting the use of endoprosthesis still persist. These include high cost of endoprosthesis, restricted availability of appropriate equipment and the requisite trained specialists in the field.

Ultrasonographic Volumetric Assessment of Achilles Tendons in Unilateral Congenital Clubfoot in Lagos, Nigeria.

PURPOSE: To assess cases of unilateral congenital talipes equinovarus (CTEV) and compare both Achilles tendons using [MSK USS]. METHODS: Twenty-two patients (44 feet) with unilateral CTEV presenting at the clubfoot clinic who met the inclusion criteria were recruited for the study. Biographic data was collected from the patients and both Achilles tendons scanned using high frequency ultrasound scan probe. The length, width, thickness were measured and area of the tendons estimated. RESULTS: The median age of the patients was 32.5days with a male to female ratio of 1.2:1. The right foot was involved in 15 patients while the left was affected in 7 cases giving a ratio 2.1:1. The Achilles tendons in Clubfeet with mean length of 2.44(±0.3) cm were consistently longer than in the normal feet with mean length of 2.25(±0.3) cm. The width, thickness and area of the Achilles tendons in normal feet with mean values of 0.52(±0.01) cm, 0.22(±0.03) cm and 0.030(±0.01) cm2 respectively were consistently more than in clubfeet with mean values of 0.43(±0.1) cm, 0.20(±0.03) cm and 0.020(±0.01) cm2 respectively. The disparity in length between the normal and clubfeet when compared with the Pirani scores of the affected feet revealed no statistically significant difference. This was also noted when the disparity in width, thickness and area of Achilles tendons were similarly compared with Pirani scores. CONCLUSION: The Achilles tendon of unilateral CTEV is longer but thinner and narrower than in the contralateral normal foot. The disparity in sizes of the tendon has no significant correlation with severity of the clubfeet.

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

EXPERIENCE WITH Ponseti Protocol and Achilles Tenotomy in THE MANAGEMENT OF Clubfoot at the Lagos STATE UNIVERSITY TEACHING HOSPITAL, lagos, Nigeria.

BACKGROUND: Achilles tenotomy is very frequently performed to correct persistent equinus deformity in Ponseti clubfoot management worldwide. AIM: To review the frequency of Achilles tenotomy and outcome of treatment of idiopathic clubfoot using the Ponseti method. SETTING: Lagos State University Teaching Hospital, Lagos, Nigeria. DESIGN OF THE STUDY: Prospective observational study. METHODOLOGY: All the patients with idiopathic clubfoot treated using the Ponseti protocol in the clubfoot clinic between June 2013 and October 2015 were recruited. The data obtained included biographic data, Pirani score at presentation, number of casts until initial correction, number of feet that had Achilles tenotomy and complications. They were recorded in the International Clubfoot Registry (ICR) hosted by the Centre for Bioinformatics and Computational Biology at the University of Iowa, USA and were analysed using the ICR software. RESULTS: Of the 124 patients in this study, 77 (62.1%) had bilateral foot deformities (154 feet) and 47 patients (37.9%) had unilateral clubfoot making a total of 201 clubfeet. Their ages at presentation ranged from 1 week to 6 years. Forty (32.3%) patients were aged less than 1 month, 58(46.8%) aged between 1 and 6 months, 12 (9.7%) aged between 6 and 12 months and while 14 (11.3%) aged 12 months and above. There were 77 males and 47 females with a male/female ratio of 1.6:1. The initial Pirani score was 4 and above in 140 feet with a mean of 4.3. Correction was achieved after a mean of 5.2 casts and tenotomy was performed in 45 (23.1%) feet before foot abduction brace application. CONCLUSION: This study has shown that congenital idiopathic clubfeet can be managed with good outcome using the Ponseti protocol with a reduced frequency of Achilles tenotomy.

EXPERIENCE WITH MANAGING COMPLICATED FRACTURES USING ILIZAROV PRINCIPLE IN LAGOS, NIGERIA.

BACKGROUND: Management of complicated bone fractures in our environment is very challenging. The Ilizarov principle has been found to be a viable management option worldwide, but the use of this method in our environment has been sparsely reported. AIM: To document our use of Ilizarov method to manage patients with complicated long bone fractures and the outcome. DESIGN OF STUDY: Prospective observational study. SETTING: Lagos State University Teaching Hospital, Ikeja, Nigeria. METHODOLOGY: All the patients were treated between June 2009 and December 2012 using the Linear Rail-fixator System (LRS) according to Ilizarov principle. They were followed up for at least two years and data on demography, indications, procedure and outcome were collected and subjected to statistical analysis. RESULTS: Thirty patients whose procedures had been concluded were recruited. The age range was 4 - 57 years with a mean of 38 years ; 17 were male while 13 were female with a male/female ratio of 1.3:1. Specific indications for treatment included infected non-union, failed implant with limb length discrepancy and mal-union. They all had bone defects ranging from 4cm to 12cm and the pre-operative period of morbidity ranged from 2 months to 8 years. Seventeen patients had acute docking and lengthening, 10 had bone transport while 3 had simple limb lengthening. Using the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria, bone outcome was excellent in 7 patients, good in 20 and poor in 3. Functional outcome was excellent in 8, good in 19 and poor in 3. Complications included pin site infection (grades I & II) in 14 patients, knee stiffness in 6 and regenerate fracture in 1. CONCLUSION: Ilizarov surgery is a good method of limb reconstruction in our environment. Our major complications are the high rate of pin site infection and knee stiffness. Good pin site care and early physiotherapy is essential.

A COMPARISON OF THE OBJECTIVE STRUCTURED CLINICAL EXAMINATION AND THE TRADITIONAL ORAL CLINICAL EXAMINATION IN A NIGERIAN UNIVERSITY.

BACKGROUND: Assessment of clinical skills is essential in medical education. Ideally marks should be based on the student's competence alone. The limitations of the traditional long case examinations such as the patient and examiner variability are well known. The objective structured clinical examination (OSCE) was designed to overcome these limitations. Studies comparing the OSCE and the traditional long case examination in the same group of students are very sparse. AIM: To compare the objective structured clinical examination (OSCE) and the traditional long case examination by determining their correlations with other forms of assessment in undergraduate surgery. SETTING: This study was carried out at the College of Medicine, University of Lagos, Nigeria. METHODOLOGY: The results of 612 undergraduate students in our medical school of the University of Lagos, Nigeria over a period of 4 years (2012-2015) were analysed. The scores in the long case examination , objective structured clinical examination (OSCE) , multiple choice questions and Essays were analysed and compared using the Pearson's Correlation co-efficient. SPSS version 17 software was used and a P-value < 0.01 was regarded as statistically significant. RESULTS: Overall, there was a statistical significant positive correlation among most forms of assessment. The OSCE and the long case examination had a correlation of 0.374. Compared with the long case examination, the OSCE had a higher correlation with all other forms of assessment. The total clinical score (the sum of all long case examination and OSCE) however performed better than the OSCE or the long case examination alone as it had the highest correlation with all other forms of assessment. CONCLUSION: The OSCE has been shown to be better than the long case examination as an indicator of the student overall knowledge of surgery as it had a superior correlation with other forms of assessments. The total clinical score was however the best indicator of the student overall knowledge in Surgery as it had the best correlation with other forms of assessment. We recommend and encourage institutions that presently combine the OSCE and the long case examination to carry out similar analysis such as ours to determine the desirability of combining LCE and OSCE rather than outright replacement of LCE with OSCE.

Endoprosthetic replacement of distal femoral tumors in Nigeria: A case series.

In this observational study, three consecutive patients who were treated for distal femur tumours using endoprosthetic replacement between June 2013 and June 2014 were studied. The patients were within the ages of 28-47 years at the time of surgery. All three patients had modular endoprosthesis fixation and were evaluated using the Musculoskeletal Tumour Society (MSTS) Scoring System. Numerical values from 0 to 5 points were assigned for each of the following 6 categories: pain, function, emotional acceptance, use of supports, walking ability and gait. These values were added and the functional score was presented as a percentage of the maximum possible score. The results for each patient were graded according to the following scale: Excellent - 75-100%; good - 70-74%; moderate - 60-69%; fair - 50-59% and poor - <50%. Of the 3 patients evaluated, 2 had a diagnosis of Giant Cell Tumour (GCT) of the distal femur; the third patient was diagnosed to have plasmacytoma. All underwent wide local resection with modular endoprosthetic distal femur reconstruction. The MSTS functional scores calculated were 70%, 78%, and 52% respectively. Complications noted included wound dehiscence in two patients and thrombosis of the Pulmonary artery needing an arterial embolectomy in one of these two patients. The same patient also had a post-operative loss of motor and sensory function below the level of the ankle.

Sport participation and injuries among undergraduate students of a Nigerian University.

Backgroud: Sports participation is a healthy behaviour but it is not without the risk of injuries. Information on the extent of sport participation and sport injuries among Nigerian Unversity students is sparse. Objeclive: To determine the prevalence and types of sport participation and injuries among university.students in Nigeria. Factors associated with sport participation among students were also examined. METHODS: A cross-sectional survey was conducted using a self-administered questionnaire to collect information on the frequcncy and types of sport participation and sport-related injuries among a representative sample of undergraduate students of the University of Lagos, Nigeria. Resuts: A sport participation prevalence of 64.2% (95%CI: 59.5 - 68.7) was recorded among students. Football (soccer) (53.2%) had the highest participation rate. Male students (78.4% vs.41.2%) participated more frequently in sports (p <0.001). Overall injury rate was 52.5 injuries/100 students/ year (95%CI: 46.5 - 58.5). The prevalence of injury was 45.7% in male and 12.7% in female students. About half (49.3%) of reported injuries resulted in time loss. The leg and ankle were the most frequently injured body parts for all injuries and most serious injuries. Football recorded the highest prevalence of injury (73.8%). CONCLUSION: Sport participation among students was fair and injury rate was considerably high, mostly affecting the lower extremity and most injuries resulting from football participation. This study suggests the need for improved sport participation support among students and the need for the initiation of injury prevention initiatives by stakeholders.

Mentorship in orthopaedic and trauma residency training programme in Nigeria: the residents' perspective.

Background: Mentorship is important in residency training as it is necessary for personal and professional development of the resident trainees. Objectives: This study documents mentorship in orthopaedic residency training programme in Nigeria by assessing the awareness of orthopaedic residents on the role of a mentor, willingness to be mentored and their perceived reasons for the possible lack of mentors/ participation of senior colleagues in a mentorship programme. Method: This was a descriptive cross sectional study of 37 orthopaedic residents attending a revision course of the Faculty of Orthopaedics, National Postgraduate Medical College of Nigeria. Self-administered structured questionnaires were used to collect data. Data obtained was analyzed using SPSS version 21.0. Results: The mean age of the respondent was 34.7 ± 4.7 years. The Male: Female ratio was 19:1. The average number of years already spent in the residency programme by the respondents was 2.8 ± 0.9 years. Only 27% of residents had participated in a mentorship programme since they began residency programme but only half were still being mentored at the time of the study. Sixty-five percent reported no formal mentorship programme in their institutions. However, 73% of the respondents would want a formal mentorship programme in their institution. Ninety percent of the respondents desired to be mentored. Conclusion: Most residents are willing to be mentored. Consultants and trainers should ensure that the trainees are mentored.

Ambulance services of lagos state, Nigeria: a six-year (2001-2006) audit.

BACKGROUND: Emergency medical care is designed to overcome the factors most commonly implicated in preventable mortality, such as delays in seeking care, access to health facility, and the provision of adequate care at the facility. The developed world has recognized the importance of organized emergency medical services and has well established systems. The Lagos State Government established the first emergency medical system in Nigeria in 2001. OBJECTIVE: This was to review the activities of the Lagos State Emergency Ambulance Services (LASAMBUS) within the stated period with the hope that our findings can be used to audit the system and make recommendations for further improvement. SUBJECTS, MATERIALS AND METHODS: We reviewed the records of the State Ministry of Health for the data on the activities of LASAMBUS from 2001-2006. The number and types of emergencies that were seen and managed with the associated morbidity and mortality were reviewed. The constraints that were encountered by the LASAMBUS staff were also studied. The data that was obtained was entered into a proforma designed for the study. Analysis of the data was done using the Microsoft Excel software. RESULTS: A total of 32,774 cases comprising 21,977(67.1%) males,10,797(32.9%) females and a male to female (M:F) ratio of 2.04:1, were seen during the study period. Trauma was responsible for 29,500 (90%) of the cases. No mortality was recorded during the transfer of the cases. The records of mortality for the LASAMBUS-transferred cases were not available. CONCLUSION/RECOMMENDATIONS: Trauma cases formed the majority of the cases that were seen with road traffic accident constituting a large proportion of these. Health education focusing on improving driving etiquette of Drivers and injury prevention should intensified. More equipped emergency centres should be established to reduce victims transit and injuryintervention time. Record keeping and documentations should be improved for better assessment of the activities.

Physiotherapy in the management of total knee arthroplasty: a review.

BACKGROUND: Although total knee arthroplasty (TKA) is considered the treatment of choice for patients with intractable pain and substantial functional disabilities who have not had acceptable relief and functional improvement after conservative treatment. It was found out that patients with total knee arthroplasty need physiotherapy intervention for pre-operative and post-operative management. OBJECTIVES: To take a critical look at the importance of TKA following destruction of the knee joint, its indications and contraindications and to ascertain the current trend involved in the physiotherapy management of TKA. METHODS: The current literature materials on physiotherapy management of TKA was reviewed. RESULTS: The aim of treatment is to maximize functionality and independence and to minimize complication such as deep vein thrombosis and pulmonary embolism by relieving pain using cryotherapy, improving range of motion with mobilization techniques, muscle strengthening, therapeutic exercise, transfer training, gait training and training of activities of daily living. These are administered as home programme or in organized groups led by a physiotherapist and has been shown to improve outcome related to physical activity after knee joint arthroplasty. CONCLUSION: It was concluded that interventions, including physiotherapy and functional exercises after discharge, is still beneficial after TKA.

Review of the practice of traditional bone setting in Nigeria.

BACKGROUND: The practice of traditional bone setting (TBS) is extensive in Nigeria and it enjoys enormous patronage by the populace. However, the outcome of the intervention of TBS treatment is usually poor with profound effects on the patient. There are many publications highlighting different aspects of this subject but none has summarized the entire practice and problems as a single publication. OBJECTIVE: This work aims at reviewing the entire subject of traditional bone setting in Nigeria in a single article to enable easy understanding and appreciation of the practice and problems of traditional bone setting by orthodox practitioners. METHOD: A total of thirty-one relevant published original scientific research papers involving all aspects of the subject were reviewed and the practices and problems were documented. RESULTS: The results showed that the origin of the practice is shrouded in mystery but passed on by practitioners from one generation to another. There is no formal training of bonesetters. Though the methods of treatment vary, the problems caused by them are usually similar with extremity gangrene being the worst. When attempts have been made to train the bone setters, improvement have been noted in their performance. CONCLUSION: In other to prevent some of the most debilitating outcomes like amputation, it is suggested that the TBS practitioners undergo some training from orthopaedic practitioners.

Review of the Practice of Traditional Bone Setting in Nigeria

Background: The practice of traditional bone setting (TBS) is extensive in Nigeria and it enjoys enormous patronage by the populace. However; the outcome of the intervention of TBS treatment is usually poor with profound effects on the patient. There are many publications highlighting different aspects of this subject but none has summarized the entire practice and problems as a single publication. Objective: This work aims at reviewing the entire subject of traditional bone setting in Nigeria in a single article to enable easy understanding and appreciation of the practice and problems of traditional bone setting by orthodox practitioners. Method: A total of thirty-one relevant published original scientific research papers involving all aspects of the subject were reviewed and the practices and problems were documented. Results: The results showed that the origin of the practice is shrouded in mystery but passed on by practitioners from one generation to another. There is no formal training of bonesetters. Though the methods of treatment vary; the problems caused by them are usually similar with extremity gangrene being the worst. When attempts have been made to train the bone setters; improvement have been noted in their performance. Conclusion: In other to prevent some of the most debilitating outcomes like amputation; it is suggested that the TBS practitioners undergo some training from orthopaedic practitioners

Profile of amputations in Lagos University Teaching Hospital, Lagos, Nigeria.

BACKGROUND: Amputation is a common surgical procedure for which there are several indications. There are few research works on the profile of amputation in Lagos. OBJECTIVE: The study is to determine the pattern of amputation at the Lagos University Teaching Hospital, Lagos, and to identify the indications, types, morbidity and mortality associated with amputation. METHODS: This was a retrospective study carried out at the Lagos University Teaching Hospital between Jan.2007 and Dec. 2009. All records of patients were retrieved and selected data collated. RESULTS: A total of 127 patients presented between Jan. 2007 and Dec. 2009 with various indications for amputation. The mean age was 43.0 +/- 19.4 years. Male: female ratio was 1.7 to 1. Diabetic foot gangrene was the leading cause of amputation occurring in 55.14% of patients studied. Other major indications were trauma and malignancies. Below-knee amputation was the commonest type done (46.6%). Sepsis was the commonest complication (11.8%). The mortality rate of 11.8% was mainly due to co-morbidities. CONCLUSION: Amputation in our centre is more likely to be done on males and diabetics. Majority was below knee and was associated with significant mortality. Increasing public enlightenment and early presentation are needed to reduce morbidity and mortality as well as improve limb salvage in our population.

Primary bone tumours in a tertiary hospital in Nigeria: 25 year review.

BACKGROUND: Primary bone tumors remain a daunting challenge to orthopaedic surgeons. The challenge is heightened in developing countries due to limited diagnostic and therapeutic facilities and ignorance. The published literature on the subject is sparse in our environment. OBJECTIVE: To describe the pattern of primary bone tumors seen in a tertiary hospital in Nigeria. METHODS: This is a retrospective review of all the histologically confirmed primary bone tumours seen at Lagos University Teaching Hospital (LUTH) over a 25 year period. RESULTS: A total of 242 patients (aged 7.5 to 62 years) with a mean of 25.3 years were studied. One hundred and forty four patients (59.5%) were males and 98 (40.5%) were females. The peak age incidence was in the age group 11-20 years. One hundred and thirty (53.7%) of the tumors were benign. Among these Osteochondroma was the commonest accounting for 36 cases (27.7%) followed by Osteoclastoma, 28 cases (21.5%). Osteosarcoma accounted for 66 cases (58.9%) of all primary malignant tumours in the study. CONCLUSION: This study showed that primary bone tumours were mainly benign, occurred predominantly in the second decade of life with a male preponderance. Osteochondroma and Osteosarcoma were the most common benign and primary malignant bone tumours respectively.

Deep vein thrombosis: risk factors and prevention in surgical patients.

BACKGROUND: Deep vein thrombosis (DVT) is a cause of preventable morbidity and mortality in hospitalized surgical patients. The occurrence of the disease is related to presence of risk factors, which are related primarily to trauma, venous stasis and hyper-coagulability. DVT seems not to be taken seriously by many surgeons in Nigeria. This is despite comprehensive studies that show no real differences in racial demography of the disease. OBJECTIVE: To highlight the importance of physician awareness about DVT especially its risks and prevention methods. METHODS: A detailed literature search was completed to extrapolate articles that described DVT risks and prevention. This involved hand and online searches. Specific search terms used included DVT/risk factors/prevention. The searches generated 468 papers. Of these 57 papers were included in the review. RESULTS: Predominant risk factors for DVT include middle or old age, prolonged surgery, trauma, confinement, presence of malignancy and insertion of deep venous catheters. In women, contraceptive use, hormone replacement therapy, pregnancy and the puepernum are a additional risk factors. Prophylactic measures include those directed at eliminating venous stasis and those directed at changes in blood coagulability. CONCLUSION: Deep Venous Thrombosis is a common disease with fatal and serious long term burdensome complications. We must target primary and secondary prophylaxis to improve survival and reduce morbidity from this preventable disease.

Complications of treatment of musculoskeletal injuries by bone setters.

BACKGROUND: Traditional bone setters (TBS) have existed for decades in Nigeria and other countries. Their treatment methods often lead to several complications, the most dangerous being extremity gangrene which usually leads to proximal amputation. OBJECTIVE: To apprise the Orthodox Practitioners of complications of musculoskeletal injuries treated by the bone setters, the factors that encourage patronage of TBS services and the outcome of the treatment of these complications by the orthodox practitioners. METHODS: This was a one-year prospective study involving one hundred and twenty-one consecutive patients presenting with complications related to treatment of their musculoskeletal injuries by bone setters. The following data were obtained using observer-administered questionnaires viz; demography, details of initial injury, reasons for patronage of TBS, nature of treatment, estimated cost of treatment and disability of patients at presentation. The outcome of orthodox treatment of these complications was assessed at six months using the following parameters --wound healing, bone union and use of prosthesis by the patients. RESULTS: One hundred and twenty-one patients with 155 musculoskeletal injuries and 168 complications of treatment by the TBS were seen 75 (57%) were male and 52 (43%) were female. The ages of the patients ranged from 6 weeks--72 years (mean 29.49 years). The common complications of TBS treatment were malunion and non-union which each accounted for 27 (16.1%) cases. The major reasons for TBS patronage was the perceived low cost of treatment in 47 (27.9%) and pressure from family and friends in 36 (25%) patients. The cost of treatment of the TBS ranged from USD 18-380, whereas, at the Orthopaedic Hospital, it ranged from USD 34-98. At six months after orthodox surgery, 10 (91%) of the patients who had amputation were yet to start using prosthesis, 3 (23%) who had internal fixation failed to unite. CONCLUSION: The commonest reason for patronage was the believed cheapness of the TBS services. However, this study showed that orthodox treatment is actually cheaper in most cases. Despite all the complications associated with their treatment, majority of the people still have a strong belief in their capability. A suggested solution will be the incorporation of the TBS into the healthcare system so that they could be better trained and controlled.

Management of long bone fractures and associated injuries from gunshots at a nigerian tertiary hospital.

BACKGROUND: Globally, management of gunshot injuries (GSI) encompasses resuscitation, evaluation and treatment. Wound debridement is mandatory, while definitive treatment of any associated fracture varies from one part of the world to another. In developed countries aggressive modalities of early operative fixation of such fractures have produced good results. In the Nigerian environment, the approach to such fractures is controversial and cautious, with secondary operative and even non-operative methods still being predominant. OBJECTIVE: To compare operative versus non-operative methods of treatment of long bone fractures and associated injuries from gunshots in our centre. METHODS: This is a prospective study of long bone fractures and associated injuries from civilian gunshots presenting at Lagos University Teaching Hospital (LUTH), Lagos, Nigeria between 1st January 2000 and 31st December 2003. LUTH, one of the tertiary hospitals in Nigeria receives most of the multi-system trauma referrals in Lagos State, Nigeria. RESULTS: Three hundred and sixty patients with GSI were studied, 322 (89.4%) were males while 38 (10.6%) were females, giving a male: female ratio of 8.5:1. One hundred and thirty-six patients (37.8%) had long bone fractures, 94 (69.1%) on the lower limbs. All wounds were debrided and 198 (55.0%) had serial debridement. Eighty-two (60.3%) of 136 patients with fractures from G.S.I had operative treatment done secondarily and 87.5% of them achieved union. Also 42 (77.8%) of 54 patients treated non-operatively achieved union. Two hundred and thirty-four (65.0%) of the gunshot wounds healed by secondary intention, 81 (22.5%) had split thickness skin grafting and 18 (5.0%) had flap cover. CONCLUSION: This study showed that secondary operative treatment of long bone fractures in GSI produces good outcome.

Congenital club foot in a teaching hospital in Lagos, Nigeria.

Congenital club foot has been sparsely reported in literature in Nigeria, although it has been reported as the commonest congenital musculoskeletal abnormality. This study enumerates the point prevalence of this disease in a university teaching hospital in Lagos. Better understanding of the epidemiology in our community should improve awareness, and influence management. Between June 2005 and July 2006, 72 consecutive patients with congenital club feet were seen in the orthopaedic clinic of our Hospital. Demographic data, birth weight, family history, birth facility, maternal age and associated congenital anomalies were recorded and analysed using Statistical Programme for Social Sciences (SPSS) version 15. A total of 72 patients were seen, 28 of whom had bilateral club feet resulting in a total of 100 feet. There were 38 males and 34 females. Only 29% presented in the first month of life and 28% in the second month. Maternal ages ranged between 19 and 38 years and no family history of congenital club foot was given,. Babies delivered outside the orthodox medical system (churches, traditional healers, home etc) constituted 28%. The commonest associated congenital anomalies were tibia hemimelia, hydrocephalus, inguinal hernia and umbilical hernia. A default rate of 28% was observed during treatment. Congenital club foot may not be uncommon in Nigeria. Late presentation and high default rate before correction of the deformity were observed. Establishment of special club foot clinics should reduce the default rate. Training of healthcare workers in maternity units as well as Public awareness should encourage early referral to specialists.