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   Table of Contents - Current issue
July-December 2020
Volume 19 | Issue 2
Page Nos. 43-79

Online since Tuesday, December 15, 2020

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Total knee replacement for extreme valgus deformity: Early outcome in six consecutive cases p. 43
Charles Ayekoloye, Ajibola Babatunde Oladiran, Ajibade Babatunde Omololu, Temitope Olusegun Alonge, Samuel Olusegun Ogunlade, Imonichie I Adeoye-Sunday, Michael Oluyinka Okunola, Abraham Ajimzo Anejukwo
Introduction: About 10%–15% of patients who present for total knee replacement (TKR) present with valgus knee deformity. Valgus angulation above 20° is regarded as severe deformity. The aim of this study is to present our initial experience of the surgical management of six consecutive cases with extreme valgus deformity, highlighting surgical techniques and level of constraint required as well as clinical outcome. Patients and Methods: Six consecutive patients with end-stage osteoarthritis and extreme valgus underwent TKR between 2016 and 2020. Demographic information, radiographic assessment and operative details were documented. Difficulties encountered and techniques used to achieve correction of deformity during surgery were detailed. Post-operative assessment includes Oxford Knee Score (OKS) and patient satisfaction score. Results: All patients were females. The mean age was 71.8 (range: 67–82). Four patients had pie-crusting release and valgus-varus constraint (VVC), one had posterior stabilised implant and one a rotating-hinge (RH) implant. Complications include one recurrent valgus instability, one partial peroneal nerve palsy treated with drop foot splint and one early post-operative infection which resolved with treatment. The mean post-operative follow-up was 14.2 months (range: 3–48 months). OKS improved from a mean pre-operative score of 18 (range: 15–21) to post-operative mean score of 44 (range: 41–46) at a mean 14.8-month follow-up. All patients rated their results as satisfactory. Conclusion: Our results show that satisfactory correction of deformity and balance can be achieved, but higher levels of implant constraint were required. Long-term follow-up is necessary to ensure that function remains satisfactory.
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Glove perforation in orthopaedic surgery: Pattern and predictors p. 49
Adesina Ajibade, Kehinde Sunday Oluwadiya, Peter Babatunde Olaitan, Johnson Dare Ogunlusi
Background: Intact surgical gloves prevent transmission of pathogens between the surgeon and the patient. However, gloves may be breached during surgical operations with risk of cross-transmission of pathogens between the surgeon and the patient. This study aimed to determine the incidence, nature and predictors of glove perforations in orthopaedic surgery. Methods: Gloves worn by the surgeon, their assistants and the scrub nurse were tested. Number, position and nature of perforations were recorded and analysed. Binary logistic regression was used to assess the impact of six possible predictors on the likelihood of glove perforation. Results: The operative glove perforation rate was 72.2%. Perforations occurred more on the nondominant hand (62.4%) and on outer gloves (85.8%). They were more common among surgeons and their assistants than scrub nurses and in trauma and implant operations than other surgeries. Only 27.1% of glove perforations were detected intraoperatively. The status of operative personnel and duration of surgery were predictive of glove perforation. Conclusions: Glove perforation is common in orthopaedic operations and was predicted by status of the surgeon and the duration of surgery. Double gloving provides a better barrier to contamination of surgeon's skin by patients' body fluids than single gloving; however, sometimes, the barrier can still fail. We recommend that double-gloving be routinely used in orthopaedic surgery, especially where complex instrumentations are employed.
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Humeral interlocking intramedullary nailing without image intensifier in a developing country p. 54
Olalekan Akeem Anipole, Stephen Adesope Adesina, Samuel Uwale Eyesan, Innocent Chiedu Ikem, Akinsola Idowu Akinwumi, Philip Oluyemi Bamigboye, Oluwafemi Oyewole Oyewusi
Background: Interlocking intramedullary nailing under image intensifier has been a standard approach to surgical treatment of humeral fractures. Aim: We present the outcome of humeral interlocking nailing without image intensifier in a developing country. Materials and Methods: This is a prospective study of consecutive patients with humeral shaft fractures who were treated with Surgical Implant Generation Network interlocking nailing for humeral shaft fractures using an external jig system. They were followed up for at least 6 months if there was no evidence of fracture healing and restoration of functional activities. Data collected were processed with the Statistical Package for the Social Sciences and summarised in percentages and means. Results: Forty-five patients with 46 humeral shaft fractures were studied, with a mean age and standard deviation of 46 ± 14.6 years and male-female ratio of 1.8:1. At 3 months, 44 (95.7%) of the patients have had radiographic evidence of fracture healing. Over the same period, 35 (76.1%) of them had achieved shoulder abduction >90°, 37 (80.5%) had achieved painless shoulder flexion-abduction-external rotation movement and 42 (91.3%) had achieved full activities of daily living. Conclusion: In a resource-constrained population where image intensifier is difficult to come by, humeral interlocking intramedullary nailing could still be performed using external jig system with a satisfactory outcome.
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Comparing fin intramedullary nailing with standard locked intramedullary nailing in the fixation of humeral shaft fractures p. 59
Stephen Adosope Adesina, Olalekan Akeem Anipole, Samuel Uwale Eyesan, Innocent Chiedu Ikem, Akinsola Idowu Akinwumi, Philip Oluyemi Bamigboye, Oluwafemi Oyewole Oyewusi
Background: Standard interlocking intramedullary nailing of the humeral shaft fractures has its attending complications such as difficulty in locking the nail distally and associated nerve injuries. Aim: To compare the rate of fracture healing, functional outcome and complication rate between SIGN standard locked intramedullary nail (SSLIN) and SIGN intramedullary fin nail (SIFN) in the management of humeral shaft fractures. Method: This is a retrospective comparative study comprising of patients who were treated with either SSLIN or SIFN for humeral shaft fractures. They were followed up until full activities of daily living was achieved. Data collected were processed with SPSS. Comparisons were made between the two groups using student t-test for the continuous variables and Chi-square for the categorical variables. Results: Forty-three patients with humeral shaft fracture were included in this study. Thirty-one of them constituted the SSLIN group while 12 of them constituted the SIFN group. At 6 weeks, radiographic evidence of fracture healing was seen in 64.5% and 58.3% of the patients in the SSLIN and SIFN groups respectively and by the third month, 96.8% and 100% of the patients respectively had achieved radiographic evidence of fracture healing. The differences were not significantly different. There was also no significant difference in the findings from the comparative assessment of functional outcomes in both groups. Conclusion: SIFN compared favorably with the SSLIN in terms of rate of fracture healing and resumption of functional activities. SIFN is therefore encouraged to be used for humeral shaft fractures.
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The perceptions and attitudes of medical students towards orthopaedic and trauma surgery teaching in Makurdi, Nigeria p. 65
Itodo Cornelius Elachi, Joseph Namgwa Kotor, Williams Terhemen Yongu, Michael Enokela Efu
Aim: The aim of this study was to assess the perceived educational value of orthopaedic and surgery learning opportunities among medical students and to evaluate the students' motivating factors in pursuing a future career in the specialty. Methodology: A questionnaire was designed to assess undergraduate medical students' perception of learning environments in orthopaedic and trauma surgery, career intent and motivation towards a future career in the specialty. A 5-point Likert scale was employed. Results: Seventy-four students completed the questionnaire. Learning opportunities considered useful for orthopaedic and trauma surgery were bedside teaching with a consultant (n = 39, 52.7%), seeing patients in clinic (n = 36, 48.6%) and formal lectures (n = 35, 47%). Fifteen respondents (20.3%) expressed an interest in pursuing a career in the specialty, with watching or assisting open surgery being the most significant motivating factor (P = 0.001) for choice of the specialty. Conclusion: Bedside teaching with a consultant and seeing patients in outpatient clinics were found to be the most useful learning environments. A fifth of the respondents indicated an interest in a future orthopaedic and trauma surgery career, with watching or assisting open surgery being the most statistically significant motivating factor. Students may be better served incorporating the findings in future curriculum design.
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Supracondylar humeral fractures in school children: Incidence and aetiology during school terms and holidays p. 69
Olatunji Oladapo Babalola, Orlando Anozie Ugwoegbulem, Emeka Bide Izuagba, Oluwaseyi K Idowu, Adebayo Musifiru Owoola
Background: Supracondylar humeral fracture is a common injury in the paediatric age group. The morbidity from its complications such as vascular injury, compartment syndrome and malunion can last the entire lifetime of the child if not recognised and managed appropriately. The aim of the study is to determine the mechanisms of injury and to compare the incidence during school term and holiday periods in school age children. Patients and Methods: A descriptive retrospective study was carried out at the paediatric orthopaedic unit of an orthopaedic hospital. All school age children with supracondylar humeral fractures between 1 January 2014 and 31 December 2017 were included in the study. The demographic data, mechanism of injury, date of injury (to determine whether school term or holiday), Gartland classification and the mode of management were recorded. Results: A total of 53 patients were reviewed. The mean age was 5.94 ± 2.71 years, with a male: female ratio of 2.8:1. The most common mechanism of injury was fall from a height (30.2%). The overall incidence was 0.25/week over the 4-year period school term (0.22/week and holiday period 0.47/week). The extension type of injury occurred in 52 (98.1%) patients with 7 (13.5%), 4 (7.7%) and 41 (78.8%) being Gartland type I, II and III, respectively. Conclusion: The most common mechanism of injury was fall from a height and there was an increased incidence during holiday compared to the school term period. Larger studies on safety strategies during holiday activities may reduce the incidence of humeral supracondylar fractures.
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Challenges in primary hip arthroplasty for neglected post-traumatic hip dislocations with acetabular defect p. 73
Mohammed Inuwa Maitama, Yau Zakari Lawal, Friday Samuel Ejagwulu, Abubakar Mohammed Kabir, Lawal Dahiru Ismaila
Primary hip arthroplasty in the presence of acetabular defect seen in patients with neglected post-traumatic hip dislocation is quite challenging due to the need in securing stability of hemispherical cup and providing enough rigid fixation needed to prevent acetabular cup micromotion. In segmental acetabular defect, contained or uncontained, there is an acetabular rim violation, an important risk factor for cup micromotion, loosening in the long term and subsequent failure. In our environment, most of the patients with post-traumatic hip dislocation present late, making conservative management (closed reduction and traction) or primary acetabular restorative reconstruction very difficult, hence the surgeon is left with the option of either Girdlestone excision arthroplasty, arthrodesis, hemiarthroplasty or total hip replacement. For the few who present early, most of them may not afford the cost of surgery (total hip replacement) and majority of centres in developing countries do not have facilities and trained personnel to handle such complex procedures. Impaction of cancellous bone graft to the acetabular defect is a common practice among arthroplasty surgeons. This, however, does not guarantee bony ingrowth at cup/graft interface and initial rigid fixation. The resultant acetabular cup micromotion on commencing weight-bearing would affect biologic fixation and may explain the relatively high incidence of loosening in this category. It is with this background that we review this important topic in hip arthroplasty highlighting various options of treatments, outcomes and recommendations.
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Brown-sequard syndrome: A case series from a regional hospital in Nigeria p. 77
Adetunji Toluse, Taofeek Adeyemi, Ebikiye Angaye, Mustapha Alimi
Brown-Sequard syndrome (BSS) is the constellation of symptoms and signs following hemisection or hemicompression of the spinal cord. The syndrome is an uncommon form of incomplete spinal cord injury with clinical presentation of ipsilateral motor weakness, impaired proprioception and vibratory sensation, with contralateral loss of pain and temperature sensation below the level of the lesion. We report two cases of BSS following penetrating (stab) injuries. The patients were managed non-operatively and they were followed up for 12 and 18 months, respectively, during which they made significant neurologic recovery on the Medical Research Council scale. The objective of this report is to highlight that BSS following trauma can be managed non-operatively with good neurologic outcome in cases where there is no extrinsic compression of the neural tissues.
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