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Background: Discharge against medical advice (DAMA) has emerged as a pervasive problem in hospitals. Since the incidence and reasons for DAMA varies from one society to another and among clinical conditions, this study was undertaken to evaluate the occurrence of DAMA among Orthopaedic trauma patients in a teaching hospital with a view to identifying appropriate preventive strategies. Methodology: A prospective cohort study of Orthopaedic trauma patients who presented at a teaching hospital over a six-month period and indicated their desire to leave the hospital against medical advice. The patients were interviewed after obtaining informed consent; information obtained included sociodemographics and reasons for discharge against medical advice which were entered into a proforma. For those who indicated intention to go to the traditional bone setters for further treatment, the reasons for such a decision were obtained. Data was analysed using SPSS version 16. Results: A total of 488 orthopaedic trauma patients presented at the Accident and Emergency unit of the hospital during the study period. Twenty nine (5.9%) of the patients, discharged themselves against medical advice. Male to female ratio was 3.8:1.0 with median age of 30 years. Main reasons for DAMA were: going to the traditional bone setter – 11 (37.9%); not satisfied with planned treatment – 10 (34.5%); no one to take care of me/children while on admission – 6 (20.7%), financial constraints – 2 (6.9%). Of the 11 patients who left hospital to go to the traditional bone setter (TBS), 7 (63.6%) indicated that they had more faith in the TBS method of treating injuries. Conclusion: Discharge against medical advice is common among orthopaedic trauma patients in our hospital. Intensification of the campaign to purge the society of misplaced belief in the supernatural prowess of the TBS in treatment of orthopaedic trauma injuries and improvement of patient-doctor communication are advocated as preventive strategies.

Introduction: The global burden of road traffic injury (RTI)-related trauma is enormous and has the highest impact in low income economies. Loss of lives in the most productive age groups and the socio-economic costs to these weak economies, coupled with poor infrastructure for management of the severely injured dictate that well executed preventive measures be instituted in these countries. Low and middle income economies account for 90% RTI-related deaths in the world, yet in these regions, public health regulations on road safety hardly exist and where they do, are hardly enforced., Aim: To document variations in injury frequency, severity and outcomes following the ban on the use of motorcycles as a means of public transportation in Calabar., Patients and Methods: A prospective study of RTI patients who presented in our Emergency center over a 12 month period. Information recorded included biodata, anatomic location of injury, injury-arrival time, mode of transportation to hospital and final disposition at discharge. Chest injuries were excluded as there were no data for comparison. Results were analyzed by SPSS version 20 and compared with the 2005 Trauma Study Group results., Results: There were 366 road traffic injuries out of 5612 emergency room presentations during the period. There were 237 males and 99 females (M: F= 2.4: 1), mean age of patients was 30.13±12.62 years. Businessmen were the most commonly involved occupational group (n= 138; 38.7%) and the mean injury-arrival interval was 16.57±56.14 hours. Only 12 (3.6%) patients arrived by ambulance and 108 (32.1%) left against medical advice., Conclusion: RTIs constitute a major socioeconomic burden in the developing world. Lack of research, high risk behaviors and lack of enforceable road use regulations contribute to high rates of RTI-related mortality and morbidity. Preventive interventions and appropriate research to identify risk factors will reduce the burden of RTIs in low and middle income economies.

Background: Pyogenic osteomyelitis is still frequently seen in the developing world and the treatment of chronic osteomyelitis presents a considerable challenge despite advances in microbiological techniques, antibiotics and surgical techniques. Acute haematogenous osteomyelitis is commoner in children., Results: In the pre-antibiotic era, mortality rate was high and progression to chronic osteomyelitis was common. A near similar scenario still exists in many developing countries due to the combination of inappropriate and/or inadequate antibiotic therapy, delayed presentation and unorthodox interventions by traditional healers., Discussion: Chronic osteomyelitis may result from poorly treated or untreated acute osteomyelitis, open fractures, surgery for an array of orthopaedic conditions and from contiguous spread from infected soft tissue as may occur in diabetic foot infections. A large array of treatment techniques hinged on sequestrectomy/ debridement, management of dead space, improvement of oxygenation and perfusion to ischaemic tissue exist. Despite these, total eradication of disease is difficult., Conclusion: This article summarizes the pathology and methods of management available for pyogenic osteomyelitis. In its acute and chronic forms, the disease is likely to remain prevalent in the developing world until issues of ignorance, poverty and prompt access to appropriate and efficacious medical care are addressed.

Background: Several studies have shown that in Africa squamous cell carcinoma (SCC) is commoner than other skin malignancies. The risk factors are grouped generally into solar and nonsolar factors and their contributions vary with race, geographical region and site of lesion. This study attempted to identify risk factors and outcome of management of this problem in our region of southern Nigeria., Methods: All patients with histological diagnosis of SCC presenting to the University of Calabar Teaching Hospital during the period January 2005 to December 2006 were evaluated., Results: In total, 10 patients (6 male, 4 female, mean age 39.3 years, range 16-62) were seen. There were six patients (60%) with Marjolin's ulcer (MU) of the leg, with a male:female ratio of 5:1 and a latency period of 14.7 years, with trauma as the leading cause of injury. The other four patients (40%) had non-MU SCC. Two of these four patients (one man, one woman) were albino, and had lesions that involved the head. The other two patients were both women, and had vulval lesions. All 10 patients had delayed hospital admission, after poor results with topical herbal treatment. After hospital treatment, the results were satisfactory in three patients (two with MU and the male albino patient). The other seven patients had generally poor results from treatment, which comprised various combinations of excision, adjuvant chemotherapy and radiation., Conclusion: Ignorance and sociocultural factors were underlying issues in delaying treatment. Education highlighting the risk associated with chronic wounds and albinism, and the need for prevention, prompt treatment and proper surgical management, would improve prognosis with a reduction in the healthcare cost of this problem.

Background: Lightning strikes are relatively uncommon. In our culture where superstitions are strong and natural events often linked to evil forces, the traditional bonesetter/healer is often consulted first. Patients then seek orthodox care when complications develop. Patients also have difficulty accepting ablative treatment when indicated., Objective: To present an usual case of bilateral upper limb burns caused by lightning and complicated by refusal to receive orthodox treatment., Case Report: A 22 year old woman was struck by lightning while asleep. Instead of going to hospital, she was taken to a traditional healer where she spent two months before presenting with gangrenous upper limbs to hospital. Patient refused amputation and abandoned hospital against medical advice., Conclusion: This case report of bilateral upper limb burns resulting from lightning is rare. Importantly, the case highlights the role of ignorance, superstition and the disastrous results of traditional medical practice in our healthcare delivery.

A rare case of acute bilateral anterior shoulder dislocation in an elderly woman is presented. This injury resulted from domestic physical assault by her daughter inlaw. Patient defaulted after initial treatment--a common practice by patients in our society. This case is being reported to highlight the occurrence of this rare orthopaedic emergency.