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Background: There has been a global rise in surgical amputations because of vascular complications of diabetes mellitus, among other factors. About 22% of patients usually decline or delay consent for the operation leading to poor outcomes. Objective: This study aimed to determine patients' perceptions and attitudes toward surgical amputation and amputee prosthesis. Methods: A cross-sectional study was conducted over 12 months during which a semi-structured questionnaire was administered to adult patients attending the outpatient clinic at Benue State University Teaching Hospital. The questions assessed the patient's knowledge, attitude, and behavior toward amputation, amputees, and amputee prosthesis. Results: Out of 400 respondents, 320 (80%) agreed that surgical amputation is beneficial, 232 (58%) agreed that it is done to remove a dead limb, whereas sixty-five (16.2%) think that amputation is done on every leg that has a fracture. The majority of 360 (90%) were willing to encourage others to have an amputation to save a life. This was found to be significantly related to religion (P = 0.000), educational status (P = 0.000), and sex (P = 0.044). Reasons for refusal of amputation were fear of losing a limb (106, 26.5%) and deformity (93, 23.2%). Three hundred and three (78.2%) respondents were aware of artificial limbs, and 342 (85.5%) regard doctors as lifesavers. Conclusion: There is a high level of awareness and knowledge of indications for surgical amputation which is significantly influenced by religious beliefs, educational status and gender. Education on preventive measures may reduce amputation rates. The provision of a functional prosthesis will hope for productivity after limb loss.

Joint replacement therapy (JRT) commonly performed in advanced countries is being introduced in some developing countries. The objective of this study was to assess anaesthesia used and the outcome of the first 17 cases performed at a young teaching hospital in Nigeria. This was a cross-sectional descriptive study of patients for JRT at Benue State University Teaching Hospital, Makurdi, Nigeria from 23/6/2014 to 31/8/2016. Data analyzed from the anaesthetic/surgical records included age, sex, ethnicity, ASA classification, Ficat and Arlet classification of avascular necrosis, Gardens classification of fracture neck of femur, indication/type of surgery, packed cell volume (PCV), anaesthesia type, estimated blood loss, transfusions, duration of surgery and hospital stay, post-operative PCV, pain management, complications and surgical outcome. Results were summarised as means, median and percentages using SPSS version 21.0 for Windows®. One-way test of ANOVA was used for statistical significance (p= 0.05). Seventeen patients aged 27-90 years (mean 54.71±19.69). Indications were femoral neck fracture (47%), chronic osteoarthritis (35%), avascular necrosis (18%). The commonest procedure was hemiarthroplasty (41%), total hip replacement (35%), and total knee (24%). All were under regional anaesthesia with spinal (53%) and combined spinal-epidural (47%). Multimodal post-operative analgesia was used. There was no significant difference between pre and post-operative PCV (t = 0.708, p=0.05). Mean duration of hospital stay was 19.44±9.61 days. The outcome was good in all. JRT can be established in a new center with proper planning. Regional anaesthesia with multimodal analgesia is recommended. With relevant surgical skill, patient outcome is good.

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

Fractures constitute a significant component of paediatric trauma. Paediatric fractures account for significant morbidity. This study was set to elucidate the characteristics and outcome of paediatric fractures in a university teaching hospital. Case notes were reviewed for socio-demographic and clinical variables. Statistical analysis was carried out using the software Statistical Package for Social Sciences for Windows, Version 21.0. The correlation between development of complications and prior treatment by traditional bone setters was determined using chi-squared tests. Fifty four long bone fractures were studied in 52 children. Their ages ranged from 1 day to 16 years with a mean of 8.85 ± 3.86 years. There were 29 males (55.8%) and 23 females (44.2%). The aetiology of childhood fractures included road traffic crashes (n=30, 57.7%), falls (n=10, 19.3%), sports injuries (n=8, 15.4). The long bones fractured were tibia (n=19, 35.2%), femur (n=14, 25.9%), distal radius (n=14, 25.9%) and supracondylar part of the humerus (n=7, 13.0%). Non-operative treatment modalities were the most frequent means employed in treating children with fractures in this study. Limb gangrene following prior treatment by traditional bone setters was the most common complication. There was a statistically significant correlation between development of complications and prior traditional bone setters treatment (p

Though Klippel-Feil syndrome is a rare congenital anomaly and the clinical presentations are varied, a complete history, physical and radiological examinations may reveal the diagnosis.

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

The routine removal of orthopaedic fixation devices after fracture healing is a common practice among surgeons; however, its benefits Vis-a-vis risks remainan issue of debate. Thisstudy evaluated surgeons' perceptions about the indications, priority of implants removal, effectiveness, and risks of removal of orthopaedic implants in Nigeria. A 44-item questionnaire was distributed to 110 attendees of the Annual General Meeting and Scientific Conference of the Nigerian Orthopaedic Association, Lokoja- 2013. Data was analysed using SPSS version 21.The response rate was78/90 (86.7%), representing 70.9% ofattendees. Majority of surgeons did not agree that asymptomatic orthopaedic implants should be routinely removed for all patients (disagreement: 91.0%, agreement: 6.5%). The major indications for removals were breakage/mechanical failure, infected implants and allergic disposition with mean rating on a 5- point scale of 4.56±0.948, 4.37±0.937 and 4.15±1.139 respectively. Most surgeons accrued highest priority to removal of implants in children with a mean rating of 4.14±0.954, followed by forearm rush nails 3.82±1.079.Without a strict implant removal policy, a remarkable portion of the resources allocated for elective orthopaedic operations would be spent on routine hardware removal procedures. General recommendation for hardware removal is not justified; overall, implant removal should not be considered a routine procedure.

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. Language: en

Intentional injuries are a common presentation to Accident and Emergency (A&E) Departments and make a significant contribution to theglobal injury burden. This descriptive study aims to determine the pattern and treatment outcome of intentional injuries presenting to the A&E Department of Benue State University Teaching Hospital, Makurdi, Nigeria (BSUTH). Case records of all patients who presented to the A&E Department between July 2012 and December 2013 were analyzed for age, gender, circumstance surrounding injury, weapon used, body region injured, injury sustained, treatment offered, and outcome of treatment. Sixty patients with intentional injuries were included in the study. They consisted of 50 males (83.3%) and 10 females (16.7%) with ages ranging from 15 to 65 years with a modal age group of 20-29 years. The extremities were the most predominantly injured body regions (n=26, 43.3%) and firearms were the most common weapons employed (n=31, 51.7%). While armed robbery (n=31, 51.7%) was the most common reason for the injuries, attempted suicide (n=2, 3.3%) was the least.Soft tissue injuries and debridement were the most common injury type and treatment modality encountered respectively.The death rate was 8.3% with majority of deaths (80%) resulting from firearm injuries. Keywords: Intentional injury, violence, Accident and Emergency, 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. Language: en

Objectives: To study the pattern of presentation and outcome of conservative treatment of traumatic spinal cord injury (TSCI) in our institution. Setting: Benue State University Teaching Hospital, Makurdi, Benue State. Materials and Methods: A 3-year retrospective review (June 2012 to May 2015) of TSCI was done. Demographic data, cause, associated injuries, time interval to presentation, level of injury, American Spinal Injury Association (ASIA) classification at presentation and at 6 weeks were obtained from case notes. The patients were all managed conservatively and had bed rest on air or water mattress. Results: There were 45 patients mean age 33.26 ± 1.55 (range 8–77 years) with TSCI comprising 37 males and 8 females giving a male: female ratio of 4.6:1. Students were mostly affected ( n = 11, 24%) while motor vehicular accident was the cause of injury ( n = 18, 40%). Cervical spine was the most injured ( n = 24 53.3%). Majority had the ASIA Class A ( n = 22 48.9%) at presentation. Thirteen (48.1%) of them improved, two were referred, six remained the same, eight deteriorated, and 16 were discharged against medical advice. Period of hospitalization was 1–65 days. Conclusion: TSCI affects mainly young males involved in motor vehicular accident. Conservative treatment can be used in resource-constrained centers.

Objective: To document the clinico-pathological characteristics of skin malignancies seen at Benue State University Teaching Hospital, Makurdi. Materials and Methods: A 3-year retrospective study of patients with histologically-confirmed skin cancers presenting to our institution from April 1, 2012 to March 31, 2015 was done. Relevant data was extracted from the patients' records and subjected to statistical analysis. Results: Records were available for 43 patients with a mean age of 46 ± 18 years. There were 21 males and 22 females with a male:female ratio of approximately 1:1. Squamous cell carcinomas were the most common histologic type seen (44.2%) followed by melanoma and Kaposi's sarcoma (25.6% each) while basal cell carcinomas accounted for 4.7%. Farmers (37.2%) and artisans (23.3%) were the most common occupations seen. Human immunodeficiency virus (HIV)-positive patients accounted for 27.9% of the total and albinos 18.6%. Majority of the patients (60.4%) had history of prolonged exposure to sunlight with little regard for protective measures. The average duration of symptoms before presentation was 28 ± 33 months. Conclusion: The study suggested an association between skin cancer and prolonged, unprotected exposure to sunlight on one hand and HIV infection on the other. It highlights the need to promote basic preventive measures.

Split-hand/split-foot malformation (SHFM), also known as ectrodactyly or lobster claw hand deformity, is a rare congenital limb malformation characterized by a median cleft of hands and/or feet due to the absence of the central rays. SHFM has a reported incidence of 1 in 90,000 live births. It may occur either as an isolated anomaly or as part of a syndrome. We present a rare case of a 9-year-old boy with SHFM who underwent surgical correction of the cleft hand, with improved cosmetic and functional outcome.