RESUMO
INTRODUCTION: The removal of implants after fracture healing has always been a topical and controversial issue. Undisputed however, is the removal of implants which are associated with complications. In this paper, we evaluated the indications, the outcome and economic cost to the patient and the health system of routine removal of implants after union. PATIENTS AND METHODS: This is a two-year comparative, prospective study carried out in three hospitals in North Central Nigeria. All patients who presented for implant removal and consented to the study were recruited. Fracture union was confirmed both clinically and radiological. Direct costs of treatment paid for by the patients and number of absences from work and school were used as economic indices. RESULTS: Forty-seven patients comprising 20(42.6%) males and 27(57,4%) females, mean age of 31.6 (±13.4) years were analysed. Forty-two (89.4%) had fixation with plates and screws, three (6.4%) had screws with cerclage wire and two(4.2%) had tension band wiring. Patient request was the main indication for removal in 34(72.3%), surgeon's request without symptoms in 7(14.9%),six(10.7%) were symptomatic comprising four(8.5%) due to postoperative chronic osteomyelitis and intractable pain in two(4.3%). Total cost of implant removal was $33,293.59 ($ 708.37 ±22.10; range $366.97-1,100.92). Total cost of removal in patients with symptomatic implants-in-situ was $3,678,90( $ 613.15±14.50) One patient had a refracture. Mean duration away from work or school was 16 days. CONCLUSION: Routine removal of implants after fracture union constituted great waste of highly needed cash in both direct cost and loss of man-hour especially in a dwindling economy in an era of evidence based Medicare and best practice. It is recommended that each hospital adopts strict criteria for implant removal.
RESUMO
BACKGROUND: WHO estimates that some 130 million women worldwide are affected, and every year another 2 million girls and young women are at risk of undergoing the practice of FGM. Although Nigeria has a prevalence of 19% in 2003,a reduction from 25% prevalence of 1999 national survey, it still has high absolute number of cases with wide regional variation. The awareness and perception of expectant mothers may give an insight as to what awaits their unborn daughters and have a bearing on the future of the practice. METHODOLOGY: Semi-structured questionnaires were administered to 260 expectant mothers at the antenatal clinic of Jos University Teaching Hospital between 1st and 31st July 2007. RESULTS: Majority of the respondents (94.6%) were aware of FGM. Mass media was the main source of information. Majority (83.8%) wanted the practice to be discontinued, 31.3% reported having had FGM, most done by traditional healers. About 14.6% have a plan to circumcise their daughters citing tradition, marriage prospects, and faithfulness to husband as their reasons. Only 16.2% wanted the practice to continue. CONCLUSION: There is high level of awareness of the FGM among respondents who also have negative attitude to the practice, even as the practice is still prevalent. More health education is needed to illustrate the dangers of the practice in order to safeguard the health of the girl-child.
