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   Table of Contents - Current issue
Coverpage
July-December 2018
Volume 17 | Issue 2
Page Nos. 45-97

Online since Thursday, January 24, 2019

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EDITORIAL  

From the Editor's desk p. 45
Kenechi Anthony Madu
DOI:10.4103/njot.njot_31_18  
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ORIGINAL ARTICLES Top

Total hip replacement for management of severe osteoarthritis in a developing country: A 5-year assessment of functional outcome in 72 consecutive hip p. 46
Amechi Uchenna Katchy, Somtochukwu Chike Katchy, Henry Ekwedigwe, Ifeanyi Ezeobi
DOI:10.4103/njot.njot_12_18  
Background: Outcome assessment of joint replacement procedures allows providers and patients to evaluate the quality of services delivered, thereby adding value to the services provided. Objective: The study is to describe the pattern of presentations of our patients with hip osteoarthritis who had undergone cementless total hip replacement (THR), assess the outcome using the Harris Hip Score (HHS), and identify any variables that affect the outcome. Patients and Methods: The study was carried out at Davidson and Judith Consultants Clinics, Enugu, Nigeria. A total of 72 THRs, in 62 patients, carried out between 2008 and 2013 were reviewed. These patients were assessed using preoperative HHS (pre op HHS) and postoperative (post op HHS) administered at 1 year and 5 years. Results: There were 62 patients and 72 cementless THRs. Ten (16.13%) patients had bilateral conditions; 25 (40.32%) patients had right THR, while 27 (43.55%) patients had left THR. Twenty (32.26%) patients were males and 42 (67.74%) were females. Male:female is 1:2.1 patients. The most common cause from the study is still primary osteoarthritis which accounts for 51.6%, while the least is avascular necrosis (AVN) of the head of femur seen in hemoglobinopathy (22.58%). Those following idiopathic AVN are slightly higher (22.58%), while posttraumatic is 25.81%. The comparison of means of HHS shows pre op HHS and post Op HHS at 1 year has P = 000 (P < 0.05). Pre op HHS and post op HHS at 5 years has P = 0.000 (P < 0.05). The comparison of HHS means for gender shows male pre op HHS and female pre op HHS at 1 year has P = 0.341 (P > 0.05). The comparison of HHS means for morbidity shows comorbidity post op HHS and no comorbidity post op HHS at 1 year had P =0.320 (P > 0.05). Conclusion: Our patients presented at a younger age with secondary osteoarthritis secondary to hip joint affectations such as trauma and AVN and they benefited from our intervention with very low complication rate.
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The effective diagnosis of chronic monoarthropathy: What are our options? p. 53
V Anil, Supreeth Nekkanti, Abhimanyu Kukralia, Ramneek Mahajan, Arun Mahtani
DOI:10.4103/njot.njot_13_18  
Introduction: Monoarticular arthritis which means inflammation, (infective or non-infective) of single synovial joint is a huge burden in the health care system. Chronic monoarthritis is characterized by its progressive onset and slow development, commonly presenting with mild inflammatory signs. The clinical presentation is usually nonspecific especially in the early stages. To evaluate the role of clinical, hematological and immunological features in the diagnosis of peripheral large joint monoarthritis and its correlation with radiographic studies and histopathological studies of the same. Materials: A total of 30 patients of a monoarticular joint disease were studied in which conventional radiography, MR imaging, arthroscopy and synovial biopsy as techniques for its diagnosis were compared. Results: The mean age in the present study was 21.23 years with a preponderance of male patients. MRI was found to have high sensitivity (87.5%) and specificity (85.7%) in the diagnosis of chronic inflammatory synovitis. Arthroscopy wasfound to have a sensitivity of 83-85% and specificity of 85-86% in diagnosing both inflammatory and infective synovitis. Conclusion: MRI is recommended as additional techniques in the initial diagnostic evaluation when radiography yields negative results. When assessed together with ahistopathological examination of the synovium and mycobacterial cultures, MRI imaging forms a powerful tool in diagnosing tubercular synovitis early. Arthroscopic joint evaluation should be used wherever feasible for a complete evaluation of the knee joint along arthroscopic guided biopsy. Not only does it increase the diagnostic yield of the biopsy but can also diagnose other associated conditions.
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Morphometric analysis of calcaneal angles in Igbos of south east of Nigeria and its clinical implication: A plain x-ray study p. 64
Amechi Uchenna Katchy, Ngozi Rosemary Njeze, David Okoroafor
DOI:10.4103/njot.njot_15_18  
Introduction: The calcaneum is repeatedly subjected to static and dynamic stresses especially in the weight-bearing positions during walking, working or running and this is reflected in the trabecular pattern within the calcaneus. There are six radiological angles associated with this bone notably the Böhler (tuber joint) angle (BA) and Gissane's angle (GA), and they vary in different ethnic population. Aim: This is to determine the calcaneal angles among the ethnic Igbos of South Eastern Nigeria, determine the relationships between these angles, determine any correlation with gender and age, compare the values of the BA and GA to that of other populations and discuss the clinical implications of the determined values. Methodology: A 5-year review of all lateral views of X-rays of the foot and ankle done at Federal Teaching Hospitals, Abakaliki, Nigeria, from 1st January 2012 to 31st December 2016, was done. Drawing and mathematical sets were used to measure the six radiological angles on the lateral views of plain X-ray films of the ankle and subjected them to descriptive and inferential statistics. Results: There were 120 patients, 65 males and 55 females. The calcaneal angles among the ethnic Igbos of South Eastern Nigeria showed the following: BA: 32.58 ± 4.98, GA: 121.22 ± 6.11, calcaneal compression angle: 30.00 ± 3.01, talocalcaneal angle (TCA): 22.58 ± 5.28, calcaneal pitch angle: 17.35 ± 3.79 and apical angle (AA): 67.24 ± 7.27. There was no relationship between these angles. The TCA and AA showed a correlation with gender and age and other angles did not. There was a statistically significant difference between BA values in this study and that of Ugandan and American populations (P < 0.05). There was a statistically significant difference between the GA values in this study and that of Turkish, New Zealand and Indian populations. Conclusion: These determined values would be a useful tool in the management of patients of Igbo extraction with of the foot pathology.
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Attitude of orthopaedic surgeons to the e-patient: Experience from a developing country p. 72
Oluwadare Esan, Kehinde Sunday Oluwadiya, Sunday Ogunsuyi Popoola, Ranti O Babalola, Eyitayo O Alabi
DOI:10.4103/njot.njot_22_18  
Background: Increasingly, more patients are obtaining medical information from the Internet with which they are confronting their physicians. Very few studies have been reported from developing countries concerning physician's attitude to such patients, and to our knowledge, none has been reported from Sub-Saharan Africa. This study looked at the attitude of Nigerian orthopaedic surgeons to such patients. Methods: This was a questionnaire-based interview of orthopaedic surgeons and their trainees at the 2013 annual conference of the Nigerian Orthopaedic Association in Lokoja, Nigeria. It was supplemented by an online Google form survey. Results: One hundred and twelve questionnaires were returned, and seven were incompletely filled and were discarded, leaving 105 for analysis. About 94.3% of the respondents have had previous encounters with e-patients. The mean attitude score was high (3.64 ± 0.46, the highest obtainable was 5.0). Consultants and orthopaedists in semi-urban settings scored higher than other categories. The physician's self-esteem and efficacy of using the Internet correlated highly with their attitude to e-patients. Similarly, self-esteem, the frequency of using the Internet and the experience of the way e-patients have been presenting their information (print, verbal or electronic) were the significant predictors of physicians' attitude to e-patients. Conclusion: Orthopaedic surgeons and their trainees practising in Nigeria frequently encounter patients with Internet-based medical information at consultations. Most of them have high positive attitudes towards these patients. There is a need for these doctors to become skilled in online information handling to become better at guiding such patients.
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Non-union treatment outcomes in South-East Nigeria p. 77
Kenechi Anthony Madu, Henry Nnyagu, Osita Ede
DOI:10.4103/njot.njot_23_18  
Introduction: Management of non union of long bones can be challenging and frustrating for the orthopaedic surgeon. In sub Saharan Africa, the bulk of surgeries done by the orthopaedic surgeon may include a significant number of non union of long bones. This is largely because of the strong affinity for seeking treatment from the traditional bone setter as the first on call following fractures in most cases. The orthopaedic surgeon frequently gets to manage the complications arising from such treatment. In managing such cases, adjunctive therapies targeted at increasing union rates which are available to surgeons elsewhere are frequently lacking. Methodology: The study was aimed at determining the outcome of surgeries done for non union of long bones in our institution. It was a retrospective study spanning a 3 year period, from April 2013 to March 2016, involving 80 patients who presented with non union of any of the 3 long bones which had not previously been surgically managed. The patients had surgery with plate / screw construct or a solid intramedullary nail. Outcome measures analysed included occurrence of union, time to union and occurrence of complications with each treatment method for the 3 long bones. Results: We recorded a union rate of 79.2% for all 3 long bones. Majority of the femoral non unions were nailed while the humerus was more commonly plated. The humerus did better with plating than it did when nailed, though nailed non unions were observed to unite faster. Femoral non unions united better when nailed than when plated, though the difference was not statistically significant. Complications rates were higher following plating for femoral non unions. Complications following humeral non union plating were also higher than observed for nailing, with radial nerve palsy occurring in 23.5% of platings. Tibial non unions demonstrated high union rates irrespective of treatment method used. Conclusion: In conclusion, management of non union of long bones is still a challenge with a recurrence rate of 10.8%. Humeral non unions do better when plated as opposed to the femur. Tibial non unions do well with either plating or nailing.
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Disability in adult patients with chronic low back pain in a north central Nigerian hospital p. 81
Namgwa Joseph Kortor, Fidelis T Iyor, William T Yongu, Itodo C Elachi, Daniel D Mue
DOI:10.4103/njot.njot_29_18  
Background: Chronic low back pain (CLBP) is a common health problem that is often associated with physical disability and reduced quality of life. Functional disability is the inability to perform age-approximate physical, mental and social activities of daily living. It is, therefore, pertinent to determine the prevalence of disability in patients with CLBP as this will help clinicians to look out for risk factors associated with disability and thus facilitate management decisions. Aim: The aim of this study is to determine the prevalence and level of disability in patients with CLBP. Patients and Methods: Patients with CLBP observed at the orthopaedic clinic of Benue State University Teaching Hospital, Makurdi from June 2016 to February 2017 were recruited for this study. A designed questionnaire was used to collect data. Oswestry low back pain disability questionnaire was used to assess the level of disability. Results: A total of 126 patients with CLBP were evaluated, consisting of 45 males (35.7%) and 81 females (64.3%) with a male:female ratio of 1:1.8. The prevalence of disability in patients with CLBP in this study was 78.6%. 66 (52.4%) of patients had a moderate disability, 32 (25.4%) of patients had a severe disability, 27 (21.4%) of patients had mild or no disability and only one patient (0.8%) was crippled. There was a significant association between the age and level of disability (P = 0.001). Conclusion: Disability in patients with chronic back pain is a common health problem in our environment. Determination of disability prevalence will create more awareness for the need to assess risk factors and evaluate the effectiveness of various treatment options.
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CASE REPORTS Top

Percutaneous laser lumbar disc decompression p. 85
Sunday Onimisi Salami, Adedayo Gbolahan Osholowu, David Anuoluwapo Oyeniran
DOI:10.4103/njot.njot_16_18  
Acute or chronic back and neck pain is a major social, economic and healthcare issue in all communities. Nearly 80% of the population experiences backache during their lifetime. Percutaneous laser disc decompression (PLDD) is one of the minimally invasive methods for treating low back pain. There have been numerous reports of its use since the first case in 1986, and the indications are expanding daily. We present a case of a 38-year-old banker with chronic prolapsed intervertebral disc who had 7-year history of recurrent low back pain from prolapsed L4–L5 intervertebral disc with radiculopathy. She had PLDD procedure in our clinic under local anaesthesia as day case. After the procedure, the patient was observed for 4 h and discharged home. She felt significant pain relief after the operation and was placed on a lumbar corset for a week. The pre-surgery assessment using Oswestry Low Back Pain Disability Index was 58% (severe disability) but was reduced to 26.7% (moderate disability) after 3-month post-surgery follow-up. At 12-month follow-up, the Oswestry score was 16% and the patient outcome was good according to MacNab's criteria. PLDD is safe and effective for the treatment of low back pain seen in the post-operative result of this presented case.
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Seat belt syndrome p. 89
Kelechukwu M Onuoha, Kingsley K Ekwe, Ikechukwu Anosike, Bolarinwa Akinola, Felix E Ogedegbe
DOI:10.4103/njot.njot_26_18  
Seat belt syndrome is a term used collectively for all injuries associated with the use of seat belts during motor vehicular accident. It usually presents with seat belt sign with associated intra-abdominal, thoracic, pelvic and spinal injuries. A 42-year-old male presented to our hospital 15 h after a head-on collision with an oncoming vehicle. He was the driver of a saloon car and was seatbelted at the time of the accident. He sustained multiple injuries which included blunt abdominal injury, multiple rib fractures and right femoral fracture. Examination revealed the seat belt sign on both anterior chest and abdominal walls and progressive abdominal distension with right femoral fracture. Chest, brain and abdominal computed tomography scans confirmed the diagnosis. He subsequently had an exploratory laparotomy and damage control orthopaedics in which an external fixator was applied to the right femur and a locked intramedullary nail thereafter. He recuperated and discharged home 26 days after the accident. Patients who present with a seat belt sign on the anterior chest or abdominal wall following a motor vehicle accident should be managed with a high index of suspicion for seat belt syndrome. Thus, the presence of any of the injuries mentioned should warrant a search for other associated injuries. With increase in the compliance of seat belt use amongst car users in Nigeria, there will be a rise in seat belt syndrome, There is need to create more awareness about seatbelt syndrome and a classification system would help to know its severity.
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A case of hip disarticulation following parenteral narcotic abuse and literature reviews p. 93
Michael Ebiyon Ugbeye, Kehinde Adesola Alatishe, Olayinka Olawoye
DOI:10.4103/njot.njot_27_18  
Pentazocine is one of the commonly prescribed narcotic analgesics for acute pain management such as post-operative or post-traumatic pain in developing countries. It has a high potential for abuse due to its euphoric effect. This abuse can lead to cutaneous, vascular, respiratory and central nervous system complications. Vascular complications include pseudoaneurysm formation, deep venous thrombosis, arteriovenous fistula, infected thrombi, arterial embolisation, infective endocarditis and gangrene. However, reports of amputation surgery for vascular complications following pentazocine abuse are few in the literature. We report a case of lower limb gangrene following a chronic abuse of self-administered injection pentazocine in a 38-year-old female who inadvertently ruptured her right femoral artery pseudoaneurysm. She had ligation of the bleeding vessel and an iliofemoral bypass surgery with synthetic polytetrafluoroethylene graft. This salvage procedure failed due to graft thrombosis, and she eventually had a right hip disarticulation.
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