Mortality Pattern in Surgical Wards in Northwestern Nigeria: A Single-Center Study.

BACKGROUND: Surgical pathologies contribute to a huge portion of the global burden of diseases. Surgical needs therefore remain high and is projected to increase even further in the near future with increasing life expectancy and comorbidities, given the projection that 16% of the world's population will be older than 65 years by 2050. The outcome of patients with surgical pathologies could be influenced by several factors. Key amongst them is the quality of care. Mortality as an outcome is one metric that could be used to assess the quality of surgical care in a health facility, hence this study with the objective of determining the pattern of inpatient mortality in our surgical wards and suggesting possible ways of addressing identified gaps in their care delivery, which may also improve the care in other centers. PATIENTS AND METHODS: A retrospective cohort study of surgical inpatients' mortality in the surgical wards of Ahmadu Bello university teaching hospital from January 1st 2016 to December 31st 2019. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.0, and presented as descriptive statistics. RESULTS: A total of 8862 admissions were made into the surgical wards, with 655 deaths, giving a crude mortality rate of 7.4%. Most of the deaths occurred in patients in the 46-60 years age group (217, 33.1%). Malignancy was the commonest surgical condition, 294 (48.7%, n=604). This was followed by trauma-related conditions, 96 (15.9%, n=604). Civil gunshot injury admissions showed an upward trend from 19 in 2017, with an exponential rise to 45 in 2019. CONCLUSION: Although malignancy- related deaths predominated amongst our surgical inpatients, the incidences of deaths from road traffic and burns injuries, as well as septic surgical conditions are also worrisomely high. There is a rise in civil gunshot- related injury admissions and deaths.

CONTEXTE: Les pathologies chirurgicales contribuent à une part énorme du fardeau mondial des maladies. Les besoins chirurgicaux restent donc élevés et devraient encore augmenter dans un avenir proche avec l'augmentation de l'espérance de vie et des comorbidités que 16 % de la population mondiale aura plus de 65 ans en 2050. L'issue des patients atteints de pathologies chirurgicales peut être influencé par plusieurs facteurs. Parmi ceux-ci, la qualité des soins. La mortalité en tant que résultat est une mesure qui pourrait être utilisée pour évaluer la qualité des soins chirurgicaux dans un établissement de santé. Cette étude a pour objectif de déterminer le modèle de mortalité des patients hospitalisés dans nos services de chirurgie et de suggérer des solutions possibles de remédier aux les lacunes identifiées dans leur prestation de soins, ce qui pourrait également améliorer les soins dans d'autres centres. PATIENTS ET MÉTHODES: Une étude de cohorte rétrospective de la mortalité des patients hospitalisés en chirurgie dans les services de chirurgie de l'hôpital universitaire d'Ahmadu Bello Ahmadu Bello, du 1er janvier 2016 au 31 décembre 2019. Les données ont été analysées en utilisant la version 20.0 du progiciel de statistiques pour les Sciences (SPSS) et présentées sous forme de statistiques descriptives. RÉSULTATS: Un total de 8862 admissions ont été faites dans les services de chirurgie, avec 655 décès., soit un taux de mortalité brut de 7,4 %. La plupart des décès sont survenus chez des patients de la tranche d'âge 46-60 ans (217, 33.1%). La malignité était l'affection chirurgicale la plus fréquente, 294 (48.7%, n=604). Elle était suivie par les affections liées à un traumatisme, 96 (15.9%, n=604). Les admissions civiles pour blessure par balle ont connu une tendance à la hausse, passant de 19 en 2017, avec une augmentation exponentielle à 45 en 2019. CONCLUSION: Bien que les décès liés à la malignité aient prédominé prédominaient parmi nos patients hospitalisés en chirurgie, l'incidence des décès dus aux de la circulation routière et des brûlures, ainsi que des états chirurgicaux septiques sont également inquiétantes. Il y a une augmentation des admissions et des décès liés à des blessures civiles par balle. Mots-clés: Mortalité chirurgicale, Décès liés à un traumatisme, Décès liés à une arme à feu.

Burden of Chronic Musculoskeletal Disorders amongst Patients Attending Orthopaedic Outpatients Clinic of a Tertiary Hospital, North-Western Nigeria.

BACKGROUND: Musculoskeletal disorders often pose significant limitation to activities of daily living due to pain or disability. These disorders often arise as a result of the normal aging process, but most have some predisposing factors that are lifestyle-related, especially in younger people as a result of repeated mal- posturing/ misuse of parts of the body in the course of their jobs or recreations. These disorders cause more functional limitations in the older adult population than any other group of disorders. Thus, with increasing aging of most populations of the world, it is expected that the burden of these disorders will continue to rise. There is paucity of epidemiological data on this subject and no published study showing the ease of affordability of treatment for these conditions in Nigeria, hence this study. PATIENTS AND METHODS: A cross -sectional study of patients with chronic musculoskeletal conditions attending the orthopaedic outpatient clinic of Ahmadu Bello university Teaching Hospital between 1st July 2019 and 31st December 2019, involving physical interview of new patients and review of case notes of old patients seen within the period. Statistical analysis was done with the Statistical Package for the Social Sciences (SPSS) version 20.0, and descriptive statistics were employed to summarize data. Pearson Chi- square test was used to examine for association between age, occupational ergonomic factors and chronic musculoskeletal conditions. RESULTS: Forty-six percent of the outpatients suffered from chronic musculoskeletal disorders. Chronic low back pain accounted for the greatest burden (64.9%), followed by osteoarthritis of the weight bearing joints (27%), chronic neck pain (4.8%) and rheumatoid arthritis (2.8%). 51.8% of the patients with chronic low back pain, 64.5% of chronic neck pain and 68.5% of osteoarthritis were in the middle-age group. Occupational ergonomic factors as an entity was a significant risk factor identified in almost all the conditions except rheumatoid arthritis (P = 0.0001). Only 121(18.7%) of the patients enjoyed health insurance, while majority do not. Also, 56.0% of the patients had the means of footing the cost of their treatment (either by way of health insurance coverage or out-of-pocket payment). CONCLUSION: The burden of chronic musculoskeletal disorders is high in our region. There is a need for the government to organize ergonomic educational programs through seminars and workshops as part of public health education, and a wider, well funded health insurance policy that covers both the formal and informal sectors and the full extent of the management of these chronic disorders to make such care accessible to all.

CONTEXTE: Les troubles musculo-squelettiques posent souvent des limitations importantes aux activités de la vie quotidienne en raison de la douleur ou d'un handicap. Ces troubles surviennent souvent à la suite du processus normal de vieillissement, mais la plupart présentent des facteurs prédisposants liés au mode de vie, en particulier chez les jeunes, à la suite d'une mauvaise posture / d'une mauvaise utilisation répétée de certaines parties du corps au cours de leur travail. ou des loisirs. Ces troubles entraînent plus de limitations fonctionnelles chez les personnes âgées que tout autre groupe de troubles. Ainsi, avec le vieillissement croissant de la plupart des populations du monde, on s'attend à ce que le fardeau de ces troubles continue d'augmenter. Il y a peu de données épidémiologiques sur ce sujet et aucune étude publiée montrant la facilité du traitement abordable pour ces conditions au Nigéria, d'où cette étude. PATIENTS ET MÉTHODES: Une étude transversale de patients atteints de troubles musculo-squelettiques chroniques fréquentant la clinique ambulatoire orthopédique de l'hôpital universitaire Ahmadu Bello entre le 1er juillet 2019 et le 31 décembre 2019, impliquant un entretien physique de nouveaux patients et un examen des notes de cas d'anciens patients vus dans la période. L'analyse statistique a été effectuée avec le progiciel statistique pour les sciences sociales (SPSS) version 20.0, et des statistiques descriptives ont été utilisées pour résumer les données. Le test du Chi-carré de Pearson a été utilisé pour examiner l'association entre l'âge, les facteurs ergonomiques professionnels et les affections musculo-squelettiques chroniques. RÉSULTATS: Quarante-six pour cent des patients ambulatoires souffraient de troubles musculo-squelettiques chroniques. La lombalgie chronique représentait le plus gros fardeau (64,9%), suivie de l'arthrose des articulations portantes (27%), de la cervicalgie chronique (4,8%) et de la polyarthrite rhumatoïde (2,8%). 51,8% des patients souffrant de lombalgie chronique, 64,5% de cervicalgie chronique et 68,5% d'arthrose appartenaient au groupe d'âge moyen. Les facteurs ergonomiques professionnels en tant qu'entité constituaient un facteur de risque significatif identifié dans presque toutes les affections à l'exception de la polyarthrite rhumatoïde (P = 0,0001). Seuls 121 (18,7%) des patients bénéficiaient d'une assurance maladie, alors que la majorité n'en bénéficiaient pas. De plus, 56,0% des patients avaient les moyens de prendre en charge le coût de leur traitement (soit par une couverture d'assurance maladie, soit par un paiement direct). CONCLUSION: Le fardeau des troubles musculo-squelettiques chroniques est élevé dans notre région. Il est nécessaire que le gouvernement organise des programmes éducatifs ergonomiques par le biais de séminaires et d'ateliers dans le cadre de l'éducation à la santé publique, et d'une politique d'assurance maladie plus large et bien financée qui couvre à la fois les secteurs formel et informel et toute l'étendue de la gestion de ces maladies chroniques. troubles pour rendre ces soins accessibles à tous. MOTS CLÉS: Clinique orthopédique, Appareil locomoteur chronique troubles, fardeau, assurance maladie.

On the use of drains in orthopedic and trauma.

INTRODUCTION: The use of drains in trauma and Orthopaedic practice has been affected by the concept of evidence based medicine that has become accepted as standard of care for all surgical or medical practice, which questions all care processes that cannot be backed by evidence to be beneficial to the patient. There have been a large number of multi centre meta-analytical studies that found drains to be of little or no benefit in trauma and Orthopaedic operations. Because of these studies, there are few situations where drains are routinely used e.g. Calcaneal fractures in developed countries. Even major procedures like total knee and arthroplasties are being performed without drains. We set to find out whether such evidence can be found in our practice. MATERIALS AND METHODS: Between 2004 and 2012, eighty six patients matched for sex and type of injury and operative procedures to be done were prospectively selected and assigned to use or no use of drains in their operations. Complications like haematoma, drain migration, infection, inadvertent drain stitching were observed in the two groups. RESULTS: Eighty six major orthopaedic operations were studied. There was no evidence of occurrence of complication arising from non use of drains in the undrained group. Those patients whose wounds were drained had no need for drain change thus making the wound care less eventful CONCLUSION: Postoperative wound drains make for neat postoperative period with less tissue swelling. There was no statistically significant differences between the drained and undrained wounds in terms of infection rates, haematoma or seroma formation.

The doctrine of informed consent in surgical practice.

Physicians and other professionals in the field of medicine have to perform invasive and non-invasive procedures on patients as part of their duties. There is a legal basis upon which these procedures are done; this is called 'informed consent.' Sociocultural factors have strong influence on the sick role. These factors influence the application of informed consent in Nigeria.

Use of non-vascularized autologous fibula strut graft in the treatment of segmental bone loss.

BACKGROUND: Fractures resulting in segmental bone loss challenge the orthopedic surgeon. Orthopedic surgeons in developed countries have the option of choosing vascularized bone transfers, bone transport, allogenic bone grafts, bone graft substitutes and several other means to treat such conditions. In developing countries where such facilities or expertise may not be readily available, the surgeon has to rely on other techniques of treatment. Non-vascularized fibula strut graft and cancellous bone grafting provides a reliable means of treating such conditions in developing countries. MATERIALS AND METHODS: Over a period of six years all patients with segmental bone loss either from trauma or oncologic resection were included in the study. Data concerning the type of wound, size of gap and skin loss at tumor or fracture were obtained from clinical examination and radiographs. RESULT: Ten patients satisfied the inclusion criteria for the study. The average length of the fibula strut is 7 cm, the longest being 15 cm and the shortest 3 cm long. The average defect length was 6.5 cm. Five patients had Gustillo III B open tibial fractures. One patient had recurrent giant cell tumor of the distal radius and another had a polyostotic bone cyst of the femur, which was later confirmed to be osteosarcoma. Another had non-union of distal tibial fracture with shortening. One other patient had gunshot injury to the femur and was initially managed by skeletal traction. The tenth patient had a comminuted femoral fracture. All trauma patients had measurement of missing segment, tissue envelope assessment, neurological examination, and debridement under general anesthesia with fracture stabilization with external fixators or casts. Graft incorporation was 80% in all treated patients. CONCLUSION: Autologous free, non-vascularized fibula and cancellous graft is a useful addition to the armamentarium of orthopedic surgeon in developing countries attempting to manage segmental bone loss, whether created by trauma or excision of tumors.

Gangrene of the limb complicating Salmonella typhi septicaemia in a Nigerian child.

We report an unusual case of lower limb gangrene in a pubertal boy following a typical clinical presentation of septicaemia due to Salmonella typhi. After an initial response to presumed appropriate antibiotic and supportive therapy, the patient developed tissue ischaemia in both feet. There were no clinical or laboratory evidence suggestive of DIC or coagulopathy. Following conservative management which included oral administration of vitamin C, there was gradual regression of ischaemic changes, progressive healing and recovery of function of the left foot while the condition of the right foot deteriorated with extensive tissue necrosis and dry gangrene that extended to the distal one third of the foot. This necessitated surgical disarticulation of the metatarsophalangeal joints two months after admission. This report is to alert clinicians about this rare complication of a common curable disease with a view to anticipating the possibility of it occurring as well as considering appropriate preventive measures.

Management of Civilian Gunshot Injuries to the Extremities in Nigeria-an Overview

There is an increasing incidence of missile injury attributable to improved technology; and increased crime and conflict rates in both developing and developed nations of the world. We undertook a review of civilian gunshot injuries to the extremities in Nigeria. The pathology of these injuries as well as their implications for management are presented. The peculiar challenges they present to the orthopaedic surgeons in the management of gunshot injuries in a resource depleted country are highlighted. Community based socially and culturally acceptable conflict resolution mechanisms; control of fire arms and revision of the treatment guidelines are recommended as preventive and management strategies of gunshot injuries in Nigeria

Extremity gunshot injuries in civilian practice: the National Orthopaedic Hospital Igbobi experience.

A combined retrospective and prospective study of Gunshot Injuries (GSI) that presented to the National Orthopaedic Hospital, Igbobi (NOHL) between 1991 and 1995 was undertaken with the aim of determining the characteristics of these injuries in Lagos, Nigeria. 232 patients with 281 gunshot wounds and 212 gunshot fractures were seen during this period. 68.9% of patients in the study were in the age group 21-40 years with a mean age at presentation of 32.46 +/- 11.21 years. The male to female ratio was 9:1. 87 (37.5%) presented within 6 hours of injury. Armed robbery dominated the events surrounding the shootings with high velocity weapon (HVW) accounting for 47% of the cases. While the femur was the commonest single bone to be fractured the treatment of fractures generally was largely conservative as only 5 fractures were eventually treated by open reduction and internal fixation. Wound infection was the commonest complication (25%) with amputation being performed in 5.6% of cases. This study does not confirm the belief that high velocity weapon causes greater morbidity than low velocity weapon. Even though the average duration of hospitalisation was 33.5 +/- 23.4 days, we advise that for our present state of development gunshot fractures should not be primarily treated with internal fixation.