Prevalence and risk factors associated with musculoskeletal disorders among pregnant women in Enugu Nigeria.

BACKGROUND: Pregnancy usually triggers a wide range of changes that result in a variety of musculoskeletal disorders (MSDs). The scope and burden of these disorders in Nigeria are not known. AIM: The study aimed to determine the prevalence and risk factors of pregnancy-related MSDs in Enugu. PATIENTS AND METHODS: A cross-sectional study of pregnant women attending antenatal clinics at three tertiary hospitals in Enugu, Nigeria, was done using an observer-administered questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 22. RESULTS: A total of 317 participants were studied. A majority of the participants (93.1%) had one or more MSDs. Low back pain (LBP) and muscle cramps were the two most common pregnancy-related MSDs with prevalence rates of 56.8 and 54.8%, respectively. Increasing gestational age (P = 0.001), previous pregnancies (P = 0.027), and occupation (P = 0.018) were associated with increased risk of MSDs. A majority of the MSDs were of mild and moderate severity and 10.4% of the participants had significant impairment of their daily activities. CONCLUSION: MSDs are common in pregnancy with LBP and muscle cramps as the most prevalent conditions. Increasing gestational age, multigravidity, and occupation increased the risk of MSDs among our cohorts. Preventive and therapeutic measures should be instituted when necessary to ensure optimal maternal health during pregnancy.

Ponseti clubfoot management method: Initial experience with 273 clubfeet treated in a clubfoot clinic of a Nigerian regional orthopedic hospital.

OBJECTIVE: The aim of this study was to evaluate the initial experience and outcome of clubfoot treated using the Ponseti technique in a regional orthopedic hospital setting of a developing country. METHODS: This was a retrospective review of all the clubfoot patients who were treated at the clubfoot clinic of National Orthopaedic Hospital Enugu from 1st of August 2013 to 31st January 2015. RESULT: There were 175 patients with 273 clubfeet. The male to female ratio was 1.2:1, and the age range was 1 week to 27 years with a median age of 11 months. One hundred and fifty-one patients (86.5%) had congenital clubfoot, whereas 24 (13.5%) had acquired clubfoot. The mean Pirani score of the patients at presentation was 4. The mean number of cast sessions needed for correction was 6.3. The majority of the feet (96.6%) were treated and correction achieved with Ponseti method alone, whereas 3.4% had other additional surgical procedures. Seventy-two (41.1%) patients afforded and used foot abduction brace as prescribed. Plaster sores in 12.5% of patients were the most common complication. At a mean follow-up period of 6 months, a relapse rate of 3.4% was observed. CONCLUSION: Ponseti clubfoot management technique alone is very effective in most cases of clubfoot in our setting. Late presentation of patients and foot abduction brace related challenges observed call for a policy response aimed at educating the public on the importance of early presentation and improving the use of foot abduction brace.

Auto tricycle injuries and the vulnerability of occupants and pedestrians in a developing Country: A multi-center study.

BACKGROUND: Auto tricycle is an emerging common means of public transport in Nigeria. This study aimed to determine the scope and type of collisions and injuries from auto tricycles crashes in Nigeria, and identify potential areas for interventions to facilitate injury prevention. PATIENTS AND METHODS: This was a prospective study of all the patients with auto tricycle injuries that visited Emergency rooms of three Nigerian tertiary hospitals from 1st February 2015 to 31st July 2016. RESULTS: There were 210 victims; auto tricycle - other vehicle collisions, lone auto tricycle collisions and auto tricycle- pedestrian collisions accounted for injuries in 67.2%, 19% and 13.8% of them respectively. Preponderance of collisions at nighttime (60%), and on intra-city roads (86.7%) was observed. The rate of severe injury was significantly higher on inter-city than intra-city roads (32.11% vs. 9.3%, P < 0.001), and in daytime than night time (16.7% vs. 6.0%, P < 0.043). The lower extremity (50%), head (38.6%) and upper extremity (30.4%) were the three top anatomical regions involved. The case fatality rate was 1.4%: head injury accounted for two-third of the mortality. CONCLUSION: In Nigeria, auto tricycle has come to stay as a means of public transport and vulnerable road users are not immune to auto tricycle related injuries and its associated morbidity and mortality. This calls for preventive strategies, based on the findings in this study, which may curb the menace of auto tricycle crash and resultant injuries.

Epidemiology of injuries seen in a nigerian tertiary hospital.

BACKGROUND: The study aimed to describe the pattern of injuries among patients presenting at a tertiary care hospital in Enugu southeast Nigeria. PATIENTS AND METHODS: A retrospective review of records of all injured patients seen in our hospital over a 12-month period was done. RESULTS: A total of 789 patients had complete medical records and were included in the study. Road traffic accident (RTA) was the most common cause of injury. Lacerations/abrasions, fractures, and traumatic brain injury (TBI) were the most frequently seen injuries. The injury severity score (ISS) of the patients ranged from 1 to 50 with a mean score of 8.9 ± 3.5. RTAs were responsible for 90.8% of patients with ISS >15. Patients with ISS >15 contributed to 64.1% of all deaths. The mortality rate was 4.5%. Most deaths resulted from RTA and were associated with TBI (P = 0.001). CONCLUSION: Lacerations and fractures were the most common injuries. RTA was the leading cause of injury. TBI was the most common cause of injury-related death.

Compartment syndrome complicating acute osteomyelitis of the radius in a neonate: a case report.

BACKGROUND: Acute osteomyelitis in neonates is uncommon and compartment syndrome complicating this condition is rare. METHOD: The evaluation of a 4-week old female neonate who presented with compartment syndrome of the right forearm following an acute osteomyelitis of the right radius is presented. RESULT: The patient had a full recovery with emergency fasciotomy and antibiotics therapy. CONCLUSION: A high index of suscipion is needed to recognize this limb and life-threatening complication, specially in neonates and infants. Prompt surgical intervention is necessary for the best clinical outcome.

Traumatic hip dislocation at a regional trauma centre in Nigeria.

BACKGROUND: Traumatic dislocation or fracture-dislocation of the hip is an orthopaedic emergency that is steadily increasing in incidence due to high-speed motor vehicular accidents. These injuries need to be recognized early and promptly treated to prevent morbidity and long-term complications. Some of the fundamental issues in the management of traumatic dislocations of the hip are the critical interval between injury and reduction, the type of reduction most suitable for various types of injury and the duration of immobilization that give the best results. This study was carried out at the National Orthopaedic Hospital Enugu, a regional trauma and orthopaedic centre in South-East Nigeria. The purpose of the study is to describe the pattern of presentation and to identify the factors that determine the long-term outcome in the treatment of traumatic dislocations and fracture-dislocations of the hip at Enugu, Nigeria. METHODS: The case notes of all the patients that presented with traumatic dislocations and fracture-dislocations of the hip between January 2003 and December 2007 were reviewed. The information extracted and analyzed included the patients' demographics, etiology of injury, time interval before reduction, associated injuries, treatment offered, complications and follow-up. Thompson-Epstein classification was used to grade the posterior hip dislocations. The outcome of treatment was evaluated using the clinical and radiological criteria proposed by Epstein (1974). Three patients with incomplete data and two patients with central fracture dislocation were excluded from this study. RESULTS: Forty-eight patients with 50 hip dislocations were analyzed. The age range was 12 years to 67 years with a mean age of 34.8 years. Thirty-nine patients (81.3%) were males and 9 (18.7%) were females. Road-traffic accident was the leading cause of traumatic hip dislocation in this series, 44 cases (91.6%). Posterior dislocation occurred in 48 hips (96%) while anterior dislocation occurred in 2 hips (4%). Forty-seven hips (94%) were treated by primary closed reduction, two hips (4%) were treated with open reduction and one patient (2%) had Girdlestone excision arthroplasty. Thirty-six hips (73.5%) were reduced with 12 hours of the injury. Concomitant injuries were found in 37 patients (77%). The follow up period ranged from 10 months to 36 months with a mean follow up period of 15 months. Post-traumatic osteoarthritis occurred in 2 hips (4%) avascular necrosis of the femoral head was seen in 2 hips (4%). Five patients had sciatic nerve paresis while there was recurrence in one hip. No mortality was recorded. CONCLUSION: Traumatic dislocations and fracture-dislocations of the hip are severe injuries caused mostly by high-speed motor-vehicular accidents. Young adult males are most commonly affected, and there is a high rate of concomitant injuries. Excellent results can be achieved by early and stable closed reduction of these injuries with immobilization of the affected hips.

Musculoskeletal complications of sickle cell disease in Enugu, Nigeria.

BACKGROUND: Sickle cell disease (SCD) is one of the most important haemoglobinopathies. It is an autosomal recessive genetic condition in which a defective form of haemoglobin, haemoglobin S (HbS) results from a single amino acid substitution. The amino acid valine replaces glutamic acid at position 6 in the beta globin gene. Musculoskeletal complications are often observed in the evolution of this disease and are common causes of morbidity and disability in these patients. The objective of this study is to describe the pattern and presentation of musculoskeletal complications in sickle cell disease at the National Orthopaedic Hospital Enugu Nigeria. METHOD: a retrospective review of the patients with musculoskeletal complications who are genotype-confirmed sicklers who were treated in our hospital from January 1993 to December 2007 was carried out. The data collected included age, sex, complications, anatomic site, grade of disease, treatment, outcome of management and follow up. Patients with incomplete data were excluded from the study. RESULTS: Twenty seven patients with musculoskeletal complications of SCD were treated within the study period. Two patients were excluded from the study because of incomplete data. Twenty-five patients with 44 complications were analyzed. The age range was between 7 years to 30 years with a mean age of 19.2 years. Fifty six percent of patients were males. Malleolar ulcers were the commonest complications. This was followed by avascular necrosis (AVN) of the femoral head and osteomyelitis. Septic arthritis and osteomyelitis were most common in children less than 10 years while avascular necrosis and malleolar ulcers occurred more commonly in patients more than 15 years. Majority of the malleolar ulcers were treated by split skin grafting. Seventy five percent of the femoral head avascular necrosis was treated conservatively CONCLUSION: Musculoskeletal complications are common causes of morbidity and disability in sickle cell disease. Malleolar ulcers were the commonest musculoskeletal complications. The predominant presentation in children below the age of 10 years is osteomyelitis and septic arthritis while AVN and malleolar ulcers occurred mostly in adolescents.

Oucome of management of non-gonococcal septic arethritis at National Orthopaedic Hospital, Enugu, Nigeria.

BACKGROUND: Septic arthritis is an accute bacterial infection of a synovial joint. It is an orthopaedic emergency that can lead to morbidity or mortality if not properly treated. the fundamental issues in the management of septic arthritis include the duration of antibiotic therapy, the mode of joint drainage and the role of physiotherapy. There is a paucity of local data on septic arthritis in Nigeria. The study wa carried out at the National Orthopoedic Hospital, Enugu; a regional trauma and orthopaedic center with wide catchments area covering at least three geopolitical zones of Nigeria. The objective of the study is to describe the pattern and distribution of non-gonococcal septic arthritis, the causative organisms, and the outcome of management of this condition at Enugu, Nigeria and make recommendations on the antibiotic therapy. METHOD: A retrospective study of all the patients that presented at the National Orthopaedic Hospital Enugu with Non-gonococcal septic arthritis between January 1997 and December, 2006 was done. The patient's case notes were retrieved from the Medical Record Department. Information extracted and analyzed included demographic data, joints affected, cultured organisms, antibiotic sensitivity pattern, duration of parenteral and oral antibiotics therapy, complications and follow-up period. Patients with incomplete records, immune-compromised patients and those with subjacent osteomyelitis were excluded from the study. RESULT: Forty-three patients were seen within the period and 40 had analyzable data. The age range was 1 month to 39 years, with a mean age of 10.2 years. Twenty-one patients (52.5%) were males and 19 (47.5%) were females. The hip joint was the most commonly affected (47.5%). Staphylococcus aureus was the most common organism (50%), followed by Coliformn (42.5%). Most patients (75%) had parenteral antibiotics for 3-5 days, while 77.5% of patients received oral antibiotics for 2-4 weeks. All the patients had arthrotomy and joint irrigation within 48 hours of admission. Complicatins were recorded in 11 patients (27.5%). Fixed flexion deformity was the commonest complication (17.5%). No mortality was recorded. CONCLUSION: Septic arthritis is an orthopaedic emergency. Early diagnosis and prompt treatment with appropriate ontibiiotics and surgical drainage are the keys to a successful outcome. In our environment (Enugu), the coliforms ore competing favourably with stophylococcus oaureus as causative agents of septic arthritis. Short term parenteral antibiotics of 3-5 days seems to be as effective as the 1-2 weeks therapy in the non-immune compromised patients and in cases not complicated by juxtarticular osteomyehlitis or presence of prosthetic implants.

Outcome of Management of Non-Gonococcal Septic Arthritis at National Orthopaedic Hospital; Enugu; Nigeria

Septic arthritis is an acute bacterial infection of a synovial joint. It is an orthopaedic emergency that can lead to morbidity or mortality if not properly treated. The fundamental issues in the management of septic arthritis include the duration of antibiotic therapy; the mode of joint drainage and the role of physiotherapy. There is paucity of local data on septic arthritis in Nigeria. The study was carried out at the National Orthopaedic Hospital; Enugu; a regional trauma and orthopaedic center with wide catchments area covering at least three geopolitical zones of Nigeria.The objective of the study is to describe the pattern and distribution of non-gonococcal septic arthritis; the causative organisms; and the outcome of management of this condition at Enugu; Nigeria and make recommendations on the antibiotic therapy. A retrospective study of all the patients that presented at the National Orthopaedic Hospital Enugu with Non-gonococcal septic arthritis between January 1997 and December; 2006 was done. The patient's case notes were retrieved from the Medical Record Department. Information extracted and analyzed included demographic data; joints affected; cultured organisms; antibiotic sensitivity pattern; duration of parenteral and oral antibiotics therapy; complications and follow-up period. Patients with incomplete records; immunecompromised patients and those with subjacent osteomyelitis were excluded from the study. Forty-three patients were seen within the period and 40 had analyzable data. The age range was 1 month to 39 years; with a mean age of 10.2 years. Twenty-one patients (52.5) were males and 19 (47.5) were females. The hip joint was the most commonly affected (47.5). Staphylococcus aureus was the most common organism (50); followed by Coliforms (42.5). Most patients (75) had parenteral antibiotics for 3-5 days; while 77.5of patients received oral antibiotics for 2-4 weeks. All the patients had arthrotomy and joint irrigation within 48 hours of admission. Complications were recorded in 11 patients (27.5). Fixed flexion deformity was the commonest complication (17.5). No mortality was recorded. Septic arthritis is an orthopaedic emergency. Early diagnosis and prompt treatment with appropriate antibiotics and surgical drainage are the keys to a successful outcome. In our environment (Enugu); the coliforms are competing favourably with staphylococcus aureus as causative agents of septic arthritis. Short term parenteral antibiotics of 3 - 5 days seems to be as effective as the 1 - 2 weeks therapy in the non-immune compromised patients and in cases not complicated by juxtarticular osteomyelitis or presence of prosthetic implants