Risk factors for pressure ulceration in a resource constrained spinal injury service.

STUDY DESIGN: Pressure ulceration and other complications constitute an encumbrance in the management of spinal cord injury in many services with limited resources in developing countries. These services undertake patients' care without adequate prehospital care, limited modern infrastructure and limited number of trained staff. OBJECTIVES: To evaluate the associated risk factors for pressure ulceration in traumatic spinal cord injured managed in a resource constrained spinal injury unit in Lagos, Nigeria. A regional acute trauma and rehabilitation centre serving a population of >20 million. METHODS: This is a prospective study in patients presenting with traumatic spinal cord injury between 1 October 2004 and 30 November 2006. The data collected include demographic characteristics, interval before admission in the unit, type of spinal cord injury and serum albumin. The incidence of pressure ulcers and the isolated organisms was recorded for patients who developed pressure ulcers on admission and during the period of stay in the unit. The length of hospital stay was also recorded for all the patients. RESULTS: The overall incidence of pressure ulceration on admission was 57.1%. There was an average lengthening of hospital stay of 33.1 days in the group of patients with pressure ulceration compared to patients without pressure ulcers. The nutritional status on admission, interval before admission and the type of neurological injury were significant factors for the incidence of pressure ulcers. CONCLUSION: The incidence of pressure ulceration was high, delay in admission and poor nutritional status may be significant factors in the incidence of pressure ulceration in spinal cord injury.

Complications of treatment of musculoskeletal injuries by bone setters.

BACKGROUND: Traditional bone setters (TBS) have existed for decades in Nigeria and other countries. Their treatment methods often lead to several complications, the most dangerous being extremity gangrene which usually leads to proximal amputation. OBJECTIVE: To apprise the Orthodox Practitioners of complications of musculoskeletal injuries treated by the bone setters, the factors that encourage patronage of TBS services and the outcome of the treatment of these complications by the orthodox practitioners. METHODS: This was a one-year prospective study involving one hundred and twenty-one consecutive patients presenting with complications related to treatment of their musculoskeletal injuries by bone setters. The following data were obtained using observer-administered questionnaires viz; demography, details of initial injury, reasons for patronage of TBS, nature of treatment, estimated cost of treatment and disability of patients at presentation. The outcome of orthodox treatment of these complications was assessed at six months using the following parameters --wound healing, bone union and use of prosthesis by the patients. RESULTS: One hundred and twenty-one patients with 155 musculoskeletal injuries and 168 complications of treatment by the TBS were seen 75 (57%) were male and 52 (43%) were female. The ages of the patients ranged from 6 weeks--72 years (mean 29.49 years). The common complications of TBS treatment were malunion and non-union which each accounted for 27 (16.1%) cases. The major reasons for TBS patronage was the perceived low cost of treatment in 47 (27.9%) and pressure from family and friends in 36 (25%) patients. The cost of treatment of the TBS ranged from USD 18-380, whereas, at the Orthopaedic Hospital, it ranged from USD 34-98. At six months after orthodox surgery, 10 (91%) of the patients who had amputation were yet to start using prosthesis, 3 (23%) who had internal fixation failed to unite. CONCLUSION: The commonest reason for patronage was the believed cheapness of the TBS services. However, this study showed that orthodox treatment is actually cheaper in most cases. Despite all the complications associated with their treatment, majority of the people still have a strong belief in their capability. A suggested solution will be the incorporation of the TBS into the healthcare system so that they could be better trained and controlled.