|Year : 2011 | Volume
| Issue : 1 | Page : 44-54
6th ASON Conference, Enugu, April, 2010
|Date of Web Publication||21-Jul-2012|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. 6th ASON Conference, Enugu, April, 2010. Niger J Surg 2011;17:44-54
New Frontier in Surgical Training: Total Joint Replacement; National Orthopedic Hospital, Enugu experience.
CU Nwadinigwe, CB Eze, AU Katchy, EC Iyidiobi, UE Anyaehie, EC Onyegbule
National Orthopaedic Hospital, Enugu
Background: Since 1960's after the work of Charnley and Gunston on the hips and knees respectively, a lot of advances had been seen in this field of orthopadics. In fact total joint replacement is regarded as the most successful orthopedic operation overseas.
In sub-Saharan Africa, this is still an emerging field. In Nigeria, National Orthopedic Hospital Enugu has taken a leading role in establishing this sub specialty.
The objective of this paper is to present our experiences and challenges in establishing this field.
Method: A review of forty three consecutive total joint replacement done in this hospital from 2008 till is presented. Their demographic data, joints affected, etiology, co-morbidities, anesthesia, post-op treatments, complications, and follow-up was analyzed.]
Result: Forty one patients had total joint arthroplasty in 43 joints. 34(79%) were hip while 21% (9) were knees. 51% (21) were males and 49% (20) were females. Age range was 25-78, average52yrs. Intractable joint pain was the commonest indication. Those who presented within 1 year were usually trauma related and usually younger. 60% were discharged within the 3 rd week, the rest in the 4 th week. Usually on crutch partial weight bearing.
The follow- up is progressing with the patients at various post-op phases ranging from 4 wks- 18months. Most patients were happy and satisfied with their progress.
However a patient was noticed to have dislocated implant 2 months post-op while in 5 others the pedal edema is regressing.
Conclusion: Total hip and knee arthroplasties are becoming routine procedures in this hospital. Most of our patients are younger. The results so far are comparable with what is obtainable abroad and should reduce need for traveling abroad to get this treatment.
Facial Injuries from Human Assault in Nnewi
TOG Chukwuanukwu, PS Nkwerem, EO Nwibo, P Onyeachunam
Department of Plastic Surgery Nnamdi Azikiwe University Teaching Hospital Nnewi
Aim: This is to observe the pattern of presentation of facial injuries that result from human assault in our centre and make some far reaching recommendation.
Method: It is a retrospective study. Folders of patient who had facial injuries that are attributable to human assault were retrieved .Patients' data -age ,sex, were noted, mechanism of injuries, treatment given were noted.
Results: Atotal of 13 patients were treated within the period. F: m 7:6. 61% of patients were between 25 and 30 years.9 Cases were human bite while the rest were stab injuries.53% of injuries were on the ear while 38%wereonlip.
Discussion: No other part of the body is as conspicuous, unique and cosmetically significant as the face. Facial injuries could result from wide range of causes- road traffic accident, domestic violence fall from height, gunshot injuries fight and so on.
In domestic violence and fight the face is usually a target. In developed countries facial injuries are now used as an index of domestic violence. In the study most people were within the age group 25 and 30years because that is the most active age group. They are most likely to indulge in fight. Lip and ear accounted for 88% of cases in this study because they are the most prominent parts of the face. Hence assailants usually aim for them.
Conclusion: Human bite is the commonest cause of facial injury from domestic violence.
Impact of Water Mattress on Incidence of Pressure Sore in Spinal Cord Injured Patients
CU Nwadinigwe, EC Iyidobi, UE Anyaehie, EC Onyegbule
National Orthopaedic Hospital Enugu, Enugu State
Background: Trauma is a leading cause of mortality and morbidity worldwide. Traumatic spinal cord injury poses great challenge to the patient and the managing team due to attendant complications. Pressure sore is the most dreaded complication. Treatment of this complication poses huge financial burden on the patient and ties down hospital beds. In 2007, the use of water mattress was introduced in the management of paraplegics and quadriplegics in National Orthopedic Hospital Enugu.
Objective: The objective of this paper is to evaluate the impact of this water bedon the incidence of pressure sores in these patients.
Method : A review of all patients who presented and were managed for complete traumatic spinal cord injury between January 2005- December 2008, was done. This period included two years pre- and post use of water mattress. Information collated from their medical records included demographic data, etiology, time to presentation, levels of injury, complications, treatments, duration of hospitalization and follow-up.
Exclusion criteria included: patients with incomplete data, injuries more than 7 days, patients admitted with pressure sores and incomplete spinal cord injuries. Descriptive analysis was done and the two groups were compared.
Result: A total of 201 patients with traumatic spinal cord injuries were admitted and managed within this period. However 104 patients met the criteria but 99 patients had analyzable results. 47 paraplegics and 42 were quadriplegics.
Age range was 9-76 years, average of 42.5year. All were males. Thirty (30%) presented within 3-7 days, 28% (28) within 24-48hrs. RTA was the commonest etiological factor. The levels of injuries were commonly C5/C6&T12/LI for quadriplegics and paraplegics respectively. There was a dramatic decline in the incidence of pressure sore from 60% in 2005to10%in2008.
Conclusion: Majority of pressure sores are preventable and water mattress is one of the ways as demonstrated by this study.
Features of Acute External Laryngeal Trauma in University of Nigeria Teaching Hospital, Enugu
CO Nwabueze*, BC Ezeanolue**
Departments of Radiology*, Otolaryngology**, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
Aim: Acute laryngeal trauma was a potentially fatal injury and many victims do not survive to reach health care facilities. This study analyzed the clinical features of acute external laryngeal trauma patients managed in UNTH, Enugu over the study period.
Method: We retrospectively reviewed the case notes of the patients who presented with acute laryngeal trauma over a two year period, from March 2008toFebruary 2010.
Results: There were six patients; all were males, with the age range between 21-34 years. Mean age was 29.3years. Penetrating neck trauma was the commonest type of laryngeal trauma (83.3%) and loss of voice was the commonest presentation (66.7%). Trachaeostomy was used to secure the airway in 4of the 6patients. The most problematic sequel was airway obstruction from post traumatic laryngotrachael stenosis,
Discussion: Laryngeal traumas were basically classified as penetrating or blunt injuries. Penetrating wounds were caused by sharp or pointed implements while blunt injuries were caused by blunt blows to the anterior neck as in fists blows, or contact sport. This study ascertained the clinical features of laryngeal trauma we managed in our center. The features were similar to those from other centers
Conclusion: Failed treatment or poorly managed acute laryngeal trauma may lead to chronic laryngotrachael stenosis with its associated challenges in treatment. Early presentation and proactive management were essential to prevent this.
Appendicitis in NAUTH: A Review of Pre-Operative and Intra-Operative Diagnosis
OAEgwuonwu, SNC Anyanwu, E Ihekwoaba, S Enendu
Department of Surgery Nnamdi Azikiwe University Teaching Hospital, Nnewi.
Background: Appendicitis is commonly encountered in clinical practice. However variability in of the presenting symptoms may delay presentation, diagnosis and increase rate of negative appendectomy.
Objective: To review the presentation and preoperative diagnosis and compare the latter with intra-operative diagnosis.
Patients and Methods: Retrospective study of patients managed in Nnamdi Azikiwe University Teaching Hospital as a case of appendicitis or its complication from January2002toDecember 2008.
Results: There were 49 (60.5%) male and 32 (39.5%) females with their ages ranging from 4 - 55 years. Mean age was 24 years. The most common complaint is abdominal pain beginning in the right iliac fossa (RIF) in 51 (63%), umbilical region in 15 (19%), generalized, lower abdomen and epigastric pain in 9, 4 and 1 patients respectively. Migratory RIF pain was seen only in 12 (14.8%), anorexia in 27 (33.3%), rebound tenderness in 48 (59.3), extra sign in 13 (16%). Site of tenderness was RIF in 68 (84.1), generalized in 7 (8.6%), lower abdomen in 4 (4.9%) and umbilical in 1 (1.2%). White blood cell count was not donein61(75.3%).
The Avorado's scores were 1-4 in 58 (72.5%), 5-7 in 20 (25%), and 8-10 in 2 (2.5%). Preoperative diagnosis were acute appendicitis in 46 (56.8%), subacute in 18 (22.2%), ? appendicitis in 7 (8.6%), and 3 (3.7%) cases each of perforated appendix, peritonitis ?cause, and intestinal obstruction. Of the 46 with diagnosis of acute appendicitis only 25 (54.3%) had an intraoperative diagnosis of acute appendicitis or its complication. The complication of acute appendicitis was seen in 12 (14.8%) patients. Emergency appendectomy was donein51(63%)
Conclusion: The intra-operative diagnosis of acute appendicitis is low when compared to the clinical diagnosis. The non-availability of histology does not make room for evidenced based improvement in accurate pre-operative diagnosis of appendicitis.
Impact of Government Policy: Partial Ban on Commercial Motorbikes within Enugu Metropolis
CU Nwadinigwe, UE Anyaehie, IO Offor
National Orthopaedic Hospital, Enugu
Background: Motorbike (motorcycle) accidents are a common occurrence in our environment where motorbikes are a popular means of commercial transportation. The ban on motorbike use on the 1 st of May 2009 in Enugu metropolis was targeted towards a reduction in the number of road traffic accidents and the criminal activities perpetrated by some motorbike users. In this study we concentrated on the effect of the ban on road traffic accidents (RTA's).
Method: A retrospective study of cases in the accident and emergency unit of the National Orthopaedic Hospital Enugu, of patients involved in road traffic accidents, in the immediate six months before the ban was done. Then a prospective study of the cases that presented at the accident and emergency unit in the immediate six months after, were analyzed with particular interest in those involving motor bikes. A literature review was also done.
Result: The total number of cases involved in RTA was 590 with 60.2% before the ban and 39.8% after the ban. The percentages of RTA's involving motorbikes in relation to total number of RTA's before and after the ban were 38% and 33% respectively. 71% of the victims were males while 29% were females. The commonest injury patterns were soft tissue injuries and tibia fractures accounting for 24.2% each.
Conclusion: The partial ban on commercial motorbikes within Enugu metropolis resulted in a change in the pattern of injuries, with a decline in the severity of the injuries.
Key words: Motorbike; road traffic accidents; Enugu
Pattern of Cervical Spine Injuries at the National Orthopaedic Hospital Enugu
GO Eyichukwu, UE Anyaehie, ON Muoghalu, JH Ogugua, UN Enweani
National Orthopaedic Hospital, Enugu
Objective: The cervical spine is an area quite prone to trauma due to its mobile character. In this study we have tried to delineate the pattern of cervical spine injuries which causes the cord injury with emphasis on the mode of acquisition and the radiologic finding.
Methods: A retrospective study was done in which 66 folders of patients that were admitted for cervical cord injury from January 1999 to 2009 (covering a ten year period) were analyzed and the following data extracted: age, sex, mechanism of injury and pattern of injury.
Results: The age range of the patients was from 5-80 years with a mean of 36.97. More males were involved 93.9% as against 6.1% for females. The commonest mechanism of injury being road traffic accidents in 66.7% and the commonest pattern of injury involving the lower cervical cord.
Conclusion: Handling of our cervical cord injured patients especially from the accident scene is very vital to the survival of this group of patients. We have seen in this study that lower cervical cord injury is more common probably because those with high cervical cord injury do not make it alive to the hospitals.
Key Words: cervical cord injury, pattern
Residents Perspective of Surgical Training in the Southeast Region of Nigeria
UE Anyaehie*, UB Anyaehie**, CU Nwadinigwe*, CD Emegoakor***, V Ogbu*
National Orthopaedic Hospital Enugu* University of Nigeria Enugu Campus** Nnamdi Azikiwe University Teaching Hospital*** Nnewi
Background: Residency training after internship or national youth service in Nigeria has become a common pathway for most doctors. There is a need to constantly review the training program to serve as feedback for innovative changes to meet global trends. This study reviewed surgical resident's perspective of their training program in three accredited tertiary health Institutions in south-eastern Nigeria.
Method: A total of Ninety (90) structured questionnaires were distributed equally to the surgical residents at National Orthopaedic Hospital Enugu (NOHE), University of Nigeria Teaching Hospital (UNTH) Enugu and Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. Fifty six (56) questionnaires 26 from NOHE, 20from UNTH and 8 from NAUTH were returned properly filled and were analyzed using Microsoft excel.
Results: Respondents were aged 29-53years with a mean of (35.3), mostly males (91.1%) and junior residents (75%). Most respondents (83.8%) rated the surgical residency training in their respective centers as inadequate, with inter-personal study with fellow residents being of greatest value to acquired knowledge. Many were only exposed to less than two hours per week teaching by their senior colleagues though 53.6% of the residents rated their percentage of skill acquisition commensurate with their status and number of years in training as above 50%. Criticisms of ground rounds bordered on misplaced objective, being geared towards fault finding and blame apportioning rather than being educative, and in some surgical specialties, it is not existent. Areas suggested to make training adequate were improved supervision and teaching by senior colleagues, inclusion of foreign postings, and improvements in infrastructure and remuneration.
Conclusion: Gaps exist between expectations of surgical residents to the training being offered in major centers in south-eastern Nigeria. There is a need for an evidenced-based review of surgical residency training to meet the aspirations of trainees and the ever changing trends in medicine. A more extensive study involving other regions of Nigeria, and expanded to the trainers (Consultants) to understand their perception and reasons for identified gaps will be of immense value.
Key Words: Resident, surgical, training, Nigeria
Early Report on Trauma Presentation at Nnamdi Azikiwe University Teaching Hospital, Nnewi Anambra State Nigeria.
AI Ugezu, HC Nzeakor, EC Ihekwoaba, CN Ekwunife, AN Osuigwe
Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State Nigeria.
Background: Trauma is an important public health problem all over the world. The incidence of trauma is on the increase. For the trauma patient, prognosis usually depends on the severity of the injury and the efficacy of trauma care. The purpose of this study is to determine the pattern of trauma presentation at Nnamdi Azikiwe University Teaching Hospital, Nnewi.
Methods: This is a prospective study of all trauma patients presenting to the Accident and Emergency Unit of this hospital for a period of one year starting from November 2009.Patients data was recorded into a proforma prepared for the study. Patients with burns were excluded from the study.
Results: The peak age frequency was in the third decade. Males were more affected than females with male to female ratio of 3.4:1.Road traffic accident was the most common cause of trauma accounting for 69.7% of cases.33.1% of road traffic accident (RTA) victims were motorcyclists.53.8% of these cases did not receive initial treatment from any health facility before presenting to our center.59.3%of patients were brought to hospital by cars notwithstanding the nature of their injuries. Most of the cases presented to our center within one to eight hours of their injury.33.1% of these injuries occurred during the afternoon period. The body region most commonly affected is the extremities.
Conclusion: Road traffic accident was the most common cause of trauma. The body region mostly affected is the extremities. Adequate control and prevention of road traffic accidents is advocated.
Key Words: Trauma, Presentation, Pattern, Nnewi
Soft Tissue Cover Following Open Tibia Fracture, 10 Year Trend in the Management in National Orthopaedic Hospital Enugu
II Onah, IE Enyanwuma, JU Achebe A Ibrahim
National Orthopaedic Hospital, Enugu
Introduction: Plastic and Orthopaedic Surgeon have been involved in the soft tissue closure of open tibia fracture.
Objective: The objective being to study degree of involvement and if there is any changing pattern.
Method: Retrospective study over 10 years 1996-2005 period. Folders are used
Results: No of patient used 142, Plastic surgeons involved in 87(60.9%) of cases while Orthopadeic 55 (39.1%) of cases. Plastic surgeons raised 45 flaps, 39 split skin graft (S.S.G) and 3 secondary closure while Orthopaedic surgeons raised 2 flaps, 28S.S.G. and 24 secondary closure. Time of intervention- 1996-1998 (4 weeks) 1999-2001 (15 days) 2002-2005 (10.2days)
Conclusion : There is increased involvement of plastic surgeons in soft tissue closure of open tibia fracture, More flaps are being raised. There is increasing early involvement of plastic surgeons in the closure.
Slipped Capital Femoral Epiphysis in Enugu
NE Duru, AU Katchy, BO Onodu, C Ngwangwa
National Orthopaedic Hospital, Enugu
Introduction: Slipped Capital Femoral Epiphysis is a rare condition that occurs almost exclusively in adolescents. It is due to a slip in the hypertrophic zone of the cartilaginous growth plate. It may be acute or chronic or sometimes acute on chronic. Boys are usually more affected than girls. This paper describes the magnitude of SCFE in our environment. It assesses the pattern of presentation, various methods of management as well as outcome of treatment.
Methodology: Case notes of patients admitted at the National Orthopaedic Hospital, Enugu, Nigeria between January 1 2000 and January12009 were retrieved and analyzed.
Results: A total of 40 cases were analyzed. There were 22 Females (55%) and 18 Males (45%). According to the grading, 19 cases were mild, 11 moderate and 10 Severe representing 47.5%, 27.5% and 25% respectively. The left Hip was more affected with 18 hips (45%) while 8 were bilateral (20%). 35 cases were treated operatively (31 cases by Open Pinning In-Situ (77.5%) and 4 cases by Valgus Osteotomy and plating(10%). 5 cases were managed conservatively by traction(12.5). The Age range of patients is 9-16 years with most patients presenting at 13 and 14 years representing 27.5% and 25% respectively. The patients were fully mobilized and in implants removed at between 5months and 3 years. The commonest complications noted were Avascular Necrosis of the head of femur and Coxa vara with3caseseach representing 7.5%.
Discussion: The paper examines the pattern of presentation of Slipped capital femoral epiphysis in our environment. It was commoner in the female patients with a male-female ratio of 1.2:1, This is at variance with other papers that showed a male preponderance 5 . All the patients were adolescents in the 9-16 year age group. 12 patients (30%) visited traditional bone setters prior to their presentation meaning that greater patient education is necessary as it accounted for delayed presentation in some cases.
Pinning In-Situ by the open method remained the commonest method of treatment. The implants used were removed when the epiphyses fused and this was between 5months to 3years after presentation. The delayed cases being mainly due to poor follow up visits. More research needs to be done in this area to enhance our treatment of this condition.
Conclusion: Slipped Capital Femoral Epiphysis ia almost limited to adolescents. It is commoner in the left hip and tends to have a slight female preponderance in our environment. Surgery is the best option of treatment.
Correlation between Serum Prostate Specific Antigens and Prostate Volume in Nigeria Men with Biopsy Proven Benign Prostate Hyperplasia
EI Ude*, NK Dakum**, OC Amu
Enugu State University Teaching Hospital Park Lane*
Jos University Teaching Hospital**
Objectives: We studied the correlation between serum prostate specific antigen and the volume of prostate in Nigerian Men with biopsy proven benign prostetic hyperplasia.
Methods: A total of 120 men with biopsy proven stromogladualr hyperplasia were included in the study. We analyzed PSA and a total prostate volume (TV) measured by tranabdominal ultrasound. We used Pearson correlation coefficient and linear regression model to describe the relationship between variables.
Results: Serum PSA level significantly correlated with TV (P<0.05.The Pearson correlation between PSA and TV was 0.3365 while that between age and PSA was 0.026. The mean age of patients recruited for the study was 63.6 years. The mean total prostate volume recorded in the study was 72.79mls years.
Conclusions: In Nigerian men with biopsy proven BPH, the volume of the prostate significantly correlated with serum PSA. There was no significant correlation between age and PSA. These findings agreed with that of Taiwanese men.
Pattern of Adult Mandibular Fractures in Enugu, Pattern of Adult Mandibular Fractures in Tertiary TraumaCentre
EEC Echezona, BC Okwor, UM Obi
Department of Burns, Plastic & Reconstructive Surgery, National Orthopaedic Hospital, Enugu
Background: Mandibular fractures are commonest following maxillofacial injuries. They are commoner amongst adults and aetiology varies from country to country and within the country depends on prevailing socioeconomic values, culture and belief. Patients require hospitalization, surgical intervention mostly and time to recover.
Aim: To establish the pattern, aetiology and management protocol of patients with mandibular fractures.
Materials and Methods : National Orthopaedic Hospital Enugu Nigeria is a regional centre for burns, plastic and reconstructive surgery as well as orthopaedic surgery. It is located in South East Nigeria. A retrospective study was carried over a period of eight years (2000-2008) using existing records of patients who had mandibular fractures and were managed.
Results: A retrospective study was done involving thirty eight patients thirty one males and seven females. Age varied from 17-56 years, (Av29.3). The mechanism of injury was mainly by road traffic accident (81.5%). Others were gunshot injuries, falls each comprising 7.8%. The body of the mandible was frequently involved (68.4%), followed by parasymphyseal/symphyseal region (15.7%) and ramus (7.8%), the patients involved stayed between three days to twelve weeks.
Treatment offered involved mainly interdental wiring (81.5%) plating (2.6%), transosseous wiring (2.6%), conservative mode of management was used for two patients (5.2%). further soft tissue reconstruction were carried out in two patients (5.2%) the use of prefabricated bakajian flaps (5) were employed. Common post management deficits noted included-oral incontence, malocclusion, and facial nerve palcy.
Conclusion: Mandibular fractures are increasingly caused by road traffic accidents involving males. The age bracket involved is 21-40 years,(4)/ Traetment modality involved non conservative approach using eyelet wiring with or without mandibulomaxillary fixation. There is the need to enforce legislations governing road users, deemphasize the dependence n second hand vehicles and ensure proper maintenance of roads.
Key Words: Mandibular; Fractures; Management
Gunshot Injuries to Hand: Ten Year Review in a Regional TraumaCentre
BC Okwor, EEC Echezona*, O Okwesili**
Department of Burns, Plastic and Reconstructive Surgery* National Orthopaedic Hospital Enugu
Department of Plastic Surgery**, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State
Background: The importance of the hand in day to day existence is inestimable. Hence every attempt must be made to manage injuries to it satisfactorily. Gunshot wounds to the hands can be debilitating if poorly managed. The study is aimed at evaluating the pattern of injuries, treatment optionsand clinical outcome with a view to improve on this.
Aim: To show pattern of injuries. Pre hospital care, time of presentation for definitive care, associated injuries if any, treatment options available, complications and deficits if any.
Design: Ten year retrospective study.
Method: The analyzed data were retrieved from patient's records in folder at accident and emergency, theatre and specialist clinics.
Results: A total of twenty seven patients were used for the study, 4 females (14%) and 23 males (85%) there was dominance of right hand affection, 15patients (55.5%) and (44.4%) 12 patients had left hand injuries. The results also showed the use of high velocity riffle in 4 cases (14.8%), low velocity riffle in 14 cases (51.8%) the rest of the cases were indeterminate. 17 case (62.9%) had pre hospital care. 9 cases (33.3%) arrived at our trauma centre within 2hours of injury while 14 cases (51.8%) arrived between 2 to 8 hours of injury. 3 case (11.1%) arrived after 8hours. It was also noted that 13 cases (14.1%) had associated injuries all the cases had debriment and wound exploration then further surgery to manage them.
Considering the duration of stay on admission, 10 patients (37%) stayed less than two weeks while11cases (40.7%) stayed more than two weeks. All cases had physiotherapy.
Conclusion: Gunshot injuries to the hand need to be properly evaluated and managed by a specialist physician trained to do this. However more emphasis should be placed on preventing this by passing enabling laws to make access to fire arms more difficult. Coupled to this is the provision by government of better social security, and better health care services for its citizens.
Cause of Burns as Seen in Ebonyi State University Teaching Hospital Abakaliki
AO Uduezue, MC Mba
Ebonyi State University Teaching Hospital Abakaliki
Objective: To highlight the pattern of presentation and common causes of burns in Ebonyi and environs as seen in Ebonyi State University Teaching Hospital Abakaliki.
Methods: Retrospective study of burn patients seen and treated from Jan 2000 to Dec 2009 at Ebonyi State University Teaching Hospital Abakaliki. Information collected from medical records og patients was collated and analyzed
Results: A total of 107 patients were seen, there were 34 Females (31.8%) and 73 males (68.2%). Grossly 55patients (51.4%) had flame burns followed by 30 patients (28%) with scald. Taking a closer look revealed that 25patients (23.4%) had scald form hot water and 17 patients (15.9%) sustained burn from kerosene explosion.
Conclusion: The single most common cause of burn was hot water in children left in the care of house help and /or siblings, followed by kerosene explosion dron refilling a lit lantern. These could easily be presented if the patients are well educated as to precautions to take in avoiding burns. Thus public enlightenment programes are still very important in burns prevention.