Motorcycle Road Traffic Injuries in a Tertiary Hospital in Nigeria: A Reflection of the Trauma Care Crisis.

BACKGROUND:  Motorcycle is a popular and growing form of intracity transportation in many Nigerian cities owing mainly to poorly developed transport systems. It contributes significantly to road traffic injuries (RTIs), which are a leading cause of death and disabilities in low- and middle-income countries. There is a lack of information on the quality of care received and the treatment outcome in patients with motorcycle RTIs in Ibadan and many cities in Nigeria. This study evaluated the characteristics of motorcycle-related RTIs, the quality of care received, and the outcome of the patients managed in a trauma reference center in Ibadan, Nigeria. METHODS:  This is a prospective cohort study. All patients involved in motorcycle road traffic crashes who presented to the emergency department of the University College Hospital, Ibadan, between August 2020 and May 2021, were included in the study. Data on patients' demographics, history of the crash, injuries sustained, definitive care, and the outcome of in-hospital care were obtained from patients (and/or their carers) and the medical records. RESULTS:  A total of 156 patients were seen, out of which 74.4% were males. About 76.2% were less than 45 years with a mean age of 35.7 ± 16.3 years, and the peak age group was 18-44 years. About 37 (23.7%) patients were involved in motorcycle/motorcycle collisions, whereas 67 (42.9%) were involved in motorcycle/car collisions. Riders accounted for 59.6% (93), and although 62% (97) of the patients presented within six hours of the crash, only 10.9% (17) presented within one hour. About 48% received some form of prehospital care rendered by officials of the Federal Road Safety Corps, police officers, or passers-by, and none was attended by a dedicated emergency ambulance team. The head and the limbs were the most affected anatomical areas, while orthopedic and neurosurgical procedures were the most required emergency surgical interventions. About 66.7% were discharged home with only 21.2% of them fit to return to pre-trauma function at discharge, and the mortality rate was 17.3%. Patients who presented at 7-24 hours (AOR = 2.99; 95% CI = 1.04-8.62; p-value = 0.043) and >24 hours after the accident (AOR = 5.65; 95% CI = 1.64-19.53; p-value = 0.006) were 2.99 and 5.65 times, respectively, more likely to die from motorcycle-related accident compared to those who presented within the first six hours. CONCLUSION:  This study identified the growing burden of disabilities and mortalities related to motorcycle RTIs. It highlights the lack of prehospital trauma care, which is a reflection of the deficiency of a national, regional, or jurisdictional trauma system and the critical need to develop a functional trauma system.

Effectiveness of neck stabilisation and dynamic exercises on pain intensity, depression and anxiety among patients with non-specific neck pain: a randomised controlled trial.

BACKGROUND AND AIMS: Non-specific neck pain (NsNP) constitutes a burden to the bearers and a management challenge to physiotherapists globally. Effectiveness of neck stabilisation and dynamic exercises in the management of NsNP has been documented, but it is not clear which exercise regimen is more effective in alleviating its associated pain, depression and anxiety. This study was carried out to compare the effectiveness of neck stabilisation and/or dynamic exercises on pain intensity, depression and anxiety among patients with NsNP. METHODS: Eighty-nine consenting individuals with NsNP participated in this single-blind, randomised controlled trial. They were recruited from the outpatient physiotherapy clinics of the National Orthopaedic Hospital in Dala, Kano State, Nigeria. Participants were randomly assigned into one of three intervention groups: neck stabilisation exercise group (NSEG; n=30), neck dynamic exercise group (NDEG; n=28) and neck stabilisation and dynamic exercise group (NSDEG; n=31). Treatment was administered thrice weekly for 8 consecutive weeks. Variables were assessed at baseline, at the end of the fourth and eighth weeks. Pain intensity was assessed through the use of a visual analogue scale, while depression and anxiety were evaluated using both the Beck Depression Inventory and Beck Anxiety Inventory. The data was analysed using descriptive statistics, multivariate analysis of variance (MANOVA) and post hoc tests with Bonferroni adjustment at the p=0.05 significant level. RESULTS: Ages of participants in NSEG (46.8±12.4 years), NDEG (48.6±11.6 years) and NSDEG (45.1±13.4 years) were comparable. The comparison for NSEG, NSDEG and NDEG within groups revealed that there was significant difference in pain intensity, depression and anxiety scores from baseline, in the fourth and eighth weeks of the study - (F=62.40, p=0.001, F=13.91, p=0.001 and F=20.93, p=0.001); (F=11.92, p=0.001, F=8.75, p=0.004 and F=9.70, p=0.001) and (F=36.63, p=0.001, F=11.99, p=0.001 and F=6.59, p=0.001), respectively. A group comparison of the pain intensity, depression and anxiety scores of participants in the NSEG, NSDEG and NDEG at the baseline of the study revealed that there were no significant differences in the pain intensity and depression and anxiety scores among the three groups: p=0.159, 0.58 and 0.179, respectively. At week 4 of the study, however, a significant difference in pain intensity and anxiety scores across the three groups was recorded - p=0.018, p=0.011, respectively, but no significant difference was noted in depression scores (p=0.93). At week 8 of the study, it was determined that there were significant differences in pain intensity and depression scores p=0.001 and p=0.041, but no significant dissimilarities in the anxiety scores. Post hoc revealed that only pain was significant and lay with NSEG. CONCLUSIONS: The study concluded that the stabilisation, dynamic and stabilisation, plus dynamic exercises were effective in relieving pain and reducing depression and anxiety in patients with NsNP. However, stabilisation showed a more marked effect than the combination exercises of stabilisation plus dynamic exercises, and dynamic exercises in reducing pain intensity in patients with NsNP. IMPLICATIONS: It is recommended that stabilisation exercises be chosen over stabilisation plus dynamic exercises, or dynamic exercise, while treating patients with NsNP. However, both are effective.

The impact of seat-belts in limiting the severity of injuries in patients presenting to a university hospital in the developing world.

BACKGROUND: Road traffic injuries are major public health problems and a leading cause of death and injury around the world. Approximately 1.2 million people are killed each year in road crashes worldwide, with up to 50 million more injured. Over 95% of these deaths and injuries occur in the low- and middle-income countries of the world. The aim of this study is to evaluate the impact of the use of seat-belts in reducing the severity of injuries from road traffic crashes and to determine the compliance and awareness of the importance of the use of seat-belts among Nigerian motorists. PATIENTS AND METHODS: The injury patterns and outcome of care in 140 patients who were seen at the emergency department of our tertiary hospital were evaluated. Initial care and resuscitation was carried out on all patients using the advanced trauma life support protocol. RESULTS: A total of 81 (57%) patients used seat-belts, while 59 (42.1%) did not. Nineteen (13.6%) patients died as a result of their injuries; 4 (21.1%) of these had used seat-belts, while 15 (79%) had not (P = 0.001). The mortality rate of 79% for patients who did not use seat-belt was statistically significant. CONCLUSIONS: The seat-belt is an effective safety tool that not only saves lives, but also significantly reduces the severity of the injury that a vehicle occupant may have sustained if they were not wearing the device. More public enlightenment is needed to increase the awareness and compliance of use of seat-belts among Nigerian motorists.

The Impact of Seat-belts in Limiting the Severity of Injuries in Patients Presenting to a University Hospital in the Developing World

Road traffic injuries are major public health problems and a leading cause of death and injury around the world. Approximately 1.2 million people are killed each year in road crashes worldwide; with up to 50 million more injured. Over 95 of these deaths and injuries occur in the low- and middle-income countries of the world. The aim of this study is to evaluate the impact of the use of seat-belts in reducing the severity of injuries from road traffic crashes and to determine the compliance and awareness of the importance of the use of seat-belts among Nigerian motorists. Patients and Methods: The injury patterns and outcome of care in 140 patients who were seen at the emergency department of our tertiary hospital were evaluated. Initial care and resuscitation was carried out on all patients using the advanced trauma life support protocol. Results: A total of 81 (57) patients used seat-belts; while 59 (42.1) did not. Nineteen (13.6) patients died as a result of their injuries; 4 (21.1) of these had used seat-belts; while 15 (79) had not ( P = 0.001). The mortality rate of 79 for patients who did not use seat-belt was statistically significant. Conclusions: The seat-belt is an effective safety tool that not only saves lives; but also significantly reduces the severity of the injury that a vehicle occupant may have sustained if they were not wearing the device. More public enlightenment is needed to increase the awareness and compliance of use of seat-belts among Nigerian motorists. for patients who did not use seat-belt was statistically significant. Conclusions: The seat-belt is an effective safety tool that not only saves lives; but also significantly reduces the severity of the injury that a vehicle occupant may have sustained if they were not wearing the device. More public enlightenment is needed to increase the awareness and compliance of use of seat-belts among Nigerian motorists

Comparison of four physiotherapy regimens in the treatment of long-term mechanical low back pain.

OBJECTIVE: This study compared efficacy of combinations of Back Muscles Endurance Exercise (BMEE) and McKenzie Exercise (ME) and McKenzie Back Care Education (MBE) in the management of long term mechanical Low Back Pain (LBP). SUBJECTS AND METHODS: A single-blind randomized controlled comparative trial was employed. Seventy three participants mean age 45.3 ± 8.1 years were recruited for the study but only 53 completed the study. Participants in group A were treated with a combination of BMEE, ME and MBE. Group B: A combination BMEE and MBE. Group C: A combination of ME and MBE. Group D: MBE only. Participants were seen thrice weekly for 8 weeks. They were measured for pain intensity, lumbar flexibility, activities limitation and self esteem. Data were analysed using descriptive and inferential statistics of F-test. Significance was set at 0.05 alpha-level. RESULTS: At the end of the study, the four treatment groups had significant reduction in pain intensity p<0.05. Post hoc analysis showed groups A, B, and C had significantly greater reduction than D, and groups A and C had significantly greater reduction than B. Groups A, B and C also had significant improvement in activities limitation p<0.05. Post hoc analysis showed groups A, B and C had significantly greater improvement than D, and group B significantly greater improvement than C. CONCLUSION: Combination physiotherapy regimens proved effective in the management of long- term mechanical LBP. Regimen A is recommended in managing long-term mechanical LBP.

Plating of Femoral Shaft Fractures: the Experience in an African Teaching Hospital.

BACKGROUND: Femoral shaft fractures are common presentation in our trauma units. It is obvious that all these fractures cannot be treated conservatively due to the pressure on trauma beds and thus a suitable method of internal fixation that is feasible in the environment has had to be adopted. OBJECTIVE: This study is a report of our experience with plate fixation of femoral shaft fracture in our environment. DESIGN: A retrospective hospital based study. PATIENT AND METHOD: All patients with femoral shaft fractures stabilized with plates and screws between 1997 and 2004 at the University College Hospital were reviewed. The case notes were retrieved and data extracted from them; all case notes entry gave sufficient information. RESULTS: The fracture pattern showed 56 cases (35.4%) of Type 32-A, 45 cases (28.5%) of Type 32-B and 57 cases (36.1%) of Type 32-C using AO classification. The outcome of treatment was excellent to good in 125 fractures (77.2%). The average time of healing was 20 weeks (range 16-48). Fracture related complications occurred in nine fractures (5.7%) which included deep infection in four fractures (2.5%) and implant failure in five fractures (3.2%). CONCLUSION: Femoral shaft plating gives good result if the principles of fixation is carefully followed and in developing countries where initial cost of procurement of equipments for closed nailing may not be forth coming, it thus provide a safe efficient and low cost method of fixation of femoral shaft fracture.