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   Table of Contents - Current issue
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January-June 2018
Volume 17 | Issue 1
Page Nos. 1-43

Online since Monday, July 30, 2018

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EDITORIAL  

NJOT: A new dawn p. 1
Kenechi Madu
DOI:10.4103/njot.njot_19_18  
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ORIGINAL ARTICLES Top

Evaluation of uncomplicated isolated extensor tendon injury repair of hand in Amritsar (India) p. 2
Hemant Kumar, Parul Rani, Ravider K Banga, Randhir Singh Boparai, Jaspal Singh
DOI:10.4103/njot.njot_3_17  
Introduction: Extensor tendon injury is one common hand injury occurring in young individuals. Extensor tendons are superficially located with minimal amount of subcutaneous tissue that predisposes the extensor mechanism to more complex tendon injuries. Surgical repair of extensor tendon requires an exact knowledge of anatomy, careful adherence to some basic surgical principles, sound clinical judgment, strict atraumatic surgical technique and a well planned postoperative programme. Aim and Objectives: We conducted this study to find out common causes of extensor tendon injuries, evaluation of hand function after repair of extensor tendon injuries and evaluation of effect of time elapsed between onset of injury to tendon repair on the final outcome. Methodology: The functional outcome after tendon repair was assessed by calculating Total Active range of Motion (TAM). Results: We concluded that the higher percentage of excellent and good cases is might be attributable to strong and meticulous repair in which more aggressive physiotherapy was tolerated by the patients and the tendons should be repaired preferably primarily.
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Orthopaedic subspecialisation: The Nigerian experience p. 8
Peace Ifeoma Amaraegbulam
DOI:10.4103/njot.njot_2_18  
Purpose: Globally, Orthopaedic Surgery is not left out in the trend towards subspecialization in the surgical specialties. This study aims to determine the current perception and practice of subspecialization in Orthopaedics by the Nigerian Orthopaedic surgeon and to make recommendations on the way forward. Methods: A questionnaire was designed and distributed among Orthopaedic surgeons of different cadres. One hundred and twenty (120) questionnaires were sent out and 107 of those were recovered. Their responses were collated and the resulting data was analyzed using the IBM SPSS version 21. Results: One hundred and three (103, 96.3%) of the respondents were males and 4 (3.7%) were females. Eighty-eight (88, 82.2%) were consultants; 98 or 91.6% worked in government facilities. Thirty-eight (38, 35.5%) said they were subspecialists. Ten (10) had subspecialty training 6 months or longer. Nine (9) had more than 75% of their practice in their subspecialty. Twelve (12) subspecialists were satisfied with their level of knowledge while eleven (11) were satisfied with their output. Most of the respondents (103, 96.3%) desired that the subspecialty training should be made mandatory while 102 (95.3%) wanted it incorporated into the regular Orthopaedic training in Nigeria. Conclusions: There is need to standardize the definition and training of Orthopaedic subspecialists in Nigeria, in order to improve the quality of practice and enhance the output and satisfaction among subspecialist surgeons. Postgraduate training in Orthopaedic subspecialties is advocated.
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Orthopaedic implant removal: Epidemiology and outcome analysis p. 12
Chikwendu Nwosu, Taofeek Olanrewaju Adeyemi, Oni Nasiru Salawu, Joseph Olorunsogo Mejabi, Abidemi Abiola Fadimu
DOI:10.4103/njot.njot_3_18  
Background: Implant removal represents one of the most common operations in bone and joint surgery. After fracture union, the implant loses its purpose and continues to exist only as a foreign object inside the patient's body and the question arises whether the implant should be removed, and if so, why and when. While early implant removal increases the risk of re-fracture, delayed removal may result in more difficult and extensive operating procedures, due to a stronger bony integration and overgrowth on implants. This will provide essential information needed for hospital policy formulation. Aims and Objectives: The aim of this study is to determine the prevalence, indications and outcomes following orthopaedic implant removal and to proffer appropriate solutions. This will provide essential information needed for hospital policy formulation. Patients and Methods: This is a retrospective study of all cases of implant removal performed in the Orthopedic Unit of Federal Medical Center and Surgery Department of Sir Yahaya Memorial Hospital all in Birnin Kebbi, Kebbi State, North-western Nigeria from January 2011 to December 2017. Case notes of the patients were retrieved and relevant information was extracted and analysed. Results: A total of 113 implants were removed from 111 patients. There were 78 males and 33 females, with a male to female ratio of 2.4:1. The peak age group is the 36–45 years. The longest duration of implant was from 13 to 18 months. Plate and screws constituted 76 (67%) of all implants removed. The femur was involved in 49 (43.3%) cases. Patient's request constituted 46 (41.5%) of the indications. There was retained hardware in 6 (5.4%) cases while external fixation (17, 15.3%) was the most common additional procedure performed. Conclusion: Most of the implants stayed for more than a year. Plate and screws were the most common implants removed. The femur was the most involved bone. Patient's request was the most common indication for removal. Retained hardware was the most common post-operative complication while external fixation was mostly performed as an additional procedure.
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The variation of the posterior tibial slope in South Indians: A hospital-based study of 290 cases p. 17
Supreeth Nekkanti, Pavan Patted, Lakshmi Malavika Nair, Vijay Chandru, G Shashank
DOI:10.4103/njot.njot_4_18  
Background: The knowledge of the normal posterior tibial slope (PTS) is important for orthopaedic surgeons during joint replacement surgeries. Inadequate tibial cuts to replicate the normal tibial slope would lead to the tibial plate loosening or restriction of complete flexion. The tibial slope varies with age, gender, race and the ethnicity. We studied the tibial slope in the South Indian population. Aim: The aim of the study was to evaluate the PTS in a Southern Indian population and compare with the different known values across geographical and ethnic variations. Materials and Methods: The prospective study was conducted using the plain radiographs of the knee joint of 290 adult patients (age ranging from 18 to 81 years old with skiagrams showing complete epiphyseal fusion around the knee) collected over a period of 1 year from 10th January 2017 to 5th January 2018. Collected data were analysed statistically using SPSS (Statistical Package for the Social Sciences software) version 21 software. Results: The PTS varied between −5° and 21° with a mean value of 10.3771° ± 4.59482°. The mean PTS in males was 10.1232° ± 4.69607° and in females was 10.8825° ± 4.36616°. The mean PTS was highest (12.279) in the patients aged between 61 and 75 years of age and was least (8.243) in patients aged more than 75 years of age. There was a significant variation (P = 0.01) in the mean PTS in each age group of our study population [Table 1]. Conclusion: The tibial slope has been reported to vary in different ethnic subsets. In this study, the PTS varied between −5° and 21° with a mean value of 10.3771° ± 4.59482°. There was no statistical significant gender-based variation in the PTS. The PTS was lower than the PTS of the American, Nigerian and Chinese Populations but higher than the French population. We attempt to publish our results of the anatomical variation of the tibial slope in the Indian subcontinent.
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Traffic related injuries from a trauma registry: Pattern and outcome p. 22
Sydney E Ibeanusi, Tamunokro E Diamond
DOI:10.4103/njot.njot_7_18  
Background: Road traffic trauma is a leading cause of death and disability in persons aged below 45 years. It has a global distribution, but its incidence and impact are greatest in low- and middle-income countries. Establishing pattern of injuries arising from traffic collisions and the outcome of such injuries helps to plan interventions effective in reducing the incidence, mortality and morbidity from road traffic crashes (RTCs). Methods: Data of patients presenting with injuries from RTCs from a trauma registry which was prospectively developed from a dedicated trauma centre based in south-south region of Nigeria were collected and analysed. Descriptive and inferential statistics of data of patients with injuries resulting from traffic collisions from the trauma registry seen between 1 January 2007 and 31 December 2012 were generated and presented. Results: During the study period, 61,820 (65.6%) patients presented with injuries resulting from RTCs. Majority of the patients were males aged between 20 and 40 years. Most of the patients (n = 51,620, 83.5%) presented after 1 h of the incident. Only about 5.2% (3215) of the victims were brought to the hospital by some type of ambulance. Majority of the patients had of injury involving the exterior in 77% (n = 47,601) and the extremities in 23.5% (n = 14,500) of the cases, respectively, but mortality was <1%. Conclusion: RTCs contributed significantly to the trauma burden in Port Harcourt, Nigeria. Delayed presentation, and improper transportation methods of injured victims to hospitals, may have contributed to poor outcome of some of the injuries.
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Burns care in Sub-Saharan Africa: Experience from a trauma registry in Nigeria – An observational study p. 29
Sydney E Ibeanusi, B Kejeh
DOI:10.4103/njot.njot_8_18  
Background: Burns is quite common and often associated with deleterious consequences. The incidence, mortality and morbidity from burns are decreasing in most developed countries over the years, but in the developing countries, the burden of burn injuries continue to pose a significant challenge. Various factors have been attributed to this persisting trend. This study aim is to highlight the pattern of presentation, care and outcome of injuries from burns from a regional trauma registry in Nigeria. Methods: Retrospective evaluation of data from a regional trauma registry in Port Harcourt Nigeria prospectively collected over a seven-year period (from January 2007 to December 2013). Descriptive and inferential statistics of the results are presented. Results: The result showed that 601 cases of burns were recorded during the period under observation. Males between the age group (20-29) years were the most involved (n = 223 {37.1%}) and flame burns (n = 380 {63.2%}) arising mainly from explosions of petroleum products (n = 333 {55.4%}) was the most commonly seen. The overall mortality recorded was 34%, but the median lethal burn surface area at which 50% of the victims died was about 40%. Most of the deaths occurred in the first week following burns. The common early complications were fluid and electrolyte derangement (n = 280 {46.6%}), while burn scarring was a common complication among survivors. Conclusion: Burns remains a significant contributor to high trauma mortality and morbidity in the region. Inadequate infrastructure, human and material resources and some persisting cultural beliefs and practises contribute to the poor outcome of burns.
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CASE REPORTS Top

Accidental electric shock injuries around the shoulder joint: A case report of two patients p. 34
Mruthyunjaya Mruthyunjaya, Supreeth Nekkanti, Arunodhaya Siddartha, MS Santosh, N Punith
DOI:10.4103/njot.njot_2_17  
Fracture-dislocations of the shoulder are grave injuries. These injuries rarely are caused by electrocution injuries. The diagnosis of these injuries is tricky. Missed diagnosis of these injuries is common due to inadequate radiological examination. We report two cases of fracture-dislocation of the shoulder following accidental electrocution injuries. Our case report includes two patients who injured their shoulder joints after suffering accidental electric shock injuries. Our first patient was an 80-year-old female who suffered an anterior fracture-dislocation of the shoulder and second patient was a 28-year-old male who suffered a posterior fracture-dislocation. Both the patients were treated by osteosynthesis using the deltopectoral approach. Our patients had a good function of their shoulders at the end of 1-year follow-up. Fracture-dislocations of the shoulder pose a significant diagnostic threat and are often missed due to inadequate radiographs. These injuries can be successfully treated by early diagnosis and anatomical fixation of the fracture. Avascular necrosis of the head of the humerus is the significant complication to these injuries.
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Management of knee ankylosis using ilizarov device p. 40
Roy T Efetoboh Enemudo
DOI:10.4103/njot.njot_6_18  
Knee ankylosis is a common complication of knee trauma and infection that poses a serious challenge to orthopaedic surgeons regularly in their practice. This study highlights the success of the use of Ilizarov device in the management of fibrous ankylosis of the knee. A 37-year-old nurse with a fibrous ankylosed knee that had a range of movement (ROM) of 0°–40° was successfully treated with Ilizarov device, indomethacin (analgesics) and physiotherapy. Her ROM of the affected right knee improved to 0°–140° and after a follow-up period became 0°–90°. She was very happy with the outcome. There was no associated knee pains afterwards. Ilizarov device, together with adequate analgesia and physiotherapy, can successfully treat knee ankylosis.
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