Outcome of management of elevated skull fractures in Enugu, South-East Nigeria.

INTRODUCTION: Elevated skull fractures, previously thought of as a very rare variety of fractures, are no longer very uncommon. They are expectedly gradually finding a slowly growing list of references in neurosurgical literature. They are mostly posttraumatic compound fractures due to the mechanism of injury. Outcome of operative neurosurgical care is generally rewarding. MATERIALS AND METHODS: A 4-year retrospective study of case notes, operation registers, and radiology records of patients diagnosed with elevated skull fractures who had neurosurgical care at the University of Nigeria Teaching Hospital, Enugu, Nigeria, between 2012 and 2015, was done. Only patients with evidence of elevated skull fracture on head computed tomography scan were included. The presenting Glasgow Coma Score and Extended Glasgow Outcome Score (GOSE) at the time of discharge from the hospital and 6 months thereafter were analyzed. RESULTS: Out of 209 patients managed with skull fractures over the study period, eight met the inclusion criteria. Seven (87.5%) were males. The latency to presentation was 6 h in one case and> 8 h in the other cases. All the patients had operative care involving debridement, duroplasty, and bone-fragment realignment (cranioplasty) either primarily or on an interval basis. The GOSE at 6 months was at least 7 in 87.5% of the patients. CONCLUSIONS: Despite the grotesque appearance at presentation, outcome of properly managed elevated skull fractures is good.

Determinants of outcome of final undergraduate surgery examinations in a Nigerian University.

BACKGROUND: Medical students' assessment is an important aspect of medical undergraduate training that requires periodic review to achieve objectivity and improve training. We reviewed the outcome and factors that influenced outcome of undergraduate students' final surgery examination. MATERIALS AND METHODS: Final examination records of undergraduate medical students in surgery from a single institution for 5 years (2013-2017) were retrospectively reviewed. Scores of the students in continuous assessments (CA), multiple-choice questions (MCQs), essays, long case, short cases, orals, and objective structured clinical examinations (OSCE) were extracted as appropriate. The data were analyzed using SPSS® for Windows version 21. RESULTS: A total of 960 candidates' results were analyzed over 5 successive years, 722 candidates (75.2%) were males, and 238 (24.8%) were females. The overall pass rate was 62.6%. Success rate in the clinical examinations was higher in females (84.5%) compared to males (72.7%). χ2 = 13.381, P < 0.001. MCQs section of the examinations had the highest failure rate (49.5%). Female gender (P < 0.001), passing CA (P < 0.001), and shorter duration-<9 years in medical school (P < 0.001) were strongly associated with passing the final surgery examination. Pass rate was 73.1% for females and 56.2% for males during the OSCE period. CONCLUSION: CA is the single most important determinant of success in final surgery examination, while MCQs constitutes the most difficult aspect of the examinations. Irrespective of method of assessment, females seem to do better than males.