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Amputation is a common surgical procedure in Nigeria but there are no national data on the subject The objective was to determine the common indications for amputation in Nigeria, mortality rate, and regional differences in indications. Results of studies on amputation in Nigeria over a 15-year period were collated and analysed. The most frequent indications for amputation were trauma (34%); complication of traditional bonesetting (TBS) (23%); malignant tumours (14.5%); diabetic gangrene (12.3%); infections (5.1%); peripheral artery disease (2.1%); and bums (2.1%). In the southern regions, trauma is the most common indication while complications of traditional bonesetting are the most common in the northern and eastern regions. The average age of the Nigerian amputee is 33 years. Hospital mortality after amputation is 10.9%. The estimated prevalence of extremity amputation in Nigeria is 1.6 per 100,000. Peripheral artery disease is an uncommon indication for amputation in Nigeria while trauma, complication of traditional bonesetting, malignant tumours and diabetic gangrene are relatively much more common. The young male is frequently affected. [ABSTRACT FROM AUTHOR]

Background: Eye injuries are major causes of visual morbidity and monocular blindness worldwide. The common causes of eye injuries needs to be well defined in each community so as to plan for prevention of high morbidity and blindness as part of blindness prevention programme., Objective: It is necessary to compare the trend in causes of ocular injuries in Ogun State after a similar study over 15 years before. The part played by road traffic accidents [RTA] compared to other causes is also to be analysed., Methodology: This prospective study was carried out between July 2004 and June 2005. All cases presenting to the Accident and Emergency Unit and Eye Clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu, and the 2 private eye clinics in Sagamu town, presenting with any form of eye injuries during the study period were included. The biodata, cause and type of eye injury, time of injury, time of presentation and treatment offered were obtained using a questionnaire. The results were analysed with Epi-Info 2002., Results: One hundred and twelve patients were studied. Eighty-one [72.3%] of the victims were males; most of them, 36[33.0%] were students and 32 [29.4%] artisans. The common causes of eye injuries were RTA 35[31.3%], assault 22[19.6%], vegetative agents 18 [16.1%] and machine tools 11[9.8%]. Most patients presented either within 24 hours, 56[50.0%] or within a week, 34[30.4%] of injury, and mostly during the day 86[97.6%]. Most injuries were found in the anterior segment 95[84.8%] and most commonly, victims 65[58%] required only medications as treatment., Conclusion: Majority of eye injuries found in Sagamu are treatable and can be handled by an experienced non-ophthalmologist successfully and most are now accounted for by RTAs and assault which indicate some changes in common causes compared to previous studies in Nigeria.

Aims and Objectives: The study was aimed at identifying the pattern of skeletal trauma in the paediatric age group as it relates to the causes., Materials and Methods: A retrospective analysis of the records on the request cards, case notes, radiographs and reports (where available) of all children aged one day to 15 years who were referred to the radiology department of Olabisi Onabanjo University Teaching Hospital, Sagamu was carried out. Fractures were analysed with respect to sex, age, causes, type and location of fracture., Results: The analysis spanned a period of twenty-eight months during which a total of three hundred and twenty eight radiographs were analysed. The mean ages of male and female patients were 5.4±4.6 and 5.1±4.6 years, respectively, with a range of 0.2-15 years. Normal radiographs were found in 124 (37.80%) patients,53.1 (16.1%) had 55 fractures, and 39 (11.9%) had soft tissue swelling. Fractures were found most commonly in male children and in the age range 4-6 years. Fractures occur three times more in the upper limbs, and the bones most frequently affected are the humerus, radius, and the ulna in descending order. Most of the fractures were due to Road Traffic Injury (RTI) seen in 18.9%, falls seen in 18.9%, and birth trauma, which was responsible for 7.5%. The most frequently involved bone in fractures is the humerus followed by the femur bone. Skull fractures occur mostly in the parietal bone., Conclusions: Fractures are still mostly investigated with plain radiographs. Fractures are more frequent in male children and in the 4-6 year age range; it is seen more in the upper limb bones especially in the humerus. Skull fractures are relatively rare. Half of the fractures occur in the distal and mid portions of long bones. This study has also high lighted the importance of road traffic injury and falls as aetiological factors in fracture occurring in children. Effort should be made to ease deliveries in order to reduce the incidence of birth trauma.

Background: Attention is rarely given to patients' opinions regarding the quality of care they received, which is an important feedback to healthcare providers, planners and policy makers., Aim: To assess how patients who survived life-threatening/emergency conditions percieved the quality of care they received., Method: This prospective study was carried out among adult patients who had received emergency care at the Accident & Emergency (A & E) unit of Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, between March and December 2004 using a semi-structured questionnaire., Results: There were 1129 respondents, 81 males and 48 females. Their mean age was 35.3 years. 62% were treated for surgical, and 37.2% for medical emergencies. The mean duration of stay at A & E was 2.4 days. Although 91% of the respondents regarded available equipments as very adequate, 38.8% perceived the overall quality of care as sub-optimal. Many of the patients were displeased with their interactions with care providers. They longed for urgent improvement in waiting time, speed of issuing drugs, imterpersonal relationship with health workers and attending to emotional distress of emergency victims. They also wished to have free treatment during emergencies, Conclusion: Majority of the patients who received care in A & E of this tertiary hospital perceived the quality of care received as satisfactory. However, a substantial proportion regarded the quality of care as sub-optimal. Although most thought equipments were adequate, many of them expressed displeasure with their interactions with care providers. To improve patient's satisfaction with emergency care, greater emphasis needs to be placed on enhancing the interpersonal relationships between health workers and patients than is currently done.

Background: Elective orthopaedic operations on the knee is rarely complicated by arterial injury., Report: A case report is presented of a 10 year old girl that developed gangrene of the foot following an elective orthopaedic operation on the proximal tibial metaphysis. A transfixion wire that breached the posterior tibial cortex was most probably responsible for popliteal artery injury that resulted in ischaemia and gangrene. The patient had an amputation of all the toes in the affected limb and recovered satisfactory limb function., Conclusion: In operations on the proximal tibial metaphysis, implants (screws, pins, wires) should not be allowed to perforate the posterior cortex. When this occurs inadvertently, they should be readjusted as soon as radiographs confirm this, to avoid injury to the popliteal artery.

Objective: To investigate the efficacy, tolerability and cost effectiveness of three antibiotics in a short-term antibiotic regimen in patients undergoing elective implant surgery., Patients and Methods: 89 patients who underwent 101 implantation procedures were enrolled during a period of five years and randomly divided into three groups to receive: (a) Rocephin (Ceftriaxone) 1g intravenously at induction and 1g 12 hours later (Group 1). (b) Zinacef (Cefuroxime) 1.5 g intravenously at induction and 750 mg six hourly for 12 hours (Group 2). Ciprotab (ciprofloxacine) 400mg intravenously at induction and 200mg six hourly for 12 hours (group 3)., Results: The patients in the three groups were comparable regarding age, gender, pre-operative length of hospitalization and duration of surgery. The overall surgical site infection rate was 6.9% (7/101) with gram-negative organisms being the most common causative organisms (71.4%). The infection rates of 6.3% in group 1,7.3% in group 2 and 7.1% in group 3 show no statistical significance (P>0.05). The cost benefit ratio for the three drugs showed that treatment with Ciprotab was cheaper than that with Rocephin or Zinacef. Severe complications warranting discontinuation of therapy did not occur in any of the three groups of patients., Conclusion: While we can safely conclude that all the drugs have similar efficacy and safely in preventing post-operative wound complications, it appears that Ciprotab is most cost-effective. We recommend that a larger study be undertaken to confirm the predominance of gram-negative organisms in implant surgery.

Background: Controversy exists about the bacterial pathogen that is most often associated with osteomyelitis in major sickling haemoglobinopathies, that is, HbSS, HbSC, and HbSthalassemia., Objective: To determine the existence of regional or continental differences in the prevalence of bacterial pathogens associated with osteomyelitis in sickling haemoglobinopathies., Method: A meta-analysis is done of 11 year hospital data set and published studies in African Journals Online (Ajol) and Pubmed electronic databases on the subject., Results: Fifteen studies including two hundred and eighty one bacterial pathogens from SubSaharan Africa, United States, Europe and the Middle East were analysed. There were 129 (45.9%) salmonellae, 82 (29.2%) Staphylococcus aureus, 55 (19.6%) other Gram negative bacilli (GNB) and 15 (5.3%) other Gram positive cocci (GPC). There were 117 isolates in the studies from Africa out of which salmonellae accounted for 21.4%, S. aureus 38.5%, other GNB 34.2% and other GPC 6%. In contrast, out of 110 isolates in the studies from the USA, salmonellae were 70%, S. aureus 16.4%, other GNB 9.1% and other GPC 4.5%. Salmonellae and S. aureus accounted for 37.9% and 62.1%; 64% and 4.9% in isolates from the Middle East and Europe respectively., Conclusions: Salmonellae are the most common bacterial pathogens of osteomyelitis in major sickling haemoglobinopathies in the USA and Europe whereas Staphylococcus aureus is the most common pathogen in SubSaharan Africa and the Middle East. The worldwide prevalence of salmonella may be reducing while that of S. aureus may be increasing. Possible reasons for this observation are suggested.

Background and Objectives: This study is aimed at identifying the characteristics of injuries and determining the efficiency of documentation of patients' records in a tertiary hospital where there is no trauma registry., Patients and Methods: A retrospective case record analysis was conducted of injured patients seen at the Accident and Emergency unit over a 12 month period from January to December 2003., Results: A total of 1078 records of injured patients that attended the A&E were analysed. Their mean age was 31 years (range 3 months to 85 years). Laceration (n = 408) and fractures (n = 266) representing 62.5% of injuries were seen. Injuries to the lower limb occurred in 239 patients, multiple anatomical sites 224, head 224, upper limb 203, the neck 20, and the abdomen 11 patients. Trauma was due to road traffic accident in 977 patients, fall in 39, assault in 14 while burns and firearm injuries occurred in 5 and 7 patients respectively. The mean injury severity score (ISS) was 4. Severe injuries, ISS > 15 occurred in 54 patients with mean ISS of 21, and resulted from RTA in 92.6% of cases. Mortality from severe injuries occurred in 31.5% of cases while overall mortality was 2%. Most deaths were associated with multiple injuries (60.9%) and head injury (30.4%). Incomplete documentation of accident and injury data occurred frequently, from 2% of some data to 100% of others., Conclusions: Lacerations and fractures were the most common injuries. Mortality is due usually to head and multiple injuries. Research into appropriate strategies for prevention of injuries, especially RTA, is required but this must start with the establishment of institutional and regional trauma registries for complete documentation of relevant data.

Background: Data on utilization of paediatric surgical services and the burden of paediatric surgical diseases in the West African subregion is scarce., Methodology: This retrospective study describes paediatric surgical admissions in a Nigerian teaching hospital between January 1998 and December 2002., Results: Two hundred and eighty three children up to 15 years of age with surgical disorders were studied. Their mean age (+/- SD) was 5.8 +/- 4 years for males and 6.9 +/- 4 years for females. Length of stay (LOS) ranged from 1 to 127 days (mean 17 days). Turnover interval declined from 22.1 to 6.4 days while percentage bed occupancy and patients per bed per year averaged 70% and 17.4 respectively between January 2000 and December 2002. The highest mean LOS was due to malignant neoplasm (38 +/- 12 days), trauma (22 +/- 25) and surgical infection (21 +/- 22 days) while the shortest mean LOS was due to foreign body (6 +/- 4 days). The most common admitting diagnoses were trauma (36.7%), congenital anomalies (27.9%) and surgical infections (22.6%). Foreign body (2.1 %), benign tumours (0.7%) and malignant neoplasms (0.7%) were uncommon. Overall mortality was 0.4%., Conclusions: Childhood injuries, congenital anomalies and infections are important paediatric health problems.

The benefits of utilisation of guidelines for radiographic skull examination of head injured patients were studied in one hundred and eleven patients. The causes of head injury were road traffic accidents (RTA) 87.4%, fall and assault 4.5% each, collapsed wall 1.8%, gunshot injury and industrial accident 0.9% each. RTA resulted predominantly from burst tyre 34%, vehicle pedestrian accidents 23.7% and vehicle collision 18.6%. Compliance with the use of the guidelines was 48%. Radiographic skull examination was carried out in 22 patients (20% of study population) and the positive yield for skull fracture was 32% (7/22 of all radiographs). At discharge, 14 of those who had radiographic examination (n=20) recovered without neurological complications while 39 among those not examined (n=58) similarly recovered, p=0.96. Among those who had skull radiography, neurological deficit occurred in 6 that had skull fractures (n=7) and in 5 of those without skull fractures (n=13), p=0.07. It was concluded that radiographic skull examination based on selective guidelines increases the yield of skull fractures and reduces unnecessary examinations, thereby saving costs. Skull radiography may not be predictive of neurological outcome of treatment. Cranial computed tomography (CT) should be obtained if available and clinically indicated.

In clinical orthopaedic practice, many patients are seen presenting with complications after being treated by traditional bone setters (TBS). These complications do not seem to deter other patients from patronising the TBS rather than modern orthopaedic service (MOS). Basic beliefs about TBS in particular and traditional healers (TH) in general are likely to be responsible for their continuing popularity. One hundred and eighty adults and adolescents were surveyed by means of interviewer administered questionnaires at a popular motor park, traditional and modern health facilities. While 37% (n = 67) of the respondents believe that TBS are indispensable (cannot do without), 32.8% (n = 65) believe they are desirable (can do without though useful) and 11% (n = 20) thought they are nuisances and fraudsters. Forty three per cent of them felt that TBS are competent or very competent, 24% adjudged their practice satisfactory (good but with some deficiencies) and 23% believe they are either incompetent or very incompetent. Education did not seem to influence these beliefs as the expressed opinion on the indispensability/desirability of TBS by those who had no formal education was similar to that of those who had primary education, p > 0.5, and College/University education, p) 0.1. The services of the TBS were thought to be cheaper (n = 103) than MOS (n = 36) although more (n = 120) believe that doctors explain the causes of injuries and illness rather than TBS (n = 35). The community opinion of TBS, irrespective of educational status, is probably predominantly positive in addition to their services being thought to be cheaper than modern orthopaedic service, hence their continued relevance in the treatment of musculo skeletal injuries and diseases.