Trauma Mortality in The Emergency Department of a Tertiary Hospital in a Low-Income Country: It's Time To Walk The Talks

BACKGROUND

Trauma in developing countries has assumed an epidemic proportion and is now a public health problem. This is largely due to the rising incidence of road traffic crashes (RTC), increasing urbanization, industrialization and armed conflicts including terrorism fuelled by political, ethnic and religious factors in most developing countries. Unfortunately, this public health menace has not gotten the attention it deserves from the governments of the low-income countries, global non-governmental organisations and the mass media compared to the infectious diseases.

METHODS

This was a 2-year retrospective cohort study of trauma patients who presented to our emergency department and died within 72 hours of admission.

RESULTS

Within the period, a total of 6,858 patients, consisting of 2,228 trauma patients were admitted into our emergency department. Out of the trauma admissions, 256 patients died; giving a mortality rate of 11.5%. However, only 237 of the dead patients' case files could be reviewed. There were 195 (82.3%) males and 42 (17.7%) females. Majority of the deaths were in the age group 31 years - 45 years, with a mean age of 33.6 years. Road traffic crash was the most common cause of trauma deaths, 194 (81.9%); followed by flame burn, 15 (6.3%). Traumatic brain injury with or without other associated lesser injuries was the predominant diagnosis at presentation, 157 (66.2%). Most of the patients presented within 4 hours of their injuries, 136 (57.4%). Majority of the patients were brought to hospital by other road users, 133 (56.1%); and commercial bus was the commonest mode of transportation of the patients to the hospital, 102 (43.1%).

CONCLUSION

The trauma mortality rate in our emergency department calls for urgent intervention measures. Critical amongst them is the need for establishment of a trauma system with an efficient pre-hospital emergency medical service component in our region.

Open Laminectomy for Lumbar Spinal Canal Stenosis due to Prolapsed Lumbar Intervertebral Discs

BACKGROUND

Back pain due to prolapsed intervertebral disc accounts for two thirds of all visits to the orthopaedic clinic. The incidence of this disease is increasing with the increased sports activities in the young and due to degeneration in the elderly. Open lumbar microdiscectomy remains the gold standard amongst surgical procedures for herniated discs with or without instrumentation. However, percutaneous/ endoscopic microdiscectomy is gaining popularity. In our environment, high cost and paucity of instrumentation and skills militate against the use of such technique. In the western world, improvement in the mentioned skills and instrumentation and shorter rehabilitation time make minimal access surgeries more appealing than open microdiscectomy in recent times.

MATERIALS AND METHODS

Patients with clinical signs and symptoms of spinal canal stenosis secondary to isolated lumbar disc herniation were investigated with plain radiographs and magnetic resonance imaging (MRI). All those with definite canal stenosis as seen on the MRI that were not responsive to conservative therapy or those with rapidly deteriorating clinical outlook without instability were included to have open Laminectomy without instrumentation. Their preoperative and postoperative walking distance, their modified Roland-Morris disability indices, Their pain numeric score (NRS), their anteroposterior distance of the spinal canal at maximal site of stenosis and finally the absence or presence of preoperative and post operative anteroposterior/instability.

RESULTS

Twenty patients had open Laminectomy. There was significant improvement in the postoperative pain numeric score, the walking distance, the Roland Morris disability score. There was no evidence of postoperative instability on the plain radiograph.

CONCLUSION

Open Laminectomy remains a useful tool in the treatment of patients with lumbar spinal canal stenosis due to prolapsed intervertebral discs.

Fractures in Children Aged 0-12 Years and their Management as seen in North Central Nigeria

BACKGROUND

Childhood injuries are often associated with fractures, and it is said to account for about 25% of all paediatrics trauma. There is a male preponderance and the peak incidence occurs among primary and secondary school age groups. The occurrence and management of these fractures are influenced by season, geographical location, educational and socio-economic status of the populace as well as time of presentation and availability of suitable facilities for treatment.

OBJECTIVES

To analyse the demographic characteristics of the subjects, aetiological factors, fracture distribution, educational and occupational status of their parents, mode of treatment and their outcomes.

SUBJECTS AND METHODS

We carried out a prospective study on children 0-12 years of age at the University Teaching Hospital, Zaria, Nigeria, with fractures who consented to the study from January 2013 to December, 2016. Eight-six children were recruited through the Accident and Emergency Department. Diagnosis was made by both clinical and radiological assessment. They were managed by either non-operative or operative modality. Their complications were also managed. Their follow-up was for 12 months.

RESULTS

A total of 86 children with 86 fractures were enrolled with mean age of 7 years and male/female ratio of 2:1. The main aetiological factors were road traffic accidents (52.4% from cars, motorcycle and tricycle), followed by falls from heights (40.0%). Forearm bone fractures were the commonest (30.2%). Non-operative modality dominated the management (72.1%). Complication rate was 20.4%.

CONCLUSION

Fractures in children have a male prepon-derance with the radius being most commonly involved. Non-operative management was the main modality of treatment.

Use of non-vascularized autologous fibula strut graft in the treatment of segmental bone loss

BACKGROUND

Fractures resulting in segmental bone loss challenge the orthopedic surgeon. Orthopedic surgeons in developed countries have the option of choosing vascularized bone transfers, bone transport, allogenic bone grafts, bone graft substitutes and several other means to treat such conditions. In developing countries where such facilities or expertise may not be readily available, the surgeon has to rely on other techniques of treatment. Non-vascularized fibula strut graft and cancellous bone grafting provides a reliable means of treating such conditions in developing countries.

MATERIALS AND METHODS

Over a period of six years all patients with segmental bone loss either from trauma or oncologic resection were included in the study. Data concerning the type of wound, size of gap and skin loss at tumor or fracture were obtained from clinical examination and radiographs.

RESULT

Ten patients satisfied the inclusion criteria for the study. The average length of the fibula strut is 7 cm, the longest being 15 cm and the shortest 3 cm long. The average defect length was 6.5 cm. Five patients had Gustillo III B open tibial fractures. One patient had recurrent giant cell tumor of the distal radius and another had a polyostotic bone cyst of the femur, which was later confirmed to be osteosarcoma. Another had non-union of distal tibial fracture with shortening. One other patient had gunshot injury to the femur and was initially managed by skeletal traction. The tenth patient had a comminuted femoral fracture. All trauma patients had measurement of missing segment, tissue envelope assessment, neurological examination, and debridement under general anesthesia with fracture stabilization with external fixators or casts. Graft incorporation was 80% in all treated patients.

CONCLUSION

Autologous free, non-vascularized fibula and cancellous graft is a useful addition to the armamentarium of orthopedic surgeon in developing countries attempting to manage segmental bone loss, whether created by trauma or excision of tumors.

The doctrine of informed consent in surgical practice

Physicians and other professionals in the field of medicine have to perform invasive and non-invasive procedures on patients as part of their duties. There is a legal basis upon which these procedures are done; this is called 'informed consent.' Sociocultural factors have strong influence on the sick role. These factors influence the application of informed consent in Nigeria.