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Introduction: The research output in surgical branches such as orthopedics and sports medicine (OSM) is meager from Africa, considering the population and the high burden of health-related problems. We conducted this study to analyze the trend of publications in OSM from African countries and compared it with other surgical specialities. Methods: We used the SCOPUS data from the Scimago Journal & Country Rank website, as it allows us to draw substantial journal metrics for research. Results: During the past three decades (between 1996 and 2022), Africa’s global contribution to all surgical specialities has increased. In OSM, this was only 0.65% in 1996 and had risen to 1.79% in 2022. The total publications in OSM were 8297 from 49 countries during this period. The number of publications has risen from 61 (in 1996) to 931 (in 2022), with the maximum surge seen during the past decade. South Africa, Egypt, and Tunisia are the leading African nations in OSM publications and have contributed 77% of the total publications from Africa in 2022. There were only three orthopedic and four other surgical specialities indexed journals listed in the SCImago, arising from Africa. Conclusions: There was an increased research output from Africa in OSM during 1996–2022, especially in the past decade. However, only three nations have contributed more than three-fourth of these publications. There is a scarcity of indexed journals in the surgical disciplines arising from Africa.

Wealthy nations must step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change The 2022 report of the Intergovernmental Panel on Climate Change (IPCC) paints a dark picture of the future of life on earth, characterised by ecosystem collapse, species extinction, and climate hazards such as heat waves and floods1. These are all linked to physical and mental health problems, with direct and indirect consequences of increased morbidity and mortality. To avoid these catastrophic health effects across all regions of the globe, there is broad agreement—as 231 health journals argued together in 2021—that the rise in global temperature must be limited to less than 1.5oC compared with pre-industrial levels.

Wealthy nations must step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change. The 2022 report of the Intergovernmental Panel on Climate Change (IPCC) paints a dark picture of the future of life on earth, characterised by ecosystem collapse, species extinction, and climate hazards such as heatwaves and floods. These are all linked to physical and mental health problems, with direct and indirect consequences of increased morbidity and mortality. To avoid these catastrophic health effects across all regions of the globe, there is broad agreement—as 231 health journals argued together in 2021—that the rise in global temperature must be limited to less than 1.5oC compared with pre-industrial levels. While the Paris Agreement of 2015 outlines a global action framework that incorporates providing climate finance to developing countries, this support has yet to materialise. COP27 is the fifth Conference of the Parties (COP) to be organised in Africa since its inception in 1995. Ahead of this meeting, we—as health journal editors from across the continent—call for urgent action to ensure it is the COP that finally delivers climate justice for Africa and vulnerable countries. This is essential not just for the health of those countries, but for the health of the whole world.

Background The etiology of preeclampsia (PE) still remains elusive. Nevertheless, early onset PE has been hypothesized to develop following defective implantation of the conceptus into the endometrium and subsequent placentation. Defective placentation leads to insufficient remodeling of spiral arteries thus hypoperfusion of the placenta and clinical manifestations. Anaemia is highly prevalent amongst pregnant women. It is postulated that hypoxia is one of the mechanisms by which PE develops. The severity of symptoms seen in patients with coexisting preeclampsia and anaemia has been linked to uteroplacental insufficiency. Few studies however, have defined the placental morphometry when the two conditions occur concurrently. Methods This unmatched case-control study was carried out at the Kenyatta National Hospital where 42 placentae were obtained; 21 from preeclamptic mothers who had anaemia in the first and third trimesters of pregnancy (cases) and 21 from preeclamptic mothers without a history of anaemia in pregnancy (controls). The tissues were obtained and macroscopically and microscopically examined to determine relative differences. Photographs of the placentae were taken using a 12 MP (f/1.8, 26mm wide, 1/2.55", 1.4μm, dual pixel PDAF, OIS) camera. Photomicrographs were taken using a ZeissTM digital photomicroscope at ×400 magnification for stereological analysis. SPSS (Version 25.0) was used to input data where median values, interquartile ranges and frequency tables were obtained. Mann-Whitney U tests were run to compare differences in medians of the clinical, gross and histological features between the 2 groups. A p-value of ≤ _0.05 was considered statistically significant. Results Hemoglobin levels in the anemic group ranged between 7.0-10.5 g/dl in the 1st trimesters and 7.6-10.9g/dl in the 3rd trimester with patients being mild to moderately anemic. Gross placental infarction was observed in 17/21 (81.0%) of the cases and 15/21 (71.4%) of the controls. The gross morphometric parameters that were lower in cases were the placental weight and volume (p-values of

Wealthy nations must step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change.

Background: The use of a combined graft of both semitendinosus (ST) and gracilis (G) tendons in anterior cruciate ligament (ACL) reconstruction may cause weakness in knee flexion. It has since been proposed that ST be used alone since sparing G leads to near complete preservation of flexion strength. The use of the semitendinosus tendon as a solitary graft for reconstruction of the anterior cruciate ligament requires adequate tendon length (>28 cm) and four strand construct diameter (>8 mm). This study sought to determine the dimensions of the semitendinosus tendon graft among Kenyans. Methods: Forty pairs of ST tendons were harvested from formalin fixed cadavers by use of a tendon stripper. Their lengths were measured after which they were folded into four strand constructs whose diameter was obtained by sizing tunnels. Descriptive statistics and analysis was done using SPSS version 21.0. Results: The average ST tendon length was 29.80 ± 3.59 cm and 67.5% of all tendons had a length ≥ 28.0 cm. The mean four strand construct diameter was 7.89 ± 0.61 mm and 56% of all tendons had a thickness ≥ 8.00 mm. Considering tendon adequacy to be the presence of both sufficient ST tendon length and four strand construct thickness, 51% of all tendons were adequate for solitary use. Conclusion: The use of ST as a solitary graft in ACL reconstruction may be feasible among Kenyans as a good proportion of our sample had adequate dimensions. We suggest that the ST tendon be harvested first during reconstruction as it may be sufficient by itself hence no need to harvest gracilis tendon.

Introduction: Avascular necrosis (AVN) is a frequent complication of scaphoid fractures especially those involving the proximal segment of the bone. This has been attributed to its precarious blood supply which is further compromised by the fracture and surgery. Knowledge of the distribution of scaphoid nutrient foramina, which show variation across populations, is thus important in estimating the risk of vascular damage during surgical approaches and hence the likelihood of AVN. It may also be useful in determining techniques to mitigate this risk. The purpose of this study was to describe the distribution of scaphoid nutrient foramina in adult Kenyans. Methods: One hundred and four human scaphoids were studied. Each was divided into 3 segments: proximal, middle and distal, and the nutrient foramina in each segment counted and categorized into type I (no foramina), type II (1-2 foramina) and type III (>2 foramina). The number of nutrient foramina on the dorsal and volar aspects of the bone was also compared. Results: Type I nutrient foramina were most common (54%) in the proximal segment of the bone while the middle and distal segments had predominantly type III and type II foramina respectively. More foramina were present on the dorsal aspect with a dorsal-volar ratio of 4.23:1. Conclusion: The dorsal approach may result in more damage to nutrient foramina heightening the risk of avascular necrosis. Non-unions in the proximal segment may require vascularized bone grafts.

Dupuytren’s disease is not common in the African population. Like in other populations early intervention before severe contractures is important in order to prevent recurrence. We present a case of a young African with Dupuytren’s diathesis. ​

A randomized clinical trial (RCT) is a type of experimental study where participants are randomly assigned to separate groups that compare different treatments (1). RCTs are considered the goal standard in evaluating the efficacy and effectiveness of treatment interventions because the potential for selection bias is avoided through randomization of the study participants (2).

Background: Trauma is a leading cause of morbidity and mortality in Africa. Bodabodas are a main form of transport in Kampala and are becoming a major cause of road traffic crashes. We examined the pattern of injuries attributed to bodabodas. Patients and Methods: We retrospectively reviewed the charts of all trauma patients who presented between June and August 2008 to the emergency ward of the Mulago hospital in Kampala and identified the patient characteristics and the nature of injuries sustained. Results: Road Traffic Crashes (RTC’s) were the leading cause of trauma and bodabodas were involved in 41% of all trauma patients. Majority of the patients were young males below the age of 40. The commonest injuries were fractures, cranial trauma and soft tissue injuries. The lower limbs bore the brunt of the injuries. Conclusions: Injuries seen as a result of bodabodas constitute a majority of trauma cases and are hence a pressing problem in need of urgent solutions. The relevant authorities should ensure preparedness of the health system to cater for the care of these patients.

An editorial is presented on 2022 report of the Intergovernmental Panel on Climate Change (IPCC). Topics include characterised by ecosystem collapse, species extinction, and climate hazards such as heatwaves and floods; and damage to environmental hygiene led to increases in diseases across sub‐Saharan Africa.

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