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Aims: To determine the response to oral calcium in Nigerian children with rickets. Methods: In a teaching hospital in Western Nigeria, 26 children (13 boys, 13 girls, aged 2-5 years) [...]

Background: Percutaneous Achilles tenotomy is an essential step in the Ponseti treatment of idiopathic clubfoot, with reported complications such as injury to the surrounding neurovascular structures and incomplete division of the Achilles tendon (AT). Knowledge of AT thickness would guide tenotomy blade insertion depth, obviating these related complications. We embarked on this study to ultrasonographically determine AT thickness at its different levels from the calcaneal insertion in children with idiopathic clubfoot., Methods: This prospective comparative study consisted of two groups of children 4 years and younger: a study group of patients with clubfoot requiring tenotomy and a control group. Both groups underwent ultrasonographic evaluation of their AT. The ultrasonographic data collected include AT thickness 1 and 2 cm from the calcaneal insertion of the AT, thickness of the thinnest portion of the tendon, and the distance of this thinnest portion from the calcaneal insertion., Results: Twenty-seven children with idiopathic clubfoot constituted the study group, and 23 children with no musculoskeletal deformity were enrolled in the control group. Mean ± SD AT thicknesses 1 and 2 cm from the calcaneal insertion in the study group were 2.4 ± 0.7 mm and 2.1 ± 0.7 mm, respectively, and in the control group were 2.5 ± 0.7 mm and 2.3 ± 0.7 mm, respectively. The average thickness of the thinnest portion of the AT along its length was 2 mm at 1.8 cm from the calcaneal insertion in both groups., Conclusions: Safe and complete percutaneous tenotomy would most likely be achieved when performed 1.8 cm from the calcaneal insertion, where the corresponding average AT thickness of 2 mm would be a guide to determine the insertion depth of the tenotomy blade.

Purpose: Current modes of diagnosing and monitoring knee osteoarthritis (OA) are based on weight bearing radiographs usually made by the time joint destruction is already established. Cartilage oligomeric matrix protein (COMP) is a breakdown product of cartilage and its serum levels may be a potential indicator of early destruction in OA. This study aimed to ascertain the usefulness of serum COMP (sCOMP) in diagnosis and monitoring of knee joint OA within the study environment., Methods: Ninety consenting adults were recruited. In the control group, 45 subjects having a diagnosis of knee OA had clinical and radiological grading done and blood samples taken for assay of sCOMP using the sandwich ELISA method. Forty-five volunteers with no features of osteoarthritis also had serum collected for sCOMP assay. Values obtained were then cross referenced with demographic indices, clinical and radiological severity grade to assess for relationships., Results: Serum COMP was found to be significantly elevated (p = 0.0001) in the study group. The mean values and standard deviation of sCOMP were 3400 ± 1042.9 ng/ml and 2222 ± 605.6 ng/ml for the study and control groups, respectively. Higher values of sCOMP were found to be associated with higher clinical and radiological grades of OA., Conclusion: The study demonstrates that sCOMP is significantly higher in patients with knee OA than in those without the disease. Values of sCOMP were also found to increase with severity of knee OA, indicating the possibility of its use as a marker of diagnosis and severity.

Background: The management of open tibia fractures remains controversial despite increase in its incidence. Some surgeons avoid internal fixations for fear of infection while others have demonstrated its superiority. Identifying an optimal management modality is of utmost benefit to our patients. Study objectives were to compare the rate of infection and mean duration to healing in the management of open tibia fractures using unreamed interlocking intramedullary nail and external fixation., Methods: The study was an interventional study comparing two known standard methods of managing open tibia fractures conducted in the orthopaedic and trauma department of a tertiary health institution in South west, Nigeria. Forty patients who presented with open tibia fractures were allocated alternately into primary interlocking nailing group and external fixation group. Follow-up was for two years., Results: Incidences of deep wound infection in both groups were 35% (external fixation) and 11.1% (interlocking nailing) respectively. The relative risk of developing infection in external fixation group was 3.2. Mean duration to union was 14.8 weeks and 14.4 weeks in the external fixation and interlocking nailing groups respectively, difference in mean was not statistically significant, (t=0.133, p=0.895)., Conclusion: The risk of wound infection was observed to be higher in this study with the use of external fixation in the management of open tibia fractures compared with unreamed interlocking intramedullary nail.

Background: Hypercalcemia occurs more frequently than is recognized in patients who are immobilized, but most of these patients are asymptomatic. This study is to determine serum and urinary calcium levels, incidence of hypercalcemia and hypercalciuria in immobilized and ambulant trauma patients., Methods: A prospective comparative study was carried out over a period of seven months. Total serum calcium level and 24-hour urinary calcium output were measured weekly over 4weeks in 55 immobilized trauma patients as study group and 51 ambulant trauma patients as control group., Results: Mean total serum calcium of immobilized patients increased progressively (on admission: 2.315±0.056mmol/l and week 4: 2.552±0.231mmol/l, p<.001) while that of ambulant patients did not change significantly (on admission: 2.306±0.041mmol/l, and week 4: 2.300±0.028mmol/l, p=.348). There is a significant difference in overall mean total serum calcium between immobilized and ambulant patients (p<.001). In immobilized and ambulant patients, mean 24-hour urinary calcium increased progressively from baseline (3.044±0.480mmol/day and 3.056±0.540mmol/day respectively), till the end of the study (8.543±2.142mmol/day and 6.783±1.372mmol/day respectively). Overall mean 24-hour urinary calcium is significantly different between immobilized and ambulant patients {multivariate Pillai F (5,100)=883.124, p<.001}. Incidence of hypercalcemia increased progressively in immobilized patients (end of week 1=7.27% and end of week 4=29.09%) while none of the ambulant patients had hypercalcemia. Incidence of hypercalciuria also increased progressively in immobilized patients (end of week 1=7.27% and end of week 4=63.64%) while ambulant patients only had hypercalciuria at the end of week 3 (9.8%) and week 4 (21.57%)., Conclusion: Mean total serum calcium increased with increased duration of immobilization in trauma patients. Both immobilized and ambulant trauma patients developed hypercalciuria but it is worse and earlier in the immobilized trauma patients., (© 2013.)

Background: Management of post trauma tibia bone gap varied with orthopedic surgeons' experience and tools available. Study aims to determine predictive factors for distraction by a monotube fixator (DMF) outcome in post tibia trauma limb length discrepancy., Methods: A prospective descriptive cross sectional study of post traumatized tibia bone gap and limb length discrepancy patients at tertiary hospitals. Patient's informed consent and institutional ethical committee approval were obtained. Bio-data, clinical and healing indexes were documented. DMF was applied for patient that met inclusion criteria. The Statistic tests used included the Chi-square, the Student's two-tailed t test, and the Wilcox on rank-sum test when appropriate. Mantel-Haenszel Common Odds Ratio (OR) and 95% confidence intervals for poor outcome potential risk factors were recorded. Bivariate correlation and logistic regression were evaluated. Significance level was set at a p value <0.05., Results: Thirty-six patients with mean age, 37.2 ± 10.3 year and male/female ratio of 1:1.25 had DMF applied. Motorcycle accident accounted for 50.0% of patients and diaphyseal segment was most commonly affected 25 (69.4%). The mean bone lengthened was 10.1 ± 4.0 cm (range: 5-21 cm) and mean duration of bone transport was 105.6 ± 38.2 days. The means of rate of distraction, healing index and percentage of lengthening were 0.99 ± 0.14 mm/day, 15.6 ± 4.3 days/cm and 38.0 ± 14.3 respectively. The mean follow up was 9.7 ±4.9 months (range: 2-17.0). Per operative complications varied and outcome was satisfactory in 30 (83.3%). Obesity (p <0.0001), multiple surgery (p = 0.012) and transfusion (p = 0.001) correlated to poor outcome. Percentage lengthening ≥ 50%, bone gap >10 cm, anemia, blood transfusion, general anesthesia administration, distraction rate >1 mm/day, osteomyelitis and prolong partial weight bearing were significant predictive factors for poor outcome in post traumatic tibia distraction., Conclusion: Distraction by a monotube fixator appears effective in achieving correction >38.0% original tibia lengthening following traumatic bone gap. Predictive factors for poor outcome were useful for prognostication.

Objective: Mortality in orthopaedic patients is not a common event. This study sets out to review the incidence and causes of mortality in orthopaedic and trauma admissions in a tertiary centre in a developing country., Methods: Medical records of patients admitted to the Orthopaedic wards of the Obafemi Awolowo University Teaching Hospital, Ile-Ife over a ten year period (January 1999-December 2008) were retrospectively reviewed. The death certificates and postmortem examination findings were used in conjunction with the medical records to arrive at the possible cause of death in the deceased patients. Frequency analysis was done using SPSS version 13., Results: Over this period, 2418 patients were admitted for orthopaedic and trauma with 84 deaths giving an overrall crude mortality rate of 3.47% (1.27% for paediatrics and 4.39% for the adults). Fourty nine patients (58.4%) died from trauma (fracture) related diagnoses followed by tumour (21, 25%) and infection (14,16.7%). Males were more affected 73.8% and the average age at death was 45.7years. Co-morbid conditions were found in 393% of the deceased patients., Conclusion: Trauma related deaths were the leading cause of mortality in our ward admissions and male patients at the prime of their lives were more often involved. Accident prevention and provision of facilities for appropriate management of trauma victims will help reduce substantially these untimely deaths in our world. The high incidence of co-morbid conditions emphasizes the role of multidisciplinary care in orthopaedic and trauma patients.

Objective: To identify bacterial isolates from superficial swabs of open fracture wounds at presentation and after infection has been established, and to determine if there are correlations between them., Method: Patients who presented with open fractures at the Wesley Guild Hospital, Ilesa, Nigeria between December 2004 and May 2006 were recruited into this prospective study. Superficial wound swabs were taken at presentation and if patient showed evidence of wound infection., Results: Sixty patients had open fractures. The initial bacteria culture of wound swabs taken on the day of presentation was positive in 41 (68.3%) patients. Of these, 19 (46.3%) yielded one bacteria isolate, 17 (41.5%) yielded two and 5 (12.2%) yielded three, making a total of 68 organisms. The most common organism was Staphylococcus aureus. However, as a group, more aerobic Gram-negative rods were isolated than any other bacteria groups. Eleven (18.3%) patients developed wound infections, all of which were polymicrobial. In 10 (90.9%) of these, the microbial isolate of the final wound swab included at least one organism that was present in the initial wound culture. No patient with an initial negative culture went on to develop a wound infection. The mean presentation interval of patients with wounds that became infected was 15.2 ± 7.9 hours (95% CI 9.8-20.5 hours) compared with 2.9 ± 3.1 hours (95% CI 2.0-3.8 hours) for those who did not develop a wound infection (p>0.01)., Conclusion: In a resource-poor setting, where pre-hospital care is unavailable and patients present late, superficial wound swabs are effective in predicting subsequent organisms that may cause wound infections., Conflict of Interest: None.

Background: Congenital clubfoot treatment continues to be controversial particularly in a resource-constrained country. Comparative evaluation of clubfoot surgery with Ponseti methods has not been reported in West Africa., Objectives: To determine the effects of Ponseti techniques on clubfoot surgery frequency and patterns in Nigeria., Methods: This was a prospective hospital-based intention-to-treat comparative study of clubfoot managed with Ponseti methods (PCG) and extensive soft tissue surgery (NPCG). The first step was a nonselective double-blind randomization of clubfoot patients into two groups using Excel software in a university teaching hospital setting. The control group was the NPCG patients. The patients' parents gave informed consent, and the medical research and ethics board approved the study protocol. Biodata was gathered, clubfoot patterns were analyzed, Dimeglio-Bensahel scoring was done, the number of casts applied was tallied, and patterns of surgeries were documented. The cost of care, recurrence and outcomes were evaluated. Kruskal-Wallis analysis and Mann-Whitney U technique were used, and an alpha error of < 0.05 at a CI of 95% were taken to be significant., Results: We randomized 153 clubfeet (in 105 clubfoot patients) into two treatment groups. Fifty NPCG patients (36.2%) underwent manipulation and extensive soft tissue surgery and 55 PCG patients (39.9%) were treated with Ponseti methods. Fifty-two patients of the Ponseti group had no form of surgery (94.5% vs. 32%, p<0.000). Extensive soft tissue surgery was indicated in 17 (34.0%) of the NPCG group, representing 8.9% of the total of 191 major orthopaedic surgeries within the study period. Thirty-five patients (70.0%) from the NPCG group required more than six casts compared to thirteen patients (23.6%) of the PCG (p<0.000). The mean care cost was high within the NPCG when compared to the Ponseti group (48% vs. 14.5%, p<0.000). The Ponseti-treated group had fewer treatment complications (p<0.003), a lower recurrence rate (p<0.000) and satisfactory early outcome (p<0.000)., Conclusion: Major clubfoot surgery was not commonly indicated among patients treated with the Ponseti method. The Ponseti clubfoot technique has reduced total care costs, cast utilization, clubfoot surgery frequency and has also changed the patterns of surgery performed for clubfoot in Nigeria.

This open prospective study compared the bacterial flora of superficial and deep-wound biopsies and swabs over a 2-year period in 4 different samples cultured from open fracture wounds at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Samples were taken from 47 patients with factures graded according to Gustilo and Anderson's classification as grade 1 (2.1%), grade II (29.8%), grade IIIA (36.2%), and grade IIIB (31%). A total of 248 samples were cultured using standard techniques. The incidence of open fracture wounds was 78.7% in male patients and 21.3% in female patients. Tibia fractures constituted 66.1%. A total of 203 bacterial isolates were cultured from 248 samples. Gram-negative bacteria constituted 53.2% of isolates, with Escherichia coli being predominant (12.8%). Staphylococcus aureus were the predominant Gram-positive cocci (15.3%), and Staphylococcus epidermidis (13.3%) may be considered to be the major source of open fracture wound contamination. The bacterial species cultured from superficial and deep-wound swabs and biopsies were similar. Resistance to antimicrobials was high for penicillins (amoxicillin and cloxacillin), with values of 68.6% and 58.3%, respectively, for superficial bacterial species and 58.2% and 31.9%, respectively, for deep-wound biopsies.

Background: Malignant musculoskeletal tumor (MMST) outcome reflects the level of supportive care provided. In Nigeria, the supportive care available to patients with MMST is limited by a lack of funding. Patients often present late, and receive only orthodox care as psychosocial care is not available. We evaluated the effect of direct incorporation of government funding and family support on MMST patient acceptance and completion of treatment., Methods: A 3-year prospective multicenter intention-to-treat study was undertaken in a tertiary care setting. The first step was a nonselective randomization of MMST patients into 2 groups, Wesley Guilds Hospital Firm A (WGHFA) and Wesley Guilds Hospital Firm B (WGHFB) using the computer software Excel. The control group was WGHFA, which consisted of patients who self-financed their oncology care. The WGHFB patients' governments (local or state) provided funds according to medical reports and the patients had relatives who offered psychosocial support. The second step entailed treatment (surgery, chemotherapy and radiotherapy) and follow-up. Outcome measures were the interval between presentation at hospital and surgical intervention, acceptability of limb amputation, completeness of treatment courses, duration of hospital stay and mortality. The reproducibility of the methodology was reappraised at the Federal Medical Center. Kruskal-Wallis analysis was used, and an alpha error of <0.05 at a CI of 95% was taken to be significant., Results: A total of 112 cases of MMST were managed during the study period. Seventy-one (63.4%; 37 WGHFA; 34 WGHFB) met the inclusion criteria. Age, sex, tribe, religion, comorbid factors and mean weekly income were not significant factors influencing improved MMST care among the WGHFB patients. 32 WGHFB versus 7 WGHFA patients accepted the treatment plan. The mean duration of hospital stay before surgery (p < 0.001), discharge against medical advice (p < 0.000), limb salvage (21 vs. 2, p < 0.001), limb amputation (3 vs. 12, p < 0.05, 95% CI 8.3-37.9), completeness of treatment (33 vs. 7, p < 0.05), mean duration of hospital stay, in days (23 vs. 39, p < 0.05) and mortality at 1-year follow-up (13 vs. 28, p < 0.02) were significant., Conclusion: The cost of cancer care is a challenge for patients with MMST in a resource-constrained country such as Nigeria. Direct integration of the government and family into MMST care will serve as a link between the cancer patient and the source of funds. It raises the possibility of an effective psychosocial approach to improve patient outcome through enhanced treatment acceptability and completion, and so reduce morbidity and short-term mortality., (Copyright 2009 S. Karger AG, Basel.)

Objective: To identify the microbial pathogens responsible for amputation wound infections, their distribution and antibiotic-sensitivity patterns., Method: Consecutive patients who had limb amputations from April 2002 to March 2006 in an Nigerian hospital were recruited into this prospective observational study. The patients' demographic features, indications for amputation, microbiology of stump wound infections and the effects on length of hospital stay were reported., Results: Fifty-seven patients (mean age 34.6 +/- 19.2 years) had amputations in 58 limbs. Trauma leading to limb gangrene following treatment by traditional bone setters was the most common indication for amputation (64%). Approximately 76% of the amputations were in the lower limbs. Wound infection occurred in 48% of the stumps, of which 71% had been amputated because of a trauma injury. Pseudomonas aeruginosa was the most commonly isolated pathogen (40%).There was a very low correlation between the aetiologic bacterial agents and the age of patient, source of referral, indication for amputation and level of amputation. Amputation wound infections significantly prolonged the patients' length of hospital stay (p=0.002)., Conclusion: Amputation wound infection constitutes a serious morbidity in our practice. Most of the causes are preventable.

An 8-year-old girl sustained closed fracture of the right ulna 10 weeks prior to presentation. She was taken to a traditional bone setter who applied a tight splint. The patient reported pain, but the splint was not removed. A week after application of the splint, a foul odor was detected and removal of the splint showed extensive exposure of the forearm bones. Above elbow amputation was rejected by the patient's parents when she was taken to hospital, where she was admitted for 8 weeks by a second traditional bone setter. A trained nurse applied herbal concoctions and dressed the wound daily in anticipation that the skin would cover the exposed bone fragments. She was brought to our hospital for wound dressing so that the skin would cover the exposed bones fragments. Examination revealed a grossly shortened right forearm--by 7 cm compared with her left--extensive exposure of both radius and ulna at the anterior aspect of the forearm, and loss of sensation and movement of the fingers. Radiographs showed sequestrated radius and ulna with involucrum around the olecranon process. Above elbow amputation was offered to the patient but the parents again declined. The forearm bones detached while scrubbing the wound for review and removal of the sequestrated bone. The wound healed within one and a half weeks of dressing, resulting in an acquired boneless forearm.

Introduction: The aim of this study was to investigate the clinicopathological characteristics of Nigerian patients with osteomyelitis., Methods: 30 patients with osteomyelitis and 30 apparently-healthy age- and sex-matched controls were investigated. The packed cell volume (PCV), white blood cells (WBC) and differentials, and platelet counts were measured using an automated counter, while the erythrocyte sedimentation rate (ESR) was determined by Westergren's technique. C3 activator, C1 esterase inhibitor (C1-INH), IgA, IgG and IgM were estimated by the single radial immunodiffusion method. Wound swabs, blood cultures and biopsies were taken and sent for microscopic, culture and sensitivity analysis., Results: Patients with osteomyelitis had elevated total leucocytes, neutrophils, and platelet counts compared to the controls. There was also significant anaemia (t equals 3.17, p-value equals 0.002) and a significantly elevated ESR (t equals 3.75, p-value equals 0.000). Serum levels of C3 activator were significantly higher in patients with osteomyelitis (t equals 6.29, p-value equals 0.000). Although serum levels of C1-INH, IgG and IgM were higher in osteomyelitis, they were not significantly so. Serum levels of IgA were reduced in patients with osteomyelitis. Significant correlations between PCV and ESR (r equals -0.486, p-value equals 0.006), ESR and total WBC count (r equals +0.542, p-value equals 0.002), ESR and platelet count (r equals 0.445, p-value equals 0.013) and total WBC count and IgG (r equals 0.507, p-value equals 0.019) were noted ., Conclusion: Nigerian patients with osteomyelitis have similar clinical and laboratory features already described in literature, with some noted immune dysfunctions.

A bloodless field is important in many orthopaedic operations necessitating the use of a pneumatic tourniquet or Esmarch bandage. The outcome of the use of an Esmarch bandage for exsanguination and as a tourniquet in 112 consecutive patients who had elective orthopaedic operations on 131 limbs was evaluated. The setting was at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, from March 2003 to February 2005. The mean age of the patients was 25.7 + standard deviation years (range 1-70 years). The duration of tourniquet application ranged from 20 min to 2 h 35 min. Four limbs (3.1%) developed acute compartment syndrome; four (3.1%) had tourniquet paralysis with ulnar nerve involvement in three limbs. All limbs regained full neurological function following physiotherapy. There was wound infection in two limbs (1.5%). In spite of its drawbacks, the Esmarch bandage is still useful for exsanguination and as a tourniquet in orthopaedic surgery where there is no pneumatic tourniquet.

Background: The decision to attempt salvage or to amputate a severely injured limb is among the most difficult decision that the orthopaedist must face., Objective: To determine possible predictive factors that could become guides in taking decision for primary amputation as a first line treatment for trauma patients., Design: A prospective study of post-traumatic primary limb amputations., Setting: The Obafemi Awolowo University Teaching Hospital Ile-Ife, Nigeria from January, 2000 to December, 2004., Subjects: Sixty six trauma patients admitted through the Accident and Emergency Unit from January 2000 to December 2004., Results: Sixty six traumatised patient limbs were primarily amputated during the study period. The male: female ratio was 3.7:1 and means age was 28.6 years +/- 16.6(range: 4-71 years). 80.3% of the patients were below forty years. All the patients had a single limb amputation. The mean MESS score was 9.4 +/- 1.3 (range: 7.0-12.0). The main predictive factors in trauma at the emergency unit for primary amputation include age, sex, occupation, limb ischaemia, gangrene, severe open fracture, source or nature of injury, presence of shock, delay in hospital presentation, and MESS., Conclusion: Immediate amputation is often viewed by the patient and family as a result of the injury. Conversely, a delayed amputation may be viewed as a failure of treatment. Identified predictive factors for primary amputation will reduce trauma associated morbidity and mortality.

Background: Most reports on amputations in Nigeria have been on adults. Few published data exist on the causes of amputations in children., Methods: A retrospective analysis of all children who had limb amputations from January 1998 to December 2004 at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife was made., Results: Thirty five (32.7%) out of 107 patients who had major limb amputations were children. The mean age was 9.9 years. Trauma accounted for 74.3% of the amputations, 92.3% of which had developed gangrene from treatment of simple fractures by traditional bone setters. Fifty one point four percent of the amputations were in the upper limbs. The most common complications were anaemia (88.6%) and wound infection (68.6%). One patient had tetanus while one died from septicaemia. Only two patients had prosthetic fitting following amputation., Conclusion: Most amputations in Nigerian children are due to traditional bone setters who manage simple, straight forward fractures in children causing gangrene of the limbs.

Background: Septic arthritis is an important osteoarticular infection in children. There is insufficient data on its pattern of presentation and sequelae in our environment., Objective: To identify the aetiologic factors, patterns of presentation and sequelae of septic arthritis in Nigerian children., Methods: A retrospective analysis of the clinical, roentgenographic and laboratory records of children with septic arthritis admitted over a 14-year period to Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria was undertaken., Results: Ninety three patients with septic arthritis involving 104 joints with a mean age of 4.5 years +/- SD (range 2 months to 15 years) were studied. The most commonly involved joint was the hip (48.4%) though the shoulder was the most commonly affected joint in infancy (36%). Trauma (a history of fall and intramuscular injection) was associated in 28% of the cases. Staphylococcus aureus was the predominant aetiologic bacterial agent (50%) even in patients with sickle cell disease. Anaemia was a common complication (64.5%). The overall result of treatment was unsatisfactory as only 37.7% had complete resolution while most had varying degrees of joint destruction resulting in limb length discrepancy and ankylosis.

Many patients with Human Immunodeficiency Virus (HIV) Infection now live long due to the availability of antiretroviral drugs. This has resulted in many hitherto unknown complications being reported. We report a 56-year-old trader who presented with a seven-month history of pain in both shoulders and hips. Laboratory investigations and x-rays confirmed oesteonecrosis of both humeral heads and femoral heads in HIV/AIDS. She is presently on antiretroviral drugs and conservative management of her multiple joint disorders.

Background: Septic arthritis is a disabling disease that requires early diagnosis and prompt management for optimal outcome. Late presentations with deformities were noticed in our clinic. The aim of this study was to determine the pattern of septic arthritis in our environment., Methods: This was an 18-month prospective study in a Nigerian teaching hospital. Thirty-nine consecutive patients with 45 incidences of septic arthritis were studied. Joint aspirates were taken for microbiologic investigation., Results: Patient ages ranged between 0.5-60 years and the mean age was 7.4 years. The male to female ratio was 2.9:1, and the knee was the most commonly affected joint. The duration of symptoms before presentation ranged between 4-17 days with a mean of 11.1 +/- 3.6 days. Twenty-five (64.1%) of the patients were on inadequate antibiotics before presentation. Seventy-three percent of septic arthritis involving the upper limb joints occurred below the age of one year and 92.3% of the involved lower limb joints occurred after one year of age., Conclusion: The upper limb joints were significantly affected below one year of age and the joints of the lower limb were more involved after one year of age (p = 0.001). Improper prescription of antibiotics before presentation to the hospital was noticed in 64.1% and should be discouraged.

Background: Non-selective, non-steroidal anti-inflammatory drugs (NSAIDs) are effective in terms of pain relief and improving function in osteoarthritis. The advent of cyclooxygenase-2 (Cox-2) specific inhibitor, celecoxib, in the treatment of osteoarthritis has shown similar efficacy in relieving pain in osteoarthritis with low incidence of GI (Gastrointestinal) symptoms., Objective: To determine the efficacy and toleration of celecoxib in treatment of osteoarthritis in Nigerian population., Methods: Eighty patients were recruited from six tertiary health institutions scattered over Nigeria. A fixed dose of 200 mg celecoxib was administered daily with patient seen on the second and six weeks after commencement of study. Efficacy of the drug and safety were assessed during the study., Results: The patients had a mean age of 57.8 years with a standard deviation of 13.3 year. The mean weight was 74.7 +/- 14.9kg while the female sex constituted the majority (73.8%) of the patients. Using the physician global assessment of osteoarthritis instrument, 36.3% of the patients were rated as having poor arthritis score at baseline. This value reduced to 2.6% at second visit and 0.00% at end of the study respectively. There was no significant difference between the vital signs, haematological indices, renal and hepatic function at baseline and the final visit. There was no case of serious adverse effect., Conclusion: The study showed statistically significant improvements in the symptoms of osteoarthristis following the administration of Celecoxib 200mg daily for six weeks.

The severe deformities of the fingers seen in poorly treated or late presenting cases of paronychia stimulated this prospective study. The aim was to make early diagnosis and to find a simple method of draining the pus in the paronychia. This was a prospective hospital based study at the Wesley Guild Hospital (WGH) Ilesa for 9 months. Using simple materials like 23G or 21G needle, cotton wool, chlorohexidine solution, methlylated spirit and zinc oxide plaster, abscess in acute paronychia was drained by lifting the nail fold with the tip of the needle. Ten cases of paronychia in 8 patients were drained with the method. Combination of the early drainage and antibiotics showed that all the patients were relieved of pain and could use their fingers normally within 2 days. There was no need of anesthesia and daily dressing. The drainage technique is simple and effective. The early drainage prevents the occurrence of any form of complication.

Acute compartment syndrome is associated with tibial fractures and failure to diagnose it leads to grave consequences. This study was conceived with the aim of determining the intra-compartmental pressure in adults with closed tibial fractures and intended to provide early diagnosis of acute compartment syndrome. The Whitesides injection method was used, using hospital [corrected] available materials. The intra-compartmental pressure in the anterior and deep posterior compartments of 52 patients with closed tibial fractures was measured at presentation and 4 hourly for 24 h. In three patients, the pressure was very high, and the differential pressure (i.e. the difference between the diastolic blood pressure and the intra-compartmental pressure) was less than or equal to [corrected] 30 mmHg, which was diagnostic of acute compartment syndrome. They were all treated by fasciotomy. It is concluded that Whitesides' [corrected] method can be used to diagnose acute compartment syndrome. The apparatus is easy to set up, cheap [corrected] and therefore ideal for use in our environment where sophisticated devices of tissue pressure measurement are not available.

In Caucasians, the range of normal intracompartmental pressure of the leg is from 0 mmHg to 15 mmHg. In the literature, such measurements have not been done in Africa to identify normal leg intracompartmental pressures. We have sought to identify the normal range of pressures in such a population of Nigerians, and to demonstrate the reproducibility of the Whitesides injection technique with materials that are easily available in most hospitals so that compartment syndromes could be identified promptly and inexpensively in developing countries. We performed a 16-month hospital-based prospective study at Wesley Guild Hospital in Ilesa, Osun State, Nigeria, to measure the intracompartmental pressures in the anterior and deep posterior compartments of 49 contralateral uninjured legs of patients with closed contralateral tibial fractures, measured at presentation. The Whitesides infusion technique was used with the aim of determining the normal range of compartmental pressure in Nigerians. The anterior compartment pressures ranged from 3 mmHg to 18 mmHg with a mean 7.6 +/- 2.6 mmHg. The pressure in the deep posterior compartment ranged from 3 mmHg to 14 mmHg with mean of 7.4 +/- 2.7 mmHg. The values are similar to those reported in the literature. There was no statistically significant difference between the pressures in the two compartments (p = 0.668).

Background: The objective of this study is to determine the pattern of bacterial isolates and antibiotic sensitivity profile in open fractures. Fifty-nine patients with open fractures of the lower limb long bones were studied. The majority of the cases were Gustilo and Anderson types II 21(35.6%), and IIIA 16(27.1%)., Method: The patients were assessed by history taking, physical examination, and plain radiographs. Wound swabs were taken for bacteriological studies. Other necessary investigations were also done. During wound debridement open fractures were classified into Grades I, II and III using the Gustilo-Anderson method of classification., Results: The infection rate was 45.8%. Gram-positive cocci and Gram-negative rods were isolated. On the whole Staphylococcus aureus 13(25%), and Coagulase-negative staphylococci (CONS) 14(26.9%), were the commonest organisms isolated. The commonest Gram-negative rods that were isolated from the wounds were Proteus mirabilis 9(17.3%), and Pseudomonas aeruginosa 8(15.4%). Multiple organisms were commonly isolated from the wounds. While all the organisms isolated showed very good sensitivity to gentamicin, cloxacillin and ofloxacin, most of the organisms were resistant to penicillin, ampicillin and tetracycline. The sensitivity ranged from 62.5% to 100%. Coagulase-negative Staphylococci (CONS) showed sensitivity to the widest range of antibiotics which included penicillin, ampicillin, chloramphenicol, gentamicin, cloxacillin and ofloxacin. The sensitivity ranged from 35.7% to 100%. There was statistically significant difference between the open tibial and femoral fracture cases with respect to the interval between injury and debridement time (p = 0.008); the rate of wound infection (p = 0.021); and the occurrence of osteomyelitis (p = 0.023). The commonest complications observed were wound infection 27(45.8%), and delayed fracture union 26(44.1%), which were commoner in the open tibial fractures., Conclusion: This study shows that Staphylococcus aureus and coagulase-negative staphylococci (CONS) were the commonest organisms associated with open fracture of the lower limbs in our centre and that delay in the initial wound debridement was a major predisposing factor to wound infection.