Definitive Taylor Spatial Frame management for the treatment of high-energy open tibial fractures: Clinical and patient-reported outcomes.

BACKGROUND: High energy open tibial fractures are complex injuries with no consensus on the optimal method of fixation. Treatment outcomes are often reported with union and re-operation rates, often without specific definitions being provided.  We sought to describe union, reoperation rates, and patient reported outcomes, using the validated EQ-VAS and Disability Rating Index (DRI) scores, following stabilisation with a Taylor Spatial Frame (TSF) and a combined orthoplastic approach for the management of soft tissues. A literature review is also provided. METHOD: A prospective cross-sectional follow up of open tibial fractures, treated at a level 1 major trauma centre, managed with a TSF using a one ring per segment technique between January 2014 and December 2019 were identified. Demographic, injury and operative data were recorded, along with Patient Reported Outcome Measures (PROM) scores, specifically the EQ-VAS and Disability Rating Index (DRI). Union rates, defined by radiographic union scale in tibia (RUST) scores, and re-operation rates were recorded. Appropriate statistical analyses were performed, with a p<0.05 considered statistically significant. RESULTS: Overall, 51 patients were included. Mean age was 51.2 ± 17.4 years, with a 4:1 male preponderance. Diaphyseal and distal fractures accounted for 76% of cases. Mean time in frame was 206.7 ± 149.4 days. Union was defined and was achieved in 41/51 (80.4%) patients. Deep infection occurred in 6/51 (11.8%) patients. Amputation was performed in 1 case (1.9%). Overall re-operation rate was 33%. Time to union were significantly longer if re-operation was required for any reason (uncomplicated 204±189 vs complicated 304±155 days; p = 0.0017) . EQ-VAS and DRI scores significantly deteriorated at 1 year follow-up (EQVAS 87.5 ± 11.7 vs 66.5 ± 20.4;p<0.0001 and DRI 11.9 ± 17.8 vs 39.3 ± 23.3;p<0.0001). At 1 year post op, 23/51(45.1%) required a walking aid, and 17/29 (58.6%) of those working pre-injury had returned to work. CONCLUSION: Open tibial fracture have significant morbidity and long recovery periods as determined by EQVAS and DRI outcome measures.  We report the largest series of open tibial feature treated primarily with a TSF construct, which has similar outcomes to other techniques, and should therefore be considered as a useful technique for managing these injuries.

Knowledge, attitude and practice of female genital cutting among antenatal patients in Aminu Kano Teaching Hospital, Kano.

BACKGROUND: Despite the widespread practice of FGC, not much attention had been given to it until recently. The attitude of expectant mothers towards it is crucial in sustaining it. OBJECTIVE: To assess knowledge, attitude and practice of female genital cutting among antenatal patients in Aminu Kano Teaching hospital in northern Nigeria METHODS: A cross-sectional study was conducted on 210 antenatal patients seen at Aminu Kano Teaching Hospital from February to March 2003. A structured interviewer-administered questionnaire was used to collect information about socio-demographic characteristics, knowledge, attitude and practice of female genital cutting. RESULTS: Majority (91.4%) of the respondents have heard about FGC. Clitoridectomy and infibulation were known by 36.2% and 5.2% of the respondents respectively. Sixty and 5.2% of respondents knew that HIV/AIDS and Hepatitis could be transmitted by methods used in FGC. Other complications mentioned include sexual dissatisfaction (25.7%) and difficult delivery (8.6%). Furthermore, 16% of respondents wished FGC would continue mainly due to cultural or religious reasons, this opinion was associated with low (20.5%) level of education. Opponents of FGC gave medical complications as their main reason. Prevalence of circumcision was 23.3% and the most common type (36.7%) was clitoridectomy. CONCLUSION: Though awareness about FGC has improved, and attitude towards it appears generally negative, the practice still persists in the north, though at a lower level than the Southeast and Southwest. It was therefore recommended that intensive campaign and health education among mothers and the general public, as well as enforcement of legislation are needed.

Ruptured tubal gestation: an unusual presentation of Schistosoma haematobium infection of the fallopian tube.

An unusual mode of presentation of schistosomiasis in the form of a ruptured tubal pregnancy in a previously asymptomatic 23-year-old woman is described. Histological examination of the salpingectomy specimens demonstrated Schistosoma haematobium ova.