Paediatric Trauma Presentations in a Teaching Hospital in Lagos, Nigeria: Epidemiology and Predictor of Mortality.

INTRODUCTION: Paediatric trauma remains a major health challenge worldwide. It remains a major reason for hospitalization among children and adolescents around the world, with resultant death or disability. This study was aimed to determine the epidemiology, pattern and outcomes of paediatric injuries presenting at a teaching hospital in Lagos, South-west Nigeria. PATIENTS AND METHODS: This was a prospective observational hospital based study conducted on all paediatric trauma patients below 18 years, who presented at the accident and emergency room of the Lagos University Teaching Hospital (LUTH) over a period of thirteen months. Data analysis was done with Stata v13 (StataCorp. Texas. USA). RESULTS: A total of 154 patients sustained 250 documented injuries. The mean age was 6.8 ± 4.6 years. Male to female ratio was 1.5:1. Children aged 8 years were mostly affected. There was significant statistical association between age of child at injury and the place of injury. (p = 0.021) Most injuries (51.3%) occurred at home followed by the road. Falls accounted for 72 cases (46.8%). Traumatic brain injury was the most common injury sustained. Injuries at home peaked at 5pm and extended to 7pm while injuries from road traffic accidents peaked at two periods; between 7am and 8am and 4pm. Paediatric trauma score predicted death accurately. The crude mortality rate was 5.8%. CONCLUSION: Paediatric trauma scourge is still a health concern. School age children are mostly affected by trauma. Falls were the most common cause of trauma in children and most falls occurred in the home environment. Injuries from road traffic accidents accounted for majority of deaths. The paediatric trauma score predicts mortality in injured children and should be routinely used.

INTRODUCTION: Les traumatismes pédiatriques demeurent un problème de santé majeur dans le monde entier. Il demeure une raison majeure d'hospitalisation chez les d'hospitalisation chez les enfants et les adolescents du monde entier, avec des décès ou un handicap résultant . Cette étude avait pour but de déterminer l'épidémiologie, et les résultats des blessures pédiatriques présentées dans un hôpital universitaire de Lagos, dans le sud-ouest du Nigeria. PATIENTS ET MÉTHODES: Il s'agit d'une étude prospective d'observation menée dans un hôpital sur tous les cas de blessures pédiatriques traumatisés de moins de 18 ans, qui se sont présentés au service des accidents et des urgences du accident et des urgences du Lagos University Teaching Hospital (LUTH) sur une période de treize mois. L'analyse des données a été réalisée avec Stata v13 (StataCorp. Texas. USA). RÉSULTATS: Au total, 154 patients ont subi 250 blessures documentées. L'âge moyen était de 6,8 ± 4,6 ans. Le rapport hommes/ femmes était de 1,5:1. Les enfants âgés de 8 ans étaient les plus touchés. Il existe une association statistique significative entre l'âge de l'enfant au moment de la blessure et le lieu de la blessure. (p = 0,021) La plupart des blessures (51,3 %) sont survenues à la maison, suivies par la route. Les chutes ont représenté 72 cas (46,8 %). Les traumatismes cérébraux est la blessure la plus fréquente. Les blessures à domicile ont atteint un pic à 17 heures et se prolongeant jusqu'à 19 heures, tandis que les blessures dues à des accidents de la route ont atteint un pic à deux périodes : entre 6h et 7h59 et à 16h. Le score de traumatisme pédiatrique permettait de prédire le décès avec précision. Le taux de mortalité brut était de 5,8 %. CONCLUSION: Le fléau des traumatismes pédiatriques reste un problème de santé. Les enfants d'âge scolaire sont les plus touchés par les traumatismes. Les chutes étaient la cause la plus cause la plus fréquente de traumatisme chez les enfants et la plupart des chutes se sont produites dans le environnement. Les blessures dues aux accidents de la route représentent la majorité des décès. Le score de traumatisme pédiatrique permet de prédire la mortalité chez les enfants blessés et devrait être utilisé de manière systématique. Mots clés: Traumatisme, Pédiatrie, Blessures, causes, mortalité, Enfance, Nigeria.

Femoral Anteversion Angles in Dry Bones of Adult Nigerians: A Comparison of Two Methods.

BACKGROUND: Version describes the angle in the axial plane subtended by the femoral neck and the femoral shaft. Femoral version varies among various major geographic and racial populations. Femoral version plays a role in some orthopaedic operations. This study documented femoral version among Nigerians comparing two methods on dry femoral bones. METHODOLOGY: This was a prospective descriptive study that involved measurements of femoral anteversion and retroversion angles on dry femoral bones using the Kingsley Olmsted (KO) method and digital measurement using a free software, IC Measure® from imaging source (The imaging source, Europe GmbH, Uberseetor 18, 28217 Bremen. Germany) Forty-eight (48) adult dry femoral bones were measured. The results obtained from these measurements were analyzed using Stata 13 (StataCorp, Texas, USA) RESULTS: The average value of anteversion angle using the Kingsley Olmsted (KO) method was 20.50 ± 5.50. The average anteversion angle using IC measure was 21.30 ± 6.00. The observed agreement was 16.67%. (Expected agreement was 5.21 %.) The measurements obtained from both KO method and digital photograph using IC measure showed high correlation with each other (r = 0.89, P < .0001). CONCLUSION: The mean anteversion angle from this study was 20.50 ± 5.50 and 21.30 ± 6.00 using the KO and digital measurements respectively. These values further elaborated that the average anteversion angle is higher in Africans compare to other racial groups. Orthopaedic surgeons should be aware of this fact during surgical operations that involve proximal femur, such as femoral derotation, hemiarthroplasty and total hip replacement in Africans.

Estimation of Femoral Head Size from Palpable Bony Prominences of the Femur.

BACKGROUND: Proximal femoral surgeries involving femoral head replacement are common procedures worldwide. In these patients, the femoral heads are replaced with femoral head prosthetic implants. Pre-operative planning to determine the likely size of the prosthetic implant is important. Estimation from radiographs is the commonest method being used but this is fraught with problems. This study, therefore, developed an alternative method that can be used to estimate the femoral head size prior to hemiarthroplasty. MATERIALS AND METHODS: This was a prospective descriptive study that involved measurements of parts of femoral bone. Forty-eight adult femoral bones were measured. Measurements taken were the femoral head size (FH), the femoral bone maximum length (ML), the trochanteric length of the femur (TL), and the distal femoral breadth (DFB) of the femur. All measurements obtained were recorded and were analyzed using STATA version 13 (StataCorp, Texas, USA). RESULTS: The maximum length of the femora ranged from 42.1 cm to 51.5 cm. The trochanteric length ranged from 39 cm to 48.3 cm. The distal femoral breadth ranged from 53.8 mm to 92.3 mm. The femoral head size ranged from 39 mm to 55 mm with a mean value of 46.6 ± 2.9 mm. An equation was generated using the trochanteric length. Femoral head size = 16 + 0.7(trochanteric length in centimeter) ± 5 mm. This will provide a range of possible femoral head prostheses that should be made available for the surgery. CONCLUSION: This study generated an alternate method to be used during the pre-operative planning of a femoral head replacement surgery. It provides the possible range of prosthetic implants sizes to be made available for such surgeries. The trochanteric length can be easily measured. The method described will be of great benefit in middle and low income countries where prosthetic implants are not usually stocked within the hospital.

Scholarly Activities Participation among Surgical Resident Doctors in Nigeria.

BACKGROUND: Scholarly activity in various forms are academic deeds such as researches and research outputs in articles, oral presentations, publications and theses which are disseminated and peer- reviewed. OBJECTIVES: This study aims to assess the level of participation of residents in scholarly activities including their attendance of national and international conferences during residency training. METHODS: This was a descriptive cross-sectional study of 81 resident doctors in General and Orthopaedic surgery, who attended the revision courses organized by their Faculties. Self-administered structured questionnaires were used to collect data. Data obtained was analyzed using SPSS version 21.0. RESULTS: The mean age of the respondents was 34.1 ± 4.5 years, and age ranged from 26 years to 48 years. The male: female ratio was 12.5:1. The average number of years of respondents in residency programme was 3.9 ± 1.8 years. 80.3% of the residents had participated in research since commencement of their residency. Only 18.5% of the resident doctors had any publications in a peer-reviewed journal. While 51.9% of residents had attended local and national conferences since the beginning of their training, only 17.3% had had oral and/or poster presentations at local conferences. No resident involved in this study had oral or poster presentation done at any of the international conferences attended, despite an attendance rate of 12.3%. CONCLUSION: Resident doctors should be encouraged to participate in researches and to publish their works. They should also be encouraged to present their works at conferences.

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.

Poor Health Literacy in Nigeria: Causes, Consequences and Measures to improve it.

Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make an appropriate decisions concerning their health. It is one of the link by which the health status of individual and the health indices and statistics of our country can be improved upon. Factors influencing health literacy in Nigeria include the culture and belief system, poor and ineffective communication, lack of education and low educational level, and low socioeconomic status Low health literacy predisposes to poorer health status, poorer disease outcome, lack of understanding in the use of preventive services, frequent hospital visitations amongst others. Factors influencing health literacy must be identified and modified to help improve the health literacy level of the populace. This will invariably improve the health status of the populace with a resultant improvement in the health indices of our country. This is a call for the Government and Health Care Professionals to acknowledge low health literacy as a problem and, therefore, be willing to play their roles in tackling this problem to achieve a healthy Nation

Anterior knee pain associated with an anterior superior patellar bony spur: a case report.

Anterior knee pain is a common presentation in Orthopaedic out patient practice. However anterior superior patellar spur is an uncommon cause.This case presentation is to highlight an anterior superior patellar spur with quadriceps tendonitis. The patient is a 52 year old man who presented with a recurrent anterior knee pain. The radiographic study revealed an anterio-superior patellar spur. The patient had a depo steroid injection as an adjunct therapy to physiotherapy and has been pain free.

Practical Approach to the Management of the Severely Injured.

Events associated with severely injured victims are common occurrences. These injured patients should be properly managed to achieve good outcome. Trauma algorithm protocols are known to improve therapeutic process and outcome. However, most hospitals in our subregion that attend to severely injured patients are yet to develop an algorithm treatment protocols for the management of these patients. The ambulance system in Nigeria is still un-coordinated and unsupervised. Most of the existing ambulances are not well equipped and usually not manned by experienced paramedics. Therefore, transfer of severely injured victims is fraught with danger during transit. Communication link to inform the trauma centres ahead of transfer is virtually non-existent. Upgrading of the trauma systems in Nigeria is necessary to prevent unnecessary mortality among the resourceful age group that are mostly affected by events causing severely injured patients .

Pipkin fractures: fracture of the head of femur a case report.

Pipkin fracture is the fracture of the head of the femur. It can be associated with neck of femur fracture or/and posterior dislocation of the hip. This fracture is very rare fracture and has not been reported at our sub-region. We present this fracture in a 26 year old with a type I Pipkin fracture treated with closed reduction and percutaneous k-wire fixation. Five (5) year after, she was very appreciative of her management with satisfactory remodeling of her femoral head.

Basic arthroscopy: a review paper.

Arthroscopy is a key hole surgical procedure that is used to visualized, diagnosed and treat pathologies inside a joint. Though it offers numerous advantages, it is technically demanding and requires a learning curve. Moreso, its uses in making diagnosis and therapeutic interventions are rewarding. However, the procedure is not yet widely practiced in our sub-region. This review to bring to fore the advantages of arthroscopic procedures, the indications and contraindications and to stimulate interest of these procedures in our sub region The literature materials on arthroscopic procedures were reviewed The era of extensive opening of joint for surgical procedure is coming to an end. The use of arthroscopic procedures in management of patients will improve the quality of care received by the patients. This review is to stimulate interest of arthroscopy in our sub-region.