Indications for Removal of Orthopaedic Implants in a Nigerian Tertiary Hospital: A Review of 128 Cases

BACKGROUND

With expanding indications for operative fracture treatment, removal of orthopaedic implants has become a frequent elective orthopaedic procedure in developing countries. The clinical indications for implant removal are not well established and there are no specific indications despite the morbidity associated with implant removal operations.

OBJECTIVE

To determine the frequency, indications and complications of removal of orthopaedic implants with a view to guiding implant removal protocol among surgeons.

MATERIALS AND METHODS

Retrospective data was obtained over a 5-year-period in NKST Rehabilitation Hospital, Mkar, Nigeria. One hundred and twenty-eight patients aged 4-88 years met the criteria for inclusion. Patients were followed up for at least 1 year and all complications recorded. Data was analysed using SPSS version 21.

RESULTS

A total of 128 patients were studied. There were 84(55%) males and 44(45%) were females. The mean age was 40.0±15.5 years. The commonest indication for implant removal was infected implant in 29(22.6%) patients, followed by patient's demand 22(17.2%). Femoral plate was the commonest [29(22.6%)] implant removed, followed by tibia plate [20(15.6%)] and humeral shaft plate [7(5.5%)]. The mean duration of hospital stay was 21.7±24.1 days. Twenty-five (19.5%) patients had post-operative complications.

CONCLUSION

The commonest indication for implant removal was infected implant followed by patients demand. Femoral plate was the commonest implant removed. Post-operative complications included fractures, bleeding, nerve injuries and infection. Findings from this study suggest that implant removal operation may be associated with substantial morbidity. Therefore, not all orthopaedic implants require removal. Strict implant removal policy is advocated to guide the surgeon.

Paediatric Septic Arthritis in a Nigerian Tertiary Hospital: A 5-Year Clinical Review

BACKGROUND

Septic arthritis is a relatively common condition in the paediatric population. It is both a medical and a surgical emergency with potential high morbidity. This disabling disease requires early diagnosis and prompt management for optimal outcome.

OBJECTIVE

This study determined the epidemiological pattern of septic arthritis and analysed factors affecting morbidity and mortality in the paediatric population.

MATERIALS AND METHODS

Retrospective data was obtained over a 5-year period in NKST rehabilitation hospital, Mkar, Nigeria. Forty patients aged 0-17 years met the criteria for inclusion. Joint aspirates were taken for microbiologic investigation. Data was analysed using SPSS version 21.

RESULTS

A total of 40 patients with 48 septic joints were studied. Twenty-two (55.0%) were males and eighteen (45.0%) were female with a male to female ratio of 1.2:1. The hip was the commonest 24(50.0%) joint involved; followed by the knee joint 18(37.5%), shoulder joint 4 (8.4%) and ankle joint 2(4.2%). Result of aspirate cultures yielded Staphylococcus aureus in 34 (70.8%) cases, Escherichia coli in 8 (16.7%), Haemophillus influenzae in 2(4.2%) and no growth was obtained in 4(8.3%) cases. Complications encountered after follow up include stiffness in 8(16.6%) joints, pain and stiffness in 2(4.1%) joint and bony ankylosis in 4(8.4%) joints and limb shortening in 2(4.1%) joints.

CONCLUSION

The keys to proper management are a high index of suspicion in any child with painful joint dysfunction and strict adherence to the principles of treatment. With prompt treatment, all complications might be avoided, and normal joint function and future growth may be preserved.

An epidemiological study of the burden of trauma in Makurdi, Nigeria

Background:

Trauma leads to considerable morbidity and mortality. The aim of this study is to elucidate the pattern and characteristics of trauma at Benue State University Teaching Hospital (BSUTH), Makurdi, Nigeria.

Materials and Methods:

Case records of all patients who presented to the Accident and Emergency (A and E) Department with trauma between January and December 2013 were analyzed for demographic data, types of injuries sustained, causes and circumstances of injuries, as well as outcome of treatment were extracted from the case files and entered onto a computerized questionnaire. Data were analyzed using the software Statistical Package for Social Sciences for Windows version 15.0 (SPSS Inc; Chicago, Illinois).

Results:

A total of 250 traumatized patients were studied consisting of 203 (81.2%) males and 47 (18.8%) females with a modal age group of 21–30 years. Unintentional injuries were the most predominant form of trauma (n = 209, 83.6%) with road traffic accidents being the leading cause (n = 180, 72.0%). Open wounds (n = 95, 28.2%) were the most common form of injury sustained and the extremities (n = 148, 43.5%), the most frequently injured body region. Most patients (n = 133, 53.2%) were treated and discharged home without permanent disabilities, while death occurred in 15.2%.

Conclusion:

Trauma in Makurdi is a predominantly young adult male occurrence with road traffic accidents being the leading etiological factor. Reducing road traffic accidents will likely reduce mortality and morbidity due to trauma.

Motorcycle-related injuries at a university teaching hospital in north central Nigeria

Background:

Motorcycle-related injuries lead to considerable morbidity and mortality. The aim of this study is to determine the pattern and outcome of motorcycle-related injuries at Benue State University Teaching Hospital, Makurdi, Nigeria.

Patients and Methods:

Case records of all patients who presented to the accident and emergency department with motorcycle-related injuries between July 2012 and June 2013 were analysed for age, gender, injury host status (i.e. rider, pillion or pedestrian), nature of collision (motorcycle versus other vehicles, motorcycle versus motorcycle, motorcycle versus pedestrian or lone riders), body region injured, injury severity score (ISS) at arrival, length of hospital stay (LOS) and mortality.

Results:

Seventy - nine patients with motorcycle-related injuries were included in the study. They consisted of 63 males (61.8%) and 16 females (15.7%). The age range was 5-65 years with a mean of 32.4 ± 14.0. Motorcycle versus vehicle collisions were the most common mechanism of injury (n = 46, 58.2%). Musculoskeletal injuries constituted the most common injuries sustained (n = 50, 47.6%) and the tibia was the most frequently fractured bone (n = 14, 35.9%). The majority of patients (57.0%) sustained mild/moderate injuries (ISS ≤ 15). There was no statistically significant difference between the sexes for sustaining mild/moderate injuries or severe/profound injuries (P > 0.05). Mortality rate was 6.3% with head injuries being involved in all cases.

Conclusion:

Young males were mostly injured in motorcycle-related trauma. Musculoskeletal injuries were the most common injuries sustained and head injuries were involved in all the deaths. Enforcement of motorcycle crash bars and helmet usage is recommended.