National Orthopaedic Hospital Enugu Research Articles

Microbial population of wound isolates and socio demographic characteristics in patients attending clinic in national orthopaedic Hospital, Enugu, Nigeria

Background: The microbial population of wound isolates remains a public health concern because of its role in spread of infections. The microorganisms present in wound swab of patients have been reviewed in order to ascertain the presence of emerging and re -emerging pathogens in hospital environment. These microorganisms are generated from nosocomial and opportunistic origin as well as immune compromised individuals. The purpose of this study is to determine the occurrence of microorganisms in wounds of patient’s attending clinic in National Orthopedic Hospital Enugu, Nigeria. Methodology: A cross sectional study of 230 wound patients was selected using convenient sampling technique. Conventional methods and 16SrRNA sequencing was used for characterization of some organisms that could not be identified in the conventional methods. Questionnaire structured from literature review was also deployed for demographic studies obtained from consented participants. Results The frequency distribution of wound isolates showed an increase in Pseudomonas aeruginosa 7(10%) and Klebsiella pneumonia 6(8.6%) respectively. Mixed growths had a notable increase of 42(18.3%),while culture with no bacteria growth had 37(16.1%). Staphylococcus aureus was prevalent with 32(13.9%), Staphylococcus epidermis 15(6.5%) and the least isolates had 1(1.4%), Male gender had the highest wound isolates of one hundred and fourty one (141) with meanSD 21.11 and median of 19.00 while the female had 88 with meanSD 20.3113.457, median of 16.50. The socio demographic data findings for participant’s age were higher in the range of 21-40yrs (94) and 41-60yr (74) while the least was >80 years (5). The mean age of the 230 participantswas 43.15±17.284yrs.Wound type had a notable increase in accident cases (63)27.4%, surgical cases (44)19.1% and lowest was laceration cases (2) 0.9%, The most prevalent population of wound cases according to occupational status was observed in artisans (148) 64.3%, students (33)14.3%, civil servants (29)12.6%, least population was the retired (20)8.7%. The portion of wound site was highest in the leg region (174), trunk (22) and the hand (12). Conclusion: it is advocated that proper measures such as adequate sanitation, personal hygiene, sterilization of hospital equipment and environment should be beefed up to prevent the spread of these microbes to the public.

Does the Proximal Femur Geometry Predict Early Functional Outcome after Plate Fixation of Geriatric Pertrochanteric Fractures?

The proximal femur geometry determines the hip force distribution. The femoral neck axis length (FNAL), the hip axis length (HAL), the femoral head diameter, and the femoral neck-shaft angle (FNSA) could influence the risk and outcome of pertrochanteric fractures. Restoring these parameters to their prefracture values could predict early hip function. To determine if the postoperative proximal femur geometry of geriatric patients with plating for pertrochanteric fractures predicts the early functional outcome. The study was a prospective study carried out at the National Orthopaedic Hospital Enugu for 18 months. Geriatric patients who had Proximal Femoral Locking fixation for pertrochanteric fractures were recruited. Radiological parameters of the proximal femur in the unaffected and fixed hips were measured and compared. The functional outcomes of the patients were measured at 3 months postoperative period using the Harris hip score (HHS). Multiple linear regression was conducted on the parameters to determine the HHS. Thirty patients participated in the study, with a significant difference (P < 0.001) in the mean FNSA between unaffected (M = 128.69, standard deviation (SD) =2.93) and operated hips (M = 121.81, SD = 8.86). The FNSA was the only significant predictor of hip function, with a 1-degree increase improving the HHS by 1.30. There is a significant difference in the FNSA between the unaffected and the operated hips. The FNSA significantly predicts the early hip function and should be reconstructed to within normal range during surgery.

Relationship of the severity of talipes equinovarus and age of presentation to time of correction: A focus on Dimeglio scoring

Objectives: The Ponseti method is the mainstay of treatment of congenital talipes equinovarus deformity. This study aims to assess the relationship between the severity of the clubfoot deformity and the time it takes to correct the deformity using Dimeglio scoring system (DSS) with Ponseti protocol. Material and Methods: A prospective observational study carried out for 15 months at the outpatient department of the National Orthopedic Hospital Enugu. Data collected included age at presentation, sex, laterality, grade of deformity, number of casts, and time to correction before the commencement of bracing. Those selected were clinically assessed using the DSS. Data obtained were analyzed using SPSS version 22.0. The association between time, the number of casts to correction, age of presentation, and severity to the time of correction of deformity was also determined. Results: A total of 70 patients (116 feet) were recruited for the study. The mean age at presentation was 21 weeks with a male-to-female ratio of 3:2. The mean DSS at presentation was 10.72. The mean number of casts required to achieve correction was 5, with the last cast left in place for 3 weeks, which gave a mean correction time of 7 weeks. Severe deformity required more cast for correction. There is a weak relationship between age and time to correction. Conclusion: Increase in the severity of the clubfeet was associated with longer correction time and a weak correlation with age at presentation. Dimeglio scoring is an effective, grading, and monitoring system.

Identification and Antibiotic Resistance Profile of Biofilm-forming Methicillin Resistant Staphylococcus aureus (MRSA) Causing Infection among Orthopedic Wound Patients

Background and Objectives: The biofilm-forming ability of Methicillin-Resistant Staphylococcus aureus(MRSA) strains have demonstrated the involvement of MRSA biofilm in antibiotic resistance, recalcitrant and persistent infections in humans. Despite a deeper understanding of the biofilm-forming ability of MRSAstrain, it is still essential to extend the research on the identification and antibiotic resistance profile of biofilm-forming MRSA causing infection among orthopedic wound patients.&#x0D; Methodology: A total of three hundred and thirty (303) patient-isolate of non-repeatable Staphylococcus aureus strains were obtained during the period of 2021 until 2022 from fracture and post-surgical orthopedic wound patients with wound duration &gt;2months at the National Orthopedic Hospital, Enugu (NOHE). S. aureus were identified using conventional microbiological cultures Technique followed by confirmation of MRSA strain through Brilliance MRSA 2 Agar. Antibiotic Susceptibility testing (AST) of biofilm-forming MRSA was performed using the Kirby–Bauer disk diffusion method and the results were interpreted using the Clinical Laboratory Standard Institute (CLSI) zone diameter breakpoints. Multidrug Resistance (MDR) was determined for biofilm-forming MRSA.&#x0D; Result:Of the 303 isolate of S. aureus, MRSA strain accounted 86(28.4 %) and 78(25.7 %) from post-surgical wound and fracture wound respectively while biofilm forming MRSA was identified in 101(33.4%) MRSA strain consisting of high proportion 66(21.8 %) fromPost-surgical wound followed by fracture wound samples recording 35(11.6 %). Association between MRSA production and biofilm formation was considered statistically significant at P&lt; .05. The proportion of biofilm-forming MRSA resistance to β-lactam accounted 71.4-100%, macrolide resistance recorded 65.7-92.4 %, lincosamideresistance 74.3-100 %, glycopeptide resistance proportion ranged from 62.8-100 % while low level of resistance to fluoroquinolones 19.7-42.9 % and Aminoglycoside 8.6-10.6 % was observed. Biofilm-forming MRSA isolate were MDR to one or more antibiotic antimicrobial agents in at least three categories withMDRIndex range ≥ 0.3 but majority of the isolate were 91.4% and 100% susceptible to Gentamicin and Imipenem.&#x0D; Conclusion: The invitro expression of biofilm formation among MRSA strain and their antibiotic resistance profile in this study makes them a potential threat and challenging pathogens with the ability to cause persistent infections in humans, especially among orthopedic wound patients. Thus the development of an antimicrobial stewardship program and regular detection of biofilm production is needed for timely intervention while judicious use of Imipenem and Gentamicin as a drug of choice for effective treatment of infection caused by biofilm-forming MRSA among orthopedic patients will avert the severity of infection. Further research of these sort should investigate the genotyping expression of a biofilm gene variant in other human diseases, different bacteria species, and orthopedic medical implant devices.

Knowledge, attitude and acceptance of amputation among amputee patients admitted in National Orthopaedic Hospital Enugu - Nigeria

Background: Amputation is perceived differently across the globe hence the study was designed to determine the knowledge, attitude and acceptance of amputation among Amputee patients in the National Orthopeadic Hospital Enugu. Objectives: The objectives were to elicit the level of knowledge of amputation, determine the attitude of respondents towards amputation and determine level of acceptance of amputation. Materials and Methods: A descriptive cross sectional design was used and data was collected using questionnaire. The entire population (106) amputees were studied. Data was analyzed using (SPSS) version 24.0 and results presented in tables. Results: Findings revealed the mean age of the respondents 35+2.25years. All the respondents (100%) were aware that amputation is a treatment option to save live. The major factors that affects acceptance of amputation were preparation for the procedure (mean 3.26+ 2.37), fear of deformity (mean 3.15+ 2.68), and cost of prosthetics (mean 3.11+ 2.56), affordability of prosthetics (mean 3.57+ 3.07) availability of prosthetic device (mean 3.57+ 3.07) and public acceptance of amputees (mean 3.21+ 2.62).

The etiology and pattern distribution of closed long bone diaphyseal fractures: A prospective survey in a regional trauma center Enugu, Nigeria

Extremity injuries have attained a significant position in musculoskeletal trauma. This study aims to describe the pattern of closed long bone diaphyseal fractures in acute trauma setting. A prospective study of patients who presented at the trauma unit of National Orthopaedic Hospital Enugu over a 6months period was undertaken. Sixty two patients with closed long bone diaphyseal fractures of femur, tibia and humerus who consented and met the study inclusion criteria were prospectively included and evaluated. Data was analyzed using the Statistical Package for the Social Sciences version 20. A total of 2880 patients presented during the period of study out of which, 62 (37 males and 25 females) presented with closed long bone diaphyseal fractures giving an incidence of 21.5/1000 trauma unit attendance (and occurring mostly in males 32.1/1000). The 21-30years age group distribution were the mostly affected (35.5%) with closed long bone diaphyseal fracture at presentation. Motor vehicular accident was the leading cause of closed long bone diaphyseal fractures (66.7%) followed by tricycle accident (19.4%) and assault (1.9%), the least. Transverse fractures (40.3%) were the most common fracture pattern followed by the comminuted fracture (27.4%), The anatomic location of fractures in diaphyseal long bones of the humerus, femur and tibia did not show any significant difference (p&lt;0.05). With transverse and comminuted fracture being the commonest fracture patterns distribution and motor vehicular accidents the leading cause, these could be of a guide for orthopaedic surgeons to decide on the best interventional approach and to improve functional outcome.

Profile of Geriatric Trauma in a Developing Country

Geriatric trauma patients require special consideration. They frequently have comorbidities and reduced physiologic reserves, influencing treatment decisions and outcomes. Hence, a comprehensive approach is fundamental to ensure better results. The authors retrospectively evaluated the profile of 332 cases of geriatric trauma over ten years (January 2010-December 2019) at National Orthopaedic Hospital Enugu, in South-East Nigeria. The mean age of patients was 74.78 years (SD = 8.69), with females presenting at a later age than men (76.05 vs 73.69 years), p = 0.013. The commonest mechanism of injury was ground-level fall (47.59%), with proximal femoral fractures being the most common (41.27%). Only 47% of geriatric patients presented to a hospital within 24 hours following injury, and the mean duration of admission was 28 days. Approximately 77% of patients had operative care, and 68.67% expressed satisfaction with the outcome of their management. The mortality rate was 2.11%. In conclusion, most geriatric fractures require surgical intervention and education to facilitate early hospital presentation is needed.

Orthopedic Day-case Surgery in Nigeria: A Single-center Experience

Background: The concept of day-case surgeries is relevant in orthopedic specialty in developing countries, where orthopedic elective procedures have relatively longer duration of surgical waiting time, mainly due to lack of inpatient bed space. We aimed to determine the scope, safety and outcome of orthopedic day-case surgeries in a Nigerian setting, and identify potential areas for intervention to improve the practice.&#x0D; Methods: This was a 12-month prospective study of 71 eligible, consenting and consecutive patients who presented at the National Orthopedic Hospital Enugu and were carefully selected and prepared for orthopedic day-case surgeries.&#x0D; Results: Within the period of study, 53 of 540 elective orthopedic procedures were carried out as daycase, giving a day-case surgery rate of 9.8%. Of the patients enrolled, male to female ratio was 1.2:1 and age range was 8 months to 76 years. Eighteen (25.4%) patients had their day-case procedure cancelled on the day of surgery. The commonest procedure was removal of implant. Conversion rate was 32% mainly due to operation occurring late. Complication (mainly pain) rate was 30%, and correlated with duration of procedure (p&lt;0.006). The satisfaction rate among patients was 98%; no re-admission or mortality was observed.&#x0D; Conclusion: In this study, orthopedic day-case procedures were safe, though there was low use of daycase surgery in scope, complexity and number of procedures. This and the high conversion rate observed call for a dedicated day-case unit and measures to facilitate timelines of the procedures.&#x0D; Keywords: Orthopedics, Day-case surgery

Analysis of machete cut fractures in Nigerian civilian trauma setting

Machete cut fracture is an important component of morbidity associated with machete injuries although it is under reported. This was a retrospective study to assess machete cut fractures in patients seen in Federal Teaching Hospital Abakaliki and National Orthopaedic Hospital Enugu from 2009 to 2018. There were 91 patients with 154 fractures, male- to- female ratio was 10:1 and mean age was 31.6 ± 14.6 years. The aetiological factors were assault (57, 62.6%), armed robbery (29, 31.9%) and accidental injury (5, 5.5%). The three top bones involved were ulna, metacarpal and finger-phalanx. Fracture was communited in (17, 11.0%), and Gustilo Anderson grade IIIC in (22, 14.3%). Injury to hospital arrival interval later than 6 h was common and correlated with prolonged length of hospital stay (p < 0.001). Anaemia, wound infection and hemorrhagic shock were the three top complications. Nine (5.8%) fractures ended in extremity amputation. Eleven (12.1%) patients left against medical advice, and 5 (5.5%) were transferred. Normal union in 98.3% of the fractures treated and followed up for a minimum of one year. Case fatality rate was 2.2%; none of the patient that died had pre hospital care, and hemorrhagic shock accounted for all the mortality. These call for appropriate injury preventive mechanisms, and improved rates of early presentation of patients to hospital, and pre hospital care.

Patterns of antimicrobial use in a specialized surgical hospital in Southeast Nigeria: Need for a standardized protocol of antimicrobial use in the tropics

Background: Antimicrobial resistance remains a growing global health menace. One of the key actions to curb this menace by the World Health Organization is antimicrobial stewardship (AMS). A prescription protocol is one of the cost‑effective AMS interventions in surgery. This study determines the patterns of antimicrobial usage in a hospital specialized in orthopedic and plastic surgeries care in Nigeria. Methods: A cross-sectional survey was carried out at National Orthopaedic Hospital Enugu, a tertiary hospital specialized in orthopedic and plastic surgeries in Southeast Nigeria in May 2019. All the inpatients were included in the study. A standardized tool for point prevalence survey was used to collect data. Data were analyzed using Epi Info version 7.2.4. Results: A total of 127 inpatients participated in the survey with 387 antimicrobial encounters. The most common reasons for antimicrobial use were for the treatment of community-acquired infections (65.0%) and prophylaxis (29.4%). The decision for their use was made majorly on an empirical basis (92.4%). The reasons for antimicrobial prescriptions were documented in the majority (97.5%) of the cases and stop review dates in all (100%) of the prescriptions. Ceftriaxone (25.7%), tinidazole (21.9%), and metronidazole (14.6%) were the commonest antimicrobials prescribed among the patients. Conclusion: Orthopedic and plastic surgery practices require tailored prophylactic antibiotic regimens in the tropics due to peculiarities of both the specialties and the subregion. The claim that existing protocols in the temperate regions may apply in the tropics has been questioned due to the microbial profile on the tropics. Keywords: Antimicrobial protocol in surgery, antimicrobial resistance, antimicrobial stewardship, prophylactic antibiotics

Comparative prospective study of early outcomes after osteosynthesis with locked intramedullary nailing or plating for closed femoral shaft fractures at the National Orthopaedic Hospital Enugu, Nigeria.

This was to compare the early outcome of closed femoral shaft fractures treated with locked intramedullary nailing and plating atthe National Orthopaedic Hospital Enugu. The study was a prospective study over 12-month period atthe National Orthopaedic Hospital Enugu. Ethical clearance was obtained from the hospital ethical committee. Written informed consent was obtained from all prospectively recruited participants. Patients who met the inclusion criteria were randomly selected by simple balloting into either intramedullary nailing group or plating group. The patients were evaluated at presentation and postoperatively within 48hours, then at twoweeks, sixweeks, 12weeks and 18weeks, respectively. Participants were evaluated using Thoresen criteria. A total of 52 femoral shaft fractures in 50 patients were included and analysed using SPSS version 20.0. Bone union was obtained in all the patients in the intramedullary nailing group at 12weeks and in 84.6% patients in the plating group between 12 and 18weeks. The overall wound infection rate was 11.5% in the locked intramedullary group and 7.7% in the plating group. Similarly, the overall limb length discrepancy was 11.5% in the locked intramedullary nailing group and 19.2% in the plating group. Based on the Thoresen criteria, good to excellent outcome was achieved in 65.4% of patients in the locked intramedullary nailing group. The patients in both groups were evaluated clinically, radiologically and functionally based on the Thoresen criteria and significantly higher number of patients in the intramedullary nailing group (17; 65.4%) than the plating group had good to excellent outcome (x2= 9.734; p= 0.020). The early outcome of treatment of closed femoral shaft fractures in adults is significantly better following locked intramedullary nailing than plating.

Pattern of malocclusion and caries experience in unrepaired cleft lip and palate patients in Enugu.

Clefts are common birth defects, usually accompanied by various malformations that include malocclusions, and may be associated with tooth decay. The aim of this study was to assess the malocclusion and caries status of the patients with unrepaired clefts who presented at the National Orthopaedic Hospital Enugu. A cross-sectional, descriptive study was conducted among patients with unrepaired cleft lip and/or palate that presented at the National Orthopaedic Hospital, Enugu between January 2009 and December 2011. Detailed records of 140 patients with cleft deformities who presented to the hospital within the study period were analyzed for the cleft pattern, whereas those patients above 6 years of age (52 patients) were analyzed for malocclusion using the Angle's classification of malocclusion. Assessment for dental caries according to WHO guidelines was made for all the patients. There were 74 males and 66 females. Cleft lip with or without alveolus involvement had equal prevalence (47.1%) (66 patients) with combined cleft lip and palate; eight patients had isolated cleft palate (4.71%). Angle's class 1 malocclusion was statistically significantly higher than other classes (P = 0.000). Class I malocclusion was seen in 38 patients (73.1%), whereas class 111 was seen in 8 patients (15.4%) and class 11 in 6 patients (11.5%). Eight patients (100%) who developed class 111 malocclusion all had a hard palatal defect. Proclining of maxillary anterior teeth (increased overjet) was the most common orthodontic anomalies, reported in 25 patients (48.1%) (P = 0.002). Caries prevalence of 12.9% was observed in this study. Caries experience was statistically significantly higher in deciduous than permanent teeth (P = 0.002). The high prevalence of malocclusion in these cleft patients emphasizes the need for an interdisciplinary team approach and early inclusion of dental care especially oral hygiene to prevent tooth decays.

Job satisfaction among health professionals in a federal tertiary hospital in Nigeria.

Job satisfaction of health workers is essential in building up employee motivation and efficiency. The objective of this study is to ascertain the level of job satisfaction among health professionals in a federal tertiary health institution in Nigeria. This study was done at the National Orthopedic Hospital, Enugu (NOHE), in south-east Nigeria. Two hundred and thirty-six health workers were recruited from the various clinical departments via a systematic sampling technique. A questionnaire documenting relevant sociodemographic data and assessing the level of satisfaction with the financial remunerations, working conditions, infrastructure and equipment, learning and academic sponsorships, welfare packages, and performance appraisal systems was administered to them. The findings revealed a relatively low level of job satisfaction among the staff of NOHE especially with regards to financial remuneration, working conditions, tools and infrastructure, learning and training opportunities/sponsorship, leadership style, and welfare packages with increasing dissatisfaction in that order. However, the average staff is satisfied with the performance appraisal system as regards promotion. The majority of the clinical staff have a low level of job satisfaction. A review of the salary structure of health professionals as well as improving the working conditions, tools, and infrastructures in the hospital is needed.

Epidemiology of lumbar disc herniations in adults with low back pain in Enugu, Nigeria

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Lumbar intervertebral disc herniation is used to describe a spectrum of anatomical abnormalities involving disc extension beyond the interspace. It follows a tear in the annulus fibrosus of the intervertebral disc. It is one of the most common causes of low back pain among adults. The study aims to assess the epidemiological pattern of lumbar disc herniations among adults with low back pain in Enugu urban.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study was a prospective study at National Orthopedic Hospital Enugu and Annunciation Specialist Hospital Enugu. Following ethical approval and written informed consent, patients who met the inclusion criteria were consecutively recruited. The MRI scans of the participants were viewed using DICOM® (Digital Imaging and Communications in Medicine) software on laptop computer. The data included the patients’ demographics, functional disability index for back pain, weight, height, the anatomical level(s) and site(s) of the herniated disc among other parameters.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 81 subjects who met the inclusion criteria were included and analyzed using SPSS version 20.0. The mean age of the subjects is 52.99±13.13 years. The most common affected age group is 51-60 years (27.2%). Majority of the subjects (68; 84%) had multiple level herniations which usually includes L4 level(74; 91.4%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; That multilevel lumbar disc herniation is far more common than single level herniation with a prevalence of 84% among adults with low back pain in Enugu urban. That, there is statistically significant association of lumbar disc herniation and increasing age.&lt;/p&gt;

Assessment of complications following use of pneumatic tourniquet for elective orthopedic procedures at National Orthopedic Hospital, Enugu

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; A pneumatic tourniquet is a constricting or compressing device with an inflatable cuff used to control venous or arterial circulation to an extremity for a period of time. Tourniquet safety is related to the cuff pressure and duration of application. The objective of this study was to determine the common complications that follow the use of pneumatic tourniquet in elective orthopaedic surgical procedures at National Orthopaedic Hospital Enugu.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a prospective study over 18 month period (June 2014 – November 2015) at National Orthopaedic Hospital, Enugu. Following ethical approval and written informed consent, patients who met the inclusion criteria were consecutively recruited. The study was conducted using the ‘intelligent pneumatic tourniquet’&lt;strong&gt;&lt;em&gt; &lt;/em&gt;&lt;/strong&gt;with single bladder reusable cylindrical cuff. The cuff pressure was determined in each case by addition of 100mmHg to the baseline systolic BP for the upper limbs and 150 mmHg to the baseline systolic BP for the lower limbs. The data collected included patients’ demographics, cuff pressure, cuff location, tourniquet duration and complication encountered among other parameters.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 160 procedures in 152 patients were included and analyzed using SPSS version 20.0. The prevalence rate of 1.9% for nerve palsy, 1.3% for tourniquet pain, 1.9% for surgical site infection and 5.6% for pressure sore were found in the study. No other complication was encountered.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; From the results of this study, it is concluded that the use of pneumatic tourniquet under the prescribed conditions is associated with low prevalence of complications.&lt;/p&gt;

Pattern of presentation and indications for amputation in national orthopaedic hospital, Enugu

Background: Globally, an increase in the rate of amputation is noted and it could be attributed to the sudden surge in the incidence of non-communicable diseases especially diabetes and peripheral vascular disease which is a complication of hypertension. There has been some variation in the pattern of presentation in different climes and locality depending on the availability of expertise and the infrastructures available for limb salvage procedures.Objective: To determine the indications, demographic pattern and clinical presentation of patients that had amputation in National Orthopaedic Hospital Enugu (NOHE).Methodology: All patients who had amputation in NOHE from 1 of September 2015 to 31 of August 2017 were recruited prospectively. The indications for amputation, demographic data and pattern of presentation of the patients were analysed with SPSS version 20.Results: A total of 137 patients were recruited concurrently. Male to female ratio was 1.6:1. Dual peak age range of 61-70 years (22.6%) and 21-30years (20.4%) were observed. There was relative preponderance of traders (27.7%) with secondary school education (39.4%) and left lower limb was mostly involved 52.6%. Commonest mode of presentation is darkish discolouration of the foot (45.9%), with duration of symptoms most commonly between 1 - 6 months (40.9%) and 39.4% had no prior treatment before presentation. Diabetes foot gangrene (in 39%) followed by trauma (24.1%) were the leading cause of amputation from our study and above knee amputation was more commonly done (44%).Conclusion: There is dual peaks in age groups with male preponderance in the amputations done. It commonly involved left lower limb in traders with secondary education and the commonest indication being Diabetic Foot Gangrene. Public enlightenment on diabetes is important to reduce the incidence of amputation.Keywords: Amputation, indication, Pattern, Diabetes

Early cleft lip and palate repair: Experience of the National Orthopedic Hospital Enugu, Southeast Nigeria

Background: Surgical treatment of clefts during infancy poses a challenge for the plastic surgeon and anesthetists. The timing of the procedures has been fraught with controversies with no consensus. Due to the many different treatment philosophies, the timing of treatment varies among cleft centers. Historically, anesthetic risk-related data suggest that the safe time period for surgery in this population of infants could be outlined by the rule of 10's. However, more sophisticated pediatric techniques and advances in intraoperative monitoring and pediatric anesthesia have resulted in the provision of safe general anesthesia for younger infants. This article attempts to provide an audit of the outcome and complications of cleft lip/palate repair performed earlier than the hitherto defined period. Aims/Objectives: The aims of the study were to evaluate the perioperative safety profile of early cleft lip and palate repairs and to evaluate early postoperative surgical complications. Materials and Methods: A retrospective audit of all patients that had early cleft lip and palate repair at the National Orthopedic Hospital Enugu, Nigeria, between May 2006 and May 2014. Early cleft lip and palate repairs were defined as repair done before 10 weeks and 9 months, respectively. Information was obtained from the folders of the patients and the smile train express database. The anesthetic technique was general anesthesia with endotracheal intubation and halothane as the inhalational agent. Armored tubes were used for palatal repairs. The Mohler's technique and Mulliken's technique were used for unilateral and bilateral lip repair, respectively. Intravelar veloplasty ± relaxing incisions/Bardach two-flap palatoplasty were used for palate repairs. All the procedures were carried out by one consultant plastic surgeon. Results: Four hundred and ninety-three cleft-related surgeries were performed in the period. Forty-one were early cleft lip/palate repairs. Thirty-one of these early procedures were done on the lip, whereas ten procedures were on the palate. There were no mortalities. One patient (2.4%) developed anesthetic complication (prolonged recovery time). There was neither need for intra- nor postoperative transfusion. One patient had a need for supplemental oxygen therapy beyond 1 h. There was no need to take any patient back to theater. The most common early complications following lip and palate repairs were wound dehiscence and palatal fistulae, respectively. Conclusion/Recommendation: These procedures can be safely carried out when performed early. The surgical complication rates appear to be few following early procedures. Further study on long-term cleft repair on facial growth and speech needed.

Ponseti clubfoot management method: Initial experience with 273 clubfeet treated in a clubfoot clinic of a Nigerian regional orthopedic hospital.

The aim of this study was to evaluate the initial experience and outcome of clubfoot treated using the Ponseti technique in a regional orthopedic hospital setting of a developing country. This was a retrospective review of all the clubfoot patients who were treated at the clubfoot clinic of National Orthopaedic Hospital Enugu from 1st of August 2013 to 31st January 2015. There were 175 patients with 273 clubfeet. The male to female ratio was 1.2:1, and the age range was 1 week to 27 years with a median age of 11 months. One hundred and fifty-one patients (86.5%) had congenital clubfoot, whereas 24 (13.5%) had acquired clubfoot. The mean Pirani score of the patients at presentation was 4. The mean number of cast sessions needed for correction was 6.3. The majority of the feet (96.6%) were treated and correction achieved with Ponseti method alone, whereas 3.4% had other additional surgical procedures. Seventy-two (41.1%) patients afforded and used foot abduction brace as prescribed. Plaster sores in 12.5% of patients were the most common complication. At a mean follow-up period of 6 months, a relapse rate of 3.4% was observed. Ponseti clubfoot management technique alone is very effective in most cases of clubfoot in our setting. Late presentation of patients and foot abduction brace related challenges observed call for a policy response aimed at educating the public on the importance of early presentation and improving the use of foot abduction brace.

Incomplete Spinal Cord Injury in Enugu, Nigeria: Epidemeology and Outcome

Background: Spinal cord injury represents one of the most physically and psychologically devastating trauma. Before modern medicine, it was considered an ailment not to be treated. In incomplete spinal cord injury (SCI), there is residual sensory and/or motor function. Method: This was to determine the epidemiology, treatment options and outcome of incomplete SCI at National Orthopedic Hospital Enugu, Nigeria, over a 5 year period. This was a descriptive retrospective study of patients managed for incomplete spinal cord injury between January 2011 and December 2015. This was to determine the epidemiology, various treatment options and their outcome in patients with incomplete SCI managed in our center. The patients’ biodata, mechanism of injury, time of presentation, pattern of injury, level of injury, type of treatment, associated injuries, complications, duration of treatment and American Spinal Injury Association (ASIA) assessment at presentation and at discharge were collected. Data analysis was done using statistical package for social sciences (SPSS) version 20.0. All tests were regarded as significant at P-values < 0.05. Results: A total of 57 patients (49 males and 8 females) were included and analyzed showing a male to female ratio of 6.3:1. Incomplete traumatic SCI forms about 44.2% of all traumatic SCI in Enugu. This represents 0.09% of all patients and 0.9% of all trauma patients seen. The cervical spine (59.6%) is the most commonly affected isolated anatomic region. Road traffic accident (52.6%) was the most common aeteology. Compression fracture was the commonest injury (33.3%). Majority of the patients (57.9%) had ASIA C at presentation while 47.4% and 33.3% of the patients had ASIA D and E respectively at discharge. Most of the patients (91.2%) had conservative treatments. Conclusion: The significant ASIA grade improvement of majority of the patients suggests good functional outcome of incomplete SCI treated conservatively at our hospital.

Estimating road traffic accidents and injuries in Enugu Nigeria

Background: Road traffic injuries are a growing public health and development problem1. In this paper, we examined the trend and impact of road traffic injuries using evidence from our hospital records. This evidence shows how serious the problem of road traffic injuries is at present and indicates that it will become worse if no appropriate action is taken.Methods: Case notes of patients with Road Traffic Accident (RTA) admitted at National Orthopaedic Hospital Enugu, (NOHE) which is a regional Trauma Centre in Nigeria between Jan 1 2011 and January 1 2015 were retrieved and analyzed.Result: There were a total of One Thousand Nine Hundred and Six (1906) victims with a total of One Thousand Six Hundred and Seventy Seven (1677) admissions. There were One Thousand Four Hundred and Nine (1409) males and Four Hundred and Ninety Seven (497) females with a male: female ratio of 2.8:2. One Thousand Six Hundred and Eighty Six (1686) victim's accident occurred within the city while two Hundred and Twenty (220) victims had their accident intercity. 9 An analysis of the occupation of the victims showed students to be the most vulnerable group with motorcycle as the victims' mode of transport. Most of these accidents occurred in months of May and June with a second peak occurring within March and April and these periods correspond with the period of students' end of session exams and Easter festivities. Most of our patients had no pre-Hospital treatment before arriving as a result of our inadequate health system and victims were rescued by passers-by using commercial vehicles as a mode of transport.Conclusion: We therefore recommend the following: development of infrastructure in academic institutions in this country to reduce the incidence of students travelling from various areas of abode in busy city centers to places of lectures, consideration of regulation such as speed limit, protective gear, road signs, training and retraining of Federal road safety corps members as first respondersKeywords: Developing Country, Magnitude, Mitigation ,Road Traffic Injuries, Public Health