Diagnostic challenges in the management of septic arthritis of the neonatal hip: A case report.

Septic arthritis of the neonatal hip is a very rare pathology. The clinical features may be different from those associated with older children, resulting in diagnostic challenges. Delay in instituting treatment, especially in neonates could be associated with severe dysfunction and deformity in a significant number of affected children. Therefore, treatment should be prompt and comprise broad-spectrum intravenous antibiotic therapy, surgical drainage, and general supportive care. The index patient is a 3-week-old neonate who had left hip arthrotomy on account of septic arthritis. The aim of this report is to highlight the challenges encountered in the diagnosis of septic arthritis of the hip in this patient.

Non operative treatment of obturator dislocation with indentation fracture of the femoral head: A case report.

Traumatic anterior hip dislocation is quite rare and accounts for 7% to 15% of all hip dislocations. Approximately 70% of anterior hip dislocations are the obturator type and represent less than 7% of all hip dislocations. Indentation fracture of the femoral head complicates 35-55% of obturator dislocations. Features of osteonecrosis of the femoral head and osteoarthritis of the hip joint may manifest within 2 years. Our index patient is a 19-year-old female who had conservative treatment for right obturator dislocation with indentation fracture of the femoral head. She recovered fully and had no features of osteonecrosis or secondary arthritis at 2 years postinjury. The aim of this report is to highlight the role of conservative treatment in the management of obturator dislocation with indentation fracture of femoral head.

Depression and posttraumatic stress disorder among road traffic accident victims managed in a Tertiary hospital in Southern Nigeria.

BACKGROUND: Psychological responses to traumatic events vary widely across different cultures but studies in the developing countries are scant. The objective of this study is to determine prevalence of depression and posttraumatic stress disorder (PTSD) among patients involved in road traffic accident (RTA) compared with that of the general population using a matched control group. MATERIALS AND METHODS: The study design was case control and employed the convenient sampling technique. All consecutive attendees of the trauma clinic of a Tertiary Hospital who had been involved in RTA in the previous year and met inclusion criteria were recruited to participate in the study. Controls were drawn from patient relatives attending other clinics in the same hospital. The final sample comprised of 46 cases and controls, totaling 92 participants. A Sociodemographic questionnaire, the PTSD, and depression modules of the Mini International neuropsychiatric interview were administered to both groups by trained research assistants. The data were analyzed using IBM SPSS version 22. Statistical significance was set at 0.05. RESULTS: The prevalence of PTSD among cases was 41.3% compared with 13% among controls, whereas the prevalence of depression among cases was 63% compared with 30.4% among the controls. Both of these findings were statistically significant (P < 0.002). Sociodemographic variables such as age, sex, marital status, religion, level of education, and occupation did not have statistically significant relationship with neither PTSD nor depression. CONCLUSION: Mental disorders such as PTSD and depression are common in victims of RTA. They would benefit from comanagement with mental health specialists.

The Heel Pad in Congenital Idiopathic Clubfoot: Implications of Empty Heel for Clinical Severity Assessment.

BACKGROUND: Clubfoot has been evaluated in many ways, including the most common classifications of clubfoot, described by Caterrall and Piraniis based on six clinical signs. The purpose of this study was to gain better understanding of the heel pad in relation to the term "empty heel", and to propose modification of clubfoot severity scoring system based on "empty heel". METHODS: A combination of prospective study of 79 clubfoot patients treated with Ponseti method and literature review of heel pad anatomy and biomechanics. The setting was a university teaching hospital. The ethical research committee approved study protocol and informed consent of patients' parent obtained. The selection criteria included patients' diagnosed congenital idiopathic clubfoot, age < 2 years, no history of previous treatment and tenotomy indicated. An evaluation of patient was assessed by orthopaedic surgeons trained on Ponseti method and has above 5 years experience. Data analysis performed on the age, sex, Pirani scores at onset of treatment, tenotomy, and 6 month after initial full correction. RESULTS: One hundred and thirty-two clubfeet in 79 patients (56 males, 23 females) completed Ponseti protocol. The median age at presentation was 5.2 months (range 0.1-23.7 months). The mean right foot abduction after correction 57.30 (S.D. 9.20), and for the left foot, was 56.30 (S.D. 9.40). The mean right foot dorsiflexion was -13.70 (S.D. 18.40) before correction while after correction, it was 20.00 (S.D. 4.50) and for the left, the mean was -8.50 (S.D. 9.60) before correction and 21.00 (S.D. 4.30) after correction. Eighteen (22.8%) patients (10 bilateral, 9 unilateral) had clubfeet with empty heel score above zero point at initial full correction (p<0.001). Clinic anatomy shows the heel pad is a solid complex structure existing in normal, moderate and severe atrophied form. Heel pad is attached tightly to calcaneus without a cavity for the calcaneus to drop. CONCLUSIONS: Heel pad probably could replace "empty heel" in modify Pirani scoring system. Clinical indication for repeat tenotomy should be based on equinus, not on the feeling of an empty heel, and families can be advised that the heel pad has a tendency to remodel over time to a normal shape. LEVEL OF EVIDENCE: Level II. CLINICAL RELEVANCE: Empty heel feeling at initial full correction of congenital idiopathic clubfoot based on Ponseti protocol is not indication for repeat tenotomy.

Antegrade Versus Retrograde Approach to Interlocking Nail Fixation of Femoral Diaphyseal Fractures: Is there Difference in Time to Union?

BACKGROUND: Antegrade reamed interlocked intramedullary nailing is the treatment of choice forfemoral diaphyseal fractures. More recently, retrograde intramedullary nailing of the femur has been seen as a viable alternative to the antegrade nail. METHODS: This was a prospective comparative study. Consecutive patients were placed alternately into a study group (retrograde nailing) and a control group (antegrade nailing) in a ratio of 2:1 i.e two retrograde nailing for every antegrade nailing. Forty one fractures had interlocking intramedullary fixation via the retrograde approach (study group), while the control group consisted of twenty fractures that had fixation via the antegrade approach. All were followed up for a minimum period of nine months (range of nine to twenty-four months). RESULTS: The mean duration of surgery in the retrograde group was 157.07minutes and 137.40 minutes in the antegrade group (p=0.093). The mean duration to fracture union was 16.98±4.71 weeks in the retrograde group and 15.80±5.43 weeks in the antegrade group (p = 0.388). There was no incidence of non-union in the two groups. CONCLUSION: Retrograde approach compares favourably with antegrade approach for intramedullary interlocking nail fixation of diaphyseal femoral fracture in adults with respect to time of fracture healing.

Haemophilic arthropathy; a case report.

AIMS AND OBJECTIVES: The objective of this article is to report a rarely encountered case of haemophilic arthropathy which should be considered in the differential diagnosis of knee swelling. PATIENTS AND METHODS: The history. physical findings and results of investigations of a patient presenting with haemophilic arthropathy and the past medical records of the patient were reviewed with relevant literature. RESULTS: This is a report of the existence of this condition in this environment and the management of this rarely encountered condition in a I0 year old boy, known haemophiliac who presented at the orthopaedic clinic with features of right knee arthropathy. He was co-managed with the haematologist with the available Fresh frozen plasma and physical therapist with good response. CONCLUSION: Haemophilia is rare in this environment. Haemophilic arthropathy is rarely considered a differential diagnosis of knee swelling. There is little experience with the presentation and the management of this condition.

Comparison of effect of retrograde and antegrade approaches to interlocking nail fixation of femoral diaphyseal fractures on ipsilateral hip and knee joint motion.

PURPOSE: The objective of this study was to evaluate the early impact of antegrade and retrograde interlocking nail fixation of femoral diaphyseal fractures on the ipsilateral hip and knee joint range of motion. METHODS: A prospective evaluation was performed of 62 consecutive limbs with femoral diaphyseal fractures that had interlocking nail fixation through the antegrade or retrograde approaches. All participants had post-operative physiotherapy. Follow-up was for 9 months. RESULTS: The mean maximum hip flexion angle at 9 months was 137.50 in the antegrade group and 133.80 in the retrograde group (p = 0.150). Trendelenburg test was negative in both groups and there was no knee extension lag at 9 months. While the mean maximum knee flexion angle at 9 months was 119.90 in the retrograde group and 134.50 in the antegrade group (p = 0.023). All patients had achieved radiologic and clinical fracture union by twenty four weeks post-operatively. CONCLUSION: There was no significant effect of antegrade or retrograde approach on the range of motion of the hip joint. However, knee motion improved more quickly in the group that had antegrade nailing.