Nigerian Journal of Orthopaedics and Trauma

: 2019  |  Volume : 18  |  Issue : 1  |  Page : 23--33

NOA Scientific Conference/AGM EKO 2018


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. NOA Scientific Conference/AGM EKO 2018.Niger J Orthop Trauma 2019;18:23-33

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. NOA Scientific Conference/AGM EKO 2018. Niger J Orthop Trauma [serial online] 2019 [cited 2024 Feb 25 ];18:23-33
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 Correction of Severe Blounts’ Disease Using the Taylor Spatial Frame in Sub-Saharan Africa

Okunola M.O, Omoyeni A, Uwajeh I.A, Magbagbeola O.A

Department of Orthopaedics, University College Hospital, Ibadan, Nigeria. E-mail: [email protected]

Background: Blount’s disease is a developmental condition affecting the posteromedial aspect of the proximal tibial physis, with severity ranging from mild hypoplasia of the medial metaphysis to pre-mature fusion of the medial physis, resulting in a physeal bar. The deformity usually comprises genu varum, procurvatum of the proximal tibia and internal tibial torsion. In severe cases, leg length discrepancies are associated features especially in unilateral cases. The Taylor spatial frame (TSF) developed in 1994 by the Taylor brothers on the basis of hexapod system based on projective geometry utilising a circular external fixator and a computer-based system to determine the programme for the correction of the deformity. It has been found to be valuable in the correction of Blounts’ disease. Case Presentation: We present four patients who presented with severe Blounts’ disease (with a minimum of Langenskiöld Grade V) and had correction of the deformities in five limbs using the TSF. The deformities’ parameters of the four patients range from varus of 5°–60°, procurvatum of 0°–50°, internal tibial torsion of 5°–60° and leg length discrepancies of 4–10 cm. The patients had application of the frame, tibial corticotomy and fibular osteotomy and subsequent gradual deformity correction using the prescribed schedule. Deformities’ correction and leg length equalisation were achieved in all patients except one limb in the bilateral case with residual varus and procurvatum of 5° and 10°, respectively. Residual deformities will require further correction. Conclusion: The TSF is relatively easy to apply and is invaluable in the simultaneous correction of multiaxial limb deformities as those seen in severe Blounts’ disease.

Keywords: Blounts, Sub Saharan Africa, taylor spatial frame


 Locking Compression Plate in Distal Intra-articular Femoral Fractures: The Swashbuckler Approach

O. Obiegbu Henry

Nnamdi Azikiwe University Teaching, Nnewi, Anambra, Nigeria. E-mail: [email protected]

Background: Distal femoral intra-articular fractures present a serious surgical challenge to an orthopaedic surgeon. These fractures are usually complex and difficult to treat, and operative treatment is usually recommended. Problems encountered in the fixation of these fractures include poor exposure of the articular surface, loss of fixation and joint congruency. Materials and Methods: This was a prospective review of all patients treated with distal femoral locking plates (including patients presenting with non-union) between June 2017 and June 2018 using the Swashbuckler approach. Fractures were categorised using the AO/OTA classification. Patients with AO Type A fractures were excluded from this study. Results: A total of six patients (5 females and 1 male) were recruited into this study. The mean age of the patients was 51 (age range of 30–70) years. Mechanism of injury was road traffic accident in 83.3% of cases. The mean time for radiological union was 12 weeks, and all (100%) patients achieved union without any further intervention. Conclusion: Use of the Swashbuckler approach for distal intra-articular fractures improves exposure of the articular surface and aids reduction and proper application of the locking distal femoral plate. High union rates can usually be achieved with these implants.

Keywords: Distal femoral, fracture, intra articular, Swashbuckler


 Management of Musculoskeletal Conditions with Prosthetic and Orthotic Devices

V. Uzuegbu, E. C. Iyidobi

Department of Clinical Services, National Orthopaedic Hospital, Enugu, Nigeria. E-mail: [email protected]

Background: The best of surgical intervention alone may not be able to produce the desired overall target where appropriate devices for pre- or post-surgical management of patients ‘as applicable’ are not deployed and monitored. Furthermore, in the field of prosthetics and orthotics, orthotic science has been viewed practically as a sub-discipline or less important in our clime or medical community. Appropriate design of appliances for patients with musculoskeletal problems vis-a-vis age, weight and clinical presentation is most appropriate in assisting a surgeon to reach his/her target of optimum rehabilitation on any selected patient. In addition, all amputees generally look forward to total rehabilitation with prosthesis without an appropriate moderation of expectations in view of predisposing factors, such as patient’s mobility grade, early presentation and treatment/medical history. In the event that such scenario presents a result below patient’s expectations, the patients and relatives assumes that the rehabilitation process undergone was either unnecessary or a failure. Objective: To ascertain the impact of custom-made exoskeletal prosthetic and orthotic devices in the management of musculoskeletal conditions and also to ascertain the level of satisfaction of the surgeon in line with his/ her overall target of rehabilitating the patient optimally with these devices. Methodology: Twenty orthotic patients comprising children (below 14 years) and young adults between the ages of 18 and 45 years were reviewed. Most cases in young adults were complicated with work- and stress-related ergonomics and trauma while children were complicated with obesity and other pathologies. Questionnaires were equally sent out and the feedback was obtained from surgeons to ascertain the outcome/rehabilitation of patients and their impression. A 3-year retrospective study from January 2015 to December 2017 on patients with musculoskeletal deformities and amputations managed jointly with the orthopaedic unit of National Orthopedic Hospital, Enugu, with the use of custom-made orthotic devices. Furthermore, amputees with contralateral limb impairment were reviewed for the additional support gotten via the use of orthotic devices. Results: About 45% reviewed among children with early presentation were managed successfully without surgery. Appropriate post-surgical orthoses and also prosthetic devices played a vital role in the outcome of 55% who underwent surgery. About 45% of the respondents were satisfactory with the outcome. On the other note, obesity, age and physical fitness were the major disadvantages in achieving a positive outcome in terms of mobility grade and eventual physical recovery and independence from assistive devices. Twenty per cent gained independence in the first 3 months, 40% gained independence in in 6 months and 40% relied longer on additional support. Conclusions: There exist major gaps in the application of exoskeletal prosthetic and orthotic devices in orthopaedic practice despite proven benefits and reasonable surgeons’ satisfaction. Delayed consent for amputation and poor patient’s compliance in the use of devices are still predominant. Recommendation: Regulated practice and guided patient information will assist in not only improving outcomes but also helping the surgeon to meet his/her target of optimal patient rehabilitation.

Keywords: Devices, Musculoskeletal, Orthosis, prosthesis


 Management of Congenital Tibial Pseudarthrosis Using a Tubularised Fibular Strut Graft and an Ilizarov Frame: A Case Report

O. Obiegbu Henry, C. U. Ndukwu

Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria. E-mail: [email protected]

Congenital pseudarthrosis of the tibia, though fortunately uncommon, represents one of the most challenging problems faced by a paediatric orthopaedic surgeon, with a substantial risk of non-union and limb length discrepancy. We report a case of a 3-year-old male child with pseudarthrosis of the left tibia, which had been previously operated upon, but union was not achieved. At surgery, sclerotic segments of the bone ends were excised resulting in defects which were filled with tubularised fibular strut graft and stabilised with an Ilizarov frame. Three months after, the radiographs showed union. It is concluded that fibular strut graft with a supporting circular (Ilizarov) frame is beneficial in the management of congenital tibia pseudarthrosis.

Keywords: Congenital pseudoarthrosis, Ilizarov, Tibia


 Rare Presentations of Lunate Dislocation: A Case Series

K. M. Onuoha, A. E. Bassey, B. Akinola, F. E. Ogedegbe, B. M. Rajan

Department of Orthopaedics, Cedarcrest Hospitals, Abuja, Nigeria. E-mail: [email protected]

Lunate dislocation is a soft tissue circumambient disruption of the lunate bone. It is an uncommon but devastating wrist injury that can have negative effect on lifestyle with significant morbidity if it affects the dominant hand. This high-energy trauma can go unrecognised by physicians, resulting in complications including but not limited to carpal tunnel syndrome and Kienbock’s disease. Timely and appropriate treatment is an important factor that affects the outcome of this injury. We present two cases of Type 4 lunate dislocation who presented to our facility in the same week of injury, one having developed carpal tunnel syndrome. Both were treated by open reduction and k-wire fixation via the volar approach. They both did well and had good function at the outpatient follow-up. Case Reports: Case 1: A 45-year-old right-handed female presented to our emergency department 2 h after falling off from a motorbike. She presented with painful deformity of the left wrist and hand. X-ray of her wrist showed widening of the scapholunate space with medial displacement of the entire carpus. There was also a volar displacement of the lunate. She had open reduction and k-wire fixation of the wrist. Case 2: A 53-year-old right-handed male presented to the emergency department with pain, swelling and deformity of the right hand with signs of median nerve entrapment 24 h after he was involved in a motor vehicular accident. Anteroposterior view of his wrist X-ray showed displacement of the lunate bone. He had carpal tunnel decompression and open reduction and k-wire fixation. Conclusion: Lunate dislocation and its complications can be easily missed in a poly-traumatised patient. A detailed clinical and radiological assessment is paramount for accurate diagnosis and treatment.

Keywords: Dislocation, lunate, rare


 Supracondylar Humeral Fractures in Schoolchildren: Epidemiology, Aetiology and Incidence during School Terms and Holidays

O. Babalola Olatunji

Department of Orthopaedics, National Orthopaedic Hospital, Igbobi Lagos, Nigeria. E-mail: [email protected]

Background: In children, supracondylar humeral fractures are common. If associated injuries such as vascular damage, or complications such as compartment syndrome, are not promptly identified and managed , morbidity that can last the entire lifetime of the child may develop. Poorly managed injuries can result in mal-union with residual deformities. Objective: To determine the epidemiology of supracondylar humeral fractures and compare its incidence during school term and holiday periods in school-aged children. Methodology: A descriptive retrospective study of the epidemiology and incidence of supracondylar humeral fractures in school-aged children was carried out in National Orthopaedic Hospital, Lagos, Nigeria. All school-aged children presenting with supracondylar humeral fractures to the Accident and Emergency Unit of the Hospital between 1st January 2014 and 31st December 2017 were included. The bio-data, causes of the injury, date of injury to determine if it is school term or holiday, type of injury, Gartland classification and treatment were obtained from the case notes and radiographs. Results: A total of 53 patients comprising 39 males and 14 females and male: female of 2.8:1 were reviewed. The mean age was 5.94 ± 2.71 years. Fall from height (30.2%) was the most common aetiology. Thirty-two (60.4%) children sustained the injuries during school term and 21 (39.6%) during holidays. Incidence was 0.25/week over the 4 years, 0.22/week during school term and 0.47/week during holidays. The extension and flexion types of injury were 52 (98.1%) and 1 (1.9%), respectively, with 41 (78.8%) Gartland Type III. Twenty-two (41.5%) children had non-operative and 30 (56.6%) had operative intervention while 1 (1.9%) discharged against medical advice. Conclusions: Supracondylar humeral fracture is common in school-aged children, with a mean age of 5.94 years and male:female of 2.8:1. The most common aetiology is fall from height and the incidence during holiday is about twice that of school term.

Keywords: Humeral, School children, Supracondylar


 Early Outcome of Open Locked Intramedullary Nailing of Femoral Diaphyseal Fractures in a Resource-poor Setting

Chukwuemeka Okechukwu Anisi, Joseph Effiong Asuquo, Innocent Egbeji Abang, Onyebuchi Gregory Osakwe, Ngim Ewezu Ngim

Department of Orthopaedics, Universiyty of Calabar Teaching Hospital, Calabar, Nigeria. E-mail: [email protected]

Closed locked intramedullary nailing is largely considered the preferred treatment option for fractures of the femoral diaphysis, owing to its associated high union and low complication rates. In resource-poor regions where intraoperative imaging is not readily available, most of these injuries are treated by open locked intramedullary nailing and plate osteosynthesis. This study was designed to assess the outcome of open locked intramedullary nailing of femoral diaphyseal fractures. Sixty-nine patients with 70 femoral diaphyseal fractures who presented at the Accident and Emergency Department of the University of Calabar Teaching Hospital between 1st July 2013 and 30th June 2017 were prospectively studied. All patients had open locked intramedullary nailing and were followed up for 6 months. Early outcome of treatment was assessed using the Thoresen criteria. The age range of the patients was 18–80 years, with a mean age of 33.56 ± 12.87 years. The male-to-female ratio was 1.69:1. Motor vehicle accident (55.8%) was the most common mechanism of injury. Majority of the patients (67.44%) had left femoral diaphyseal fracture. The overall fracture union rate was 97.14% (n = 68). Post-operative wound infection (11.4%) was the most common complication encountered. This comprised of superficial surgical site infection in 6 (8.6%) patients and deep infection/osteomyelitis in 2 (2.8%) patients. Using the Thoresen criteria, the overall outcome of treatment was excellent to good in most (93.2%) of the cases. Conclusion: Open locked intramedullary nailing of femoral diaphyseal fractures is associated with high fracture union and low complication rates.

Keywords: Femoral diaphyseal fractures, intramedullary nailing, locked, open


 Role of Pirani Scoring in Predicting the Frequency of Casting and Percutaneous Achilles Tenotomy in the Treatment of Clubfoot

Chukwuemeka O. Anisi, Joseph Effiong Asuquo, Innocent Egbeji Abang, Onyebuchi Gregory Osakwe, Ngim Ewezu Ngim

Department of Orthopaedics, University of Calabar Teaching Hospital, Calabar, Nigeria. E-mail: [email protected]

The Pirani scoring system is a simple tool widely used for grading the severity of clubfoot. This study was designed to objectively assess its value in predicting the total number of casts required and the need for percutaneous Achilles tenotomy to achieve correction of the idiopathic clubfoot treated by the Ponseti method. All patients with idiopathic clubfoot who attended our clubfoot clinic between January 2013 and December 2015 were prospectively studied. Each clubfoot was scored at presentation and at each visit using the Pirani scoring system. All patients were treated using the Ponseti treatment protocol until correction was achieved (with or without percutaneous Achilles tenotomy). Chi-square test was applied to establish any existing relationship between the Pirani scores and the need for percutaneous tenotomy as well as the number of casts required to achieve correction. Sixty-nine patients with 108 idiopathic clubfeet were recruited into the study. Fourteen patients defaulted, leaving the study with 81 clubfeet belonging to 55 patients. The median total Pirani score (TPS), midfoot contracture score and hindfoot contracture score at presentation were 4.0, 2.0 and 2.0, respectively. Fifty-seven (70.4%) feet required percutaneous Achilles tenotomy to achieve correction. The average number of casts (including casts after tenotomy) required to achieve correction was 4.9 (2–10). The average number of casts required to achieve correction was 4.1 (2–10) for the no tenotomy group and 5.4 (3–10) for the tenotomy group. Statistically, significant relationship was established between the TPS and number of casts required to achieve correction for both the tenotomy group (P = 0.039) and no tenotomy group (P = 0.05). Conclusion: High Pirani scores were associated with increased number of casts and percutaneous Achilles tenotomy for the correction of idiopathic clubfoot using the Ponseti method.

Keywords: Achilles tenotomy, casting, clubfoot, percutaneous, pirani


 Frequency of Percutaneous Achilles Tenotomy in the Treatment of Clubfoot Using the Ponseti Method

Chukwuemeka O. Anisi, Joseph Effiong Asuquo, Innocent Egbeji Abang, Onyebuchi Gregory Osakwe, Ngim Ewezu Ngim

Department of Orthopaedics, Universiyty of Calabar Teaching Hospital, Calabar, Nigeria. E-mail: [email protected]

Percutaneous Achilles tenotomy is an integral component of congenital clubfoot treatment using the Ponseti method. This study was designed to assess the frequency and outcome of percutaneous Achilles tenotomy in the conservative treatment of congenital clubfoot by the Ponseti method. A prospective study of all congenital clubfoot patients age between 0 and 2 years who attended our clubfoot clinic between January 2013 and December 2017 was carried out. At presentation, each clubfoot was assessed clinically, scored using the Pirani scoring system and treated using the Ponseti method. Percutaneous Achilles tenotomy was performed for feet with persistent equinus deformity. Statistical analysis of the distribution and associations of percutaneous Achilles tenotomy was done using IBM SPSS version 22. A total of 97 patients with 146 clubfeet were studied. The median total Pirani score (TPS), midfoot contracture score and hindfoot contracture score at presentation were 4.5, 2.5 and 2.5, respectively. Percutaneous Achilles tenotomy was performed on 97 (66.4%) feet belonging to 63 patients. Eighty-five out of 108 feet with initial TPS of 3.0 and above required percutaneous Achilles tenotomy to achieve correction (P < 0.001). Conclusion: Treatment of congenital clubfoot using the Ponseti method was associated with a tenotomy rate of 66.4%. High Pirani scores as well as increasing age at presentation were associated with the need for percutaneous Achilles tenotomy.

Keywords: Femoral diaphyseal fractures, intramedullary nailing, locked, open


 Results of Management of Penetrating Injuries of the Spine in Dala: A Case Series

M. A. Shobode, K. Abubakar, M. M. Chiroma, A. S. Oyenusi, T. A. Waheed, J. E. Mamman M. Onuminya, M. K. Abubakar, O. O. Ekundayo, O. O. A. Salami, G. H. Ibraheem

Department of Clinical Services, National Orthopaedic Hospital, Dala, Kano, Nigeria. E-mail: [email protected]

Missile and non-missile penetrating injuries of the spine are rare. We present a case series of three patients managed at our facility with penetrating injuries of the spine in the last 2 years. This report aims to highlight the need for urgent surgical intervention in patients with worsening neurological signs following penetrating injuries to the spine. Three patients presented within the study period (January 2016 to June 2018). All three were males. An orthogonal plain radiograph was sufficient to define the location and level of injury. None of the patients had computed tomographic myelography or magnetic resonance imaging scan. American Spinal Injury Association (ASIA) Impairment Scale and the MacNab classification of surgical result were used as outcome measures. One had a missile injury (arrow) while two had non-missile penetrating injuries (knife and scissors). All three had neurological impairment with two presenting in spinal shock and one with ASIA A injury. The sub-axial cervical spine, the thoracic spine and the thoracolumbar spine were affected. All presented within 24 h of injury. All three had emergency surgical retrieval of the injuring objects with one post-operative death from complications of aspiration pneumonitis recorded. Remaining two had significant post-operative neurological recovery and discharged home as ASIA D. Conclusions: Penetrating injuries with neurologic impairment are rare. Early surgical intervention with retrieval of the impaling objects is recommended.

Keywords: Missile/non missile injury, penetrating injury, spinal cord


 Results of Management of Post-operative Complications of the Lumbar Spine in Adults: A Review of 204 Cases in Dala

M. A. Shobode, K. Abubakar, M. M. Chiroma, M. Mamman, T. A. Waheed, J. E. Onuminya, M. K. Abubakar, O. O. Ekundayo, O. O. A. Salami, G. H. Ibraheem

Department of Clinical Services, National Orthopaedic Hospital, Dala, Kano, Nigeria. E-mail: [email protected]

Surgical procedures of the lumbar spine, anterior or posterior, may be associated with perioperative complications. We reviewed the risk factors, nature and presentations of the complications, investigations, treatment and outcome of the various treatment modalities in these patients. We retrospectively analysed 204 cases of adult patients treated for lumbar spine pathologies between January 2016 and June 2018. We retrieved data from the operating room, the surgical wards and the outpatient departments. General demographics were analysed and the outcomes were measured/assessed using visual analogue scale, MacNab classification of surgical result, imaging studies (plain radiographs, computed tomography scan and magnetic resonance imaging) and blood workups including full blood count, erythrocyte sedimentation rate and C-reactive protein. SPSS 17 (IBM SPSS Chicago, Illinois) was used for data analysis. Trauma and degenerative diseases of the lumbar spine with canal stenosis accounted for over 80% of surgical indications. Persistence of symptoms was seen in 7% of the cases closely followed by superficial surgical site infection (SSI) (5%). Deep SSI was seen in 1.5%. Of note is that all cases of SSI were seen during the hot season, mostly in obese women with an average duration of surgery exceeding 5 h. Reoperation rate was 5%. One death was recorded. Primary dura repair, wound exploration, regular wound care and reducing elective list during the hot seasons were among satisfactory measures taken. Conclusions: Surgery of the lumbar spine is safe and rarely associated with devastating complications. Effort should be made to improve surgical and more importantly post-operative care and rehabilitation of the patients.

Keywords: Lumbar spine, management, post operative complications


 Bizarre Pathomechanics of Spine Trauma in Northern Nigeria: An Audit of 53 Cases

M. A. Shobode, K. Abubakar, M. M. Chiroma, M. Mamman, T. A. Waheed, J. E. Onuminya, M. K. Abubakar, O. O. Ekundayo, O. O. A. Salami, G. H. Ibraheem

Department of Clinical Services, National Orthopaedic Hospital, Dala, Kano, Nigeria. E-mail: [email protected]

Although road traffic injuries account for the most common cause of trauma to the spine/spinal cord world over including Nigeria, there is a need to bring to the other causes which were hitherto unreported, albeit bizarre, in our sub-region. The study aims to highlight unconventional mechanisms of injury to the spine/spinal cord, clinico-epidemiological profiles and injury patterns/types. Fifty-three patients with unusual mechanisms of spine/spinal cord injury were studied between January 2016 and June 2018. Patient demographics, clinico-epidemiological data and injury characteristics – types and level of injury – and associated injuries were recorded. American Spinal Injury Association Impairment Scale (ASIA IS) grade was used to classify the cord injury. Imaging studies including plain radiographs, computed tomographic scan and magnetic resonance imaging scan were used to assess the injuries. Treatment modalities were also documented. SPSS version 17 software (IBM SPSS Chicago, Illinois) was used to analyse the data. The 53 patients were aged 20–74 years. All, except one, were males. Unusual pathomechanics include falls from Baobab trees (31), cattle injuries (5), falls from a camel (1), falls in a shallow well (5) and falls from a bench (1) among others. Late presentation was common. The sub-axial cervical spine was involved in over 75% of the cases. One patient had atlanto-axial dislocation. All had neurologic impairment with over 70% presenting as ASIA A injury. Burst fracture pattern was predominant with the middle column affected in over 80%. Thirty-three patients were managed with surgical stabilisation with some neurological improvements as seen on the ASIA IS. Seven mortalities were recorded including one post-operative death. Conclusions: Almost all the mechanisms are brazenly audacious and therefore preventable. There is a need to constantly provide education to people exposed to such risky behaviours, workplace/work-related hazards, etc.

Keywords: Aetiology, bizarre, spine/spinal cord injury


 A Comparative Study of Subarachnoid Block and General Anaesthesia in Elective Lumbar Spine Surgery: A Review of 89 Cases

M. A. Shobode, K. Abubakar, M. M. Chiroma, M. Mamman, T. A. Waheed, J. E. Onuminya, M. K. Abubakar, O. O. Ekundayo, O. O. A. Salami, G. H. Ibraheem, O. Fagbohun

Department of Clinical Services, National Orthopaedic Hospital, Dala, Kano, Nigeria. E-mail: [email protected]

Surgical procedures of the lumbar spine are commonly performed under general anaesthesia (GA). This is often associated with complications including atelectasis and prone position morbidities, including blindness and prolonged post-anaesthesia recovery. Use of spinal anaesthesia in carefully selected patients can obviate these complications. The study aims to compare the intra- and post-operative outcomes of the two anaesthetic techniques in elective lumbar spine procedures. We reviewed 89 patients in all. The choice of anaesthesia was dependent on patients’ preference mainly after adequate counselling. Thirty-eight cases were done under spinal anaesthesia while 51 patients opted for GA. Intraoperative events including mean arterial pressure, patients’ comfort, blood loss, duration of surgery, post-operative recovery from anaesthesia and post-operative pain were compared. Visual analogue scale (VAS) was used to assess pain while the MacNab classification of surgical result was used to assess patient satisfaction. Four patients had anterior surgery while 85 cases were approached from the posterior. Ten thoracolumbar spine procedures were done. One case had a failed subarachnoid block (SAB) and was converted to GA (total intravenous anaesthesia). While more patients opted for subarachnoid block, anaesthetists were not comfortable with use of SAB in spine surgery. Intraoperative monitoring, blood loss (mean of 500 ml for SAB group and 900 ml for the GA group), duration of surgery (mean of 120 min for the SAB group and 180 min for the GA group), post-operative pain (mean VAS of 8 for GA group and four for SAB group on the post-operative days 1 and 2) and overall patient satisfaction were significantly (P < 0.05) better with the SAB. Conclusions: In carefully selected patients, SAB gives better outcomes compared to GA in elective procedures of the lumbar spine.

Keywords: Elective lumbar surgery, general anaesthesia, subarachnoid block


 Early Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction at National Orthopaedic Hospital, Dala

A. I. Alabi, C. Nkanta, N. Okoh1, S. Arojuraye, M. Hussain, I. Kamaludeen

Departments of Orthopedics and 1Clinical Services, National Orthopaedic Hospital, Dala, Kano, Nigeria. E-mail: [email protected]

Background: The anterior cruciate ligament (ACL) is an intracapsular but intrasynovial knee ligament that prevents anterior translation of the tibia. Injuries to this ligament, especially when complete, result in knee instability with subsequent secondary menisci damage and osteoarthritis. Objective: To evaluate the early functional outcome of arthroscopic ACL reconstruction at National Orthopaedic Hospital, Dala (NOHD). Methodology: This is a hospital-based, prospective study done at NOHD, Kano. The study duration was from May 2015 to March 2018. ACL reconstruction was done using triple-weave autologous hamstring tendons. Patients who met the inclusion criteria were recruited. Lysholm knee scoring scale was used pre- and post-operatively to assess the functional outcome. Results: Twenty cases were followed up for 2 years. Eighteen were males (90%) and two were females (10%), with a mean age of 32.5 ± 7.3 years. Recreational sports accounted for 11 (55%) of cases, while all patients had complete ACL rupture. The average duration of hospital stay was 10 days. The mean Lysholm score pre-operatively was 42.8 with a mean score at 6 months of follow-up improving to 92.3. The mean Lysholm score at 2 years of follow-up was 97.9. Ninety-five per cent of patients were either satisfied or very satisfied with the outcome of their treatment. Conclusion: Arthroscopic ACL reconstruction using triple-weave hamstring autografts can achieve excellent functional outcome with high patient satisfaction.

Keywords: Outcome, arthroscopic, anterior cruciate ligament repair


 Early Outcome of Arthroscopic Bankart’s Repair Using the Caspari’s Technique at National Orthopaedic Hospital, Dala

A. I. Alabi, C. Nkanta, N. Okoh1, I. A. Jimoh, D. Abbas, S. A. Arojuraye, I. Kamaludeen

Departments of Orthopedics and 1Clinical Services National Orthopaedic Hospital, Dala, Kano, Nigeria. E-mail: [email protected]

Background: The glenohumeral joint is the most dislocated joint in the body, accounting for 50% of all dislocations. It occurs commonly in young adult males, with the most common pathology encountered being the Bankart’s lesion. The Caspari’s technique is an arthroscopic transglenoid suture reconstruction modality. Objective: To evaluate the early functional outcome of arthroscopic Bankart’s repair using Caspari’s technique. Methodology: This is a hospital-based, prospective study conducted at National Orthopaedic Hospital, Dala (NOHD), Kano, commenced in March 2015 and completed by March 2018. Twelve cases were recruited; all had arthroscopic Bankart’s repair using Caspari’s technique. Each case was followed up for 2 years. The instability shoulder index score (ISIS) and the Walch Duplay score were used as predictive tools and functional outcome measures, respectively. Results: Twelve cases were studied with male-to-female ratio of 5:1 and a mean age of 21 ± 2 years. All cases were post-traumatic with a mean frequency of dislocation of 4 ± 1 per week. All the patients had positive apprehension test. The average duration of hospital stay was 4 days. The average ISIS was 2. The average Walch Duplay score pre-operatively was −15. The scores improved to a mean score of 70 at 3 months, 85 at 6 months, 95 at 1 year and 95.8 at 2 years. Ninety per cent of the patients were either satisfied or very satisfied with the outcome of their treatment. Conclusion: Results of Caspari’s technique in recurrent shoulder dislocation in NOHD has shown an excellent outcome with acceptable patient satisfaction.

Keywords: Arthroscopic, bankart’s, casparis, outcome, repair


 Correction of Post-infective Deformities of the Tibia Using the Ilizarov Circular External Fixation

M. O. Okunola, A. Omoyeni, I. A. Uwajeh, O. A. Magbagbeola

Department of Orthopaedics, University College Hospital, Ibadan, Nigeria. E-mail: [email protected]

Introduction: Post-infective lower limb deformities constitute a relatively common but daunting challenge to an orthopaedic surgeon practicing in the low-resource setting of most Sub-Saharan African countries such as Nigeria. The cost of care including cost of productivity, and the psychosocial challenges associated with the condition make it a significant cause for concern both for a surgeon and for the patient/relations. The Ilizarov circular external fixator offers a veritable tool for correcting these complex deformities. Cases Presentation: We present three patients managed at University College Hospital, Ibadan. Case 1 is a 9-year-old male who presented with an 8-year history of a proximal left leg deformity with a shortening of 16 cm following bone infection at 5 months of age. Case 2 is a 5-year-old boy with deformity of the distal left leg and foot with 6 cm shortening following osteomyelitis. Case 3 is a 5-year-old female with deformities of the proximal and distal parts of the right leg with a shortening of about 20 cm following a previous surgery for osteomyelitis of the tibia at the age of 6 months. Management: They had two-, three- and four-staged surgeries, respectively, using the Ilizarov external circular fixators starting from soft tissue release followed by distractions, correction of deformities, centralisation of the fibular, bone lengthening and synostosis between fibular and remnant of the tibia, with residual limb length discrepancies of 2–3 cm and minor deformities that will be corrected at future surgeries. Conclusion: The Ilizarov circular external fixator is a versatile tool in the hands of orthopaedic surgeons practicing in a low-resource setting.

Keywords: Ilizarov, post infective deformities, tibia


 Correlation between Canal Compromise and Severity of Neurological Injury in Cervical Burst Fractures

M. L. Mamman, T. A. Waheed, K. Abubakar, M. A. Shobode, M. M. Chiroma, K. Salisu, P. Ejembi, B. Bunu, J. E. Onuminya

Department of Clinical Services, National Orthopaedic Hospital, Dala, Kano, Nigeria. E-mail: [email protected]

Background: Burst fractures usually result from high-energy trauma when the spine is subjected to axial loading with various amount of flexion. The energy produces substantial crush and may lead to retropulsion of material into the spinal canal and narrowing it. It remains a question whether the retropulsed material actually determines the severity of the neurological injury. Objective: Our study aimed at assessing whether canal compromise resulting from burst fractures of the cervical spine determines severity of neurological deficit. Methods: This is a retrospective study involving 33 patients with burst fracture in the cervical spine and various severities of neurological injuries. The amount of canal compromise was assessed by computed tomography and magnetic resonance imaging. Canal compromise was measured manually using a millimetric ruler on the axial views of the computed tomographic scan. Patient’s neurological injury was assessed by American Spinal Injury Association (ASIA) scale. Data obtained were analysed using Spearman’s correlation test and Mann–Whitney test. Results: We analysed 33 patients presenting with burst fractures of the cervical vertebrae in our study. Twenty-one (63.6%) patients presented with complete cervical spine injury, and 12 (36.4%) presented with incomplete cervical spine injury. Six (18.2%) had <25% canal compromise with complete cervical spine injury. Another 6 (18.2%) also presented with 25%–50% canal compromise and complete cervical spine injury. Three (9.1%) had 50%–75% canal compromise with complete injury and 6 (18.2%) had more than 75% canal compromise with complete cervical spine injury. Twelve (36.4%) presented with incomplete cervical spine injury, with 7 (21.2%) having anterior cord syndrome with 25%–50% canal compromise. Five (15.2%) came with central cord syndrome with <25% canal compromise. No incomplete injury presented with more than 50% canal compromise. A positive correlation as observed in this study will further buttress the essence of urgent decompression of a compromised canal even in the setting of complete injury. Conclusion: Despite the association of incomplete cervical injury with up to 50% canal compromise in our study, the higher canal compromise demonstrated more severe injury, revealing a positive correlation between canal compromise and severity of neurological deficit in cervical spine injury with cervical vertebral burst fractures. A study in a larger population of patients is required to further support our fin.

Keywords: Canal compromise, cervical burst fracture, neurological injury


 Syndromic Radial Hemimelia: A Series of Four Cases Successfully Managed at the National Orthopaedic Hospital, Igbobi, Lagos

E. B. Izuagba, O. A. Ugwoegbulem, O. O. Babalola

Department of Orthopaedics, National Orthopaedic Hospital, Igbobi, Lagos, Nigeria. E-mail: [email protected]

Background: Radial hemimelia (radial club hand) is a rare congenital deficiency of the upper limb, characterised by failure of formation or hypoplasia of the radius which results in radial deviation of the wrist. This bony absence is compounded by the absence of or abnormal attachments of the pre-axial forearm muscles and digits making functional use of the hand difficult. This condition can occur in isolation or form part of a syndrome that includes other life-threatening conditions. Orthopaedic management of the radial hemimelia in syndromic cases is usually not different from non-syndromic cases, but early identification of the life-threatening components of the syndromic cases is paramount to survival. We present four cases (3 patients) of syndromic radial hemimelia successfully managed with the Ilizarov technique. Objective: To study the presentation of four cases (3 patients) with syndromic radial hemimelia successfully treated at the National Orthopaedic Hospital, Igbobi, Lagos. Methodology: Three patients (4 radial hemimelia) with bilateral thrombocytopenia-absent radius syndrome (+ pterygium syndrome and bilateral vertical talus), Holt–Oram syndrome and complex cleft lip and palate-associated radial hemimelia were managed with gradual distraction using the Ilizarov fixator. Results: There were successful outcomes in all cases with stable wrist and good lever forearm. Conclusion: Gradual distraction with restoration of the wrist stability is a good treatment method for syndromic radial hemimelia.

Keywords: Hemimelia, radial, syndromic


 Management of Complex Long Bone Non-unions Using Ilizarov Technique

Mustapha Abdul-Rasheed, J. O. Donwa, N. Isa, D. D. Mue, Wada Nas

Department of Clinical Services, National Orthopaedic Hospital, Dala, Kano, Nigeria. Email: [email protected]

Background: Complex non-union is an established non-union (of at least 6 months in duration) with one or more of the following criteria: infection at the site of non-union; a bone defect of more than 4 cm; an attempt to achieve union that failed to heal after at least one supplementary intervention. It is a very challenging condition to an orthopaedic surgeon. Different treatment modalities have been tried with variable success rate. Ilizarov technique is found to be useful in the management of these patients because the principle is based on compression, distraction, bone lengthening, bone healing and correction of deformities. Objective: This study was to assess the functional and radiographic outcome in patients with complex long bone non-union treated with Ilizarov technique. Methods: It is a 10-year retrospective study of all patients who had complex long bone non-unions, treated with Ilizarov technique. The study was conducted at National Orthopaedic Hospital, Dala, Kano. Results: A total of 35 patients were treated for complex non-unions during this period. Twenty-seven (77%) were male and 8 (23%) were female, with male:female ratio of 3.4:1. The mean age was 32 years, with a range of 6–62 years. All the treated non-unions involved the tibia of which 19 (54%) involved the left tibia and 16 (46%) the right tibia. Twenty-seven (77%) were open fractures, while 8 (23%) closed fractures. The most common complication encountered was pin-track infection observed in all the patients. The outcome according to the Association for the Study and Application of the Methods of Ilizarov Scoring System revealed good outcome in most of the patients. Conclusion: Ilizarov technique offers effective treatment option in the management of complex long bone non-unions.

Keywords: Complex non-unions, Ilizarov technique, long bones


 The Outcome of the Use of Ilizarov Circular Frame in the Management of Congenital Pseudarthrosis of the Tibia: A Case Series

J. O. Donwa, N. A. Isa, A. Mustapha, C. Okoro, T. Aliyu

Department of Clinical Services, National Orthopaedic Hospital, Dala, Kano, Nigeria. E-mail: [email protected]

Background: Congenital pseudarthrosis of the tibia (CPT) is a non-union of fracture that develops spontaneously or after trivial trauma in a dysplastic bone segment of the tibial diaphysis. It usually develops during the first 2 years of life. CPT is a very challenging disorder for an orthopaedic surgeon. Various treatment modalities have been tried with mostly poor results. Objective: To describe the use of Ilizarov circular frames in the management of CPT in four patients seen in our institution and the outcomes of this modality of treatment. Methods: All four cases were managed with the application of Ilizarov circular frames after total excision of suspected pathological tissue. Compression at the pseudarthrosis site was achieved, with corticotomy and lengthening proximally done to correct limb length discrepancy. Ankle fusion was also done for a patient with a very distal pathology where the distal tibia was excised. All patients were closely followed up for outcomes post-operatively. Results: Union was achieved in only one of the four cases managed. This was in the patient with a very distal non-union that had excision of the distal tibia and ankle fusion. Conclusion: The use of Ilizarov circular frame as a single modality of the treatment of CPT cannot guarantee satisfactory outcomes. A complete excision of the pathological segment and other prognostic factors must be considered.

Keywords: Non-union, pseudarthrosis, Ilizarov, limb length discrepancy


 Early Results of Fluoroscopic-guided Transforaminal Steroid Injections in the Treatment of Degenerative Disc Diseases of the Lumbar Spine with Canal Stenosis at the National Orthopaedic Hospital, Dala, Kano

K. Abubakar, M. A. Shobode, M. M. Chiroma, T. G. Magashi, M. L. Mamman, T. A. Waheed, J. E. Onuminya

Departments of Clinical Services, National Orthopaedic Hospital, Dala, Kano, Nigeria. E-mail: [email protected]

Background: Low back pain is the most common presenting complaint in orthopaedic spine clinics worldwide. Degenerative disc disease is the primary pathology responsible for specific low back pain. When this is associated with secondary changes such as disc herniation, ligamentum flavum hypertrophy and facet arthropathy, there might be significant narrowing of the central canal, lateral recess or exiting foramina, leading to compression of the neural elements by mechanical, biological or chemical factors. Among the treatment modalities include the use of transforaminal steroid injections. Objective: To determine effectiveness of fluoroscopic-guided transforaminal steroid injections in the treatment of degenerative disc diseases of the lumbar spine. Methodology: It is a prospective interventional study. Forty-eight adult patients were recruited from the spine outpatient clinic, with complaints of low back pain and radiculopathy. All the patients had radiological (magnetic resonance imaging) evidence of degenerative disc diseases of the lumbar spine with significant canal compromise. Pre- and post-intervention Oswestry disability index (ODI) and visual analogue scale (VAS) score were documented. All the patients received 80 mg of methylprednisolone mixed with 2 ml of 0.5% plain bupivacaine transforaminally under fluoroscopic guide. The patients were followed up at the outpatient clinic at intervals of 1 week, 4 weeks, 8 weeks, 12 weeks, 6 months and 1 year. Patients with mechanical instability, spine tumour and infection were excluded. Significant pain relief was defined as 50% or more reduction of VAS score, whereas significant improvement in functional ability was defined as reduction of 40% or more of ODI. Results: Forty-eight adult patients (28 females and 19 males) aged 35–70 years (median age 57.2 years) were recruited between January and June 2018. About 41 (85.5%) patients showed significant improvement in the VAS score (>50% reduction) and 33 (68.8%) showed significant reduction in ODI (>40% reduction) for up to 12 weeks of follow-up. Only 4 (8.3%) of the patients require the second dose within 12 weeks. The result also shows statistically significant association between the duration of symptom and the reduction in the ODI (P < 0.05). No complication related to the procedure was recorded in all the patients. Conclusion: Transforaminal steroid injection under fluoroscopy is effective in providing short- and medium-term pain relief and improvement in functional status in degenerative disc disease of the lumbar spine with canal stenosis. However, the longer the duration of the symptoms, the less favourable the outcome.

Keywords: Degenerative disc disease, lumbar spine, transforaminal injection, steroid, effectiveness


 Operative Treatment of Chronic Isolated Posterolateral Corner Injury in Nigerian Footballers

S. O. Salami

Department of Orthopaedics. Grandville Medical and Laser, Lagos, Nigeria. E-mail: [email protected]

Introduction: The posterolateral corner (PLC) is often referred to as the dark side of the knee. Isolated PLC tears are relatively rare events with most cases being associated with other ligament injuries. Various surgical techniques to treat posterolateral knee instability have been described. We report our experience of treating isolated PLC injuries in Nigerian footballers. Methods: This is a retrospective review of footballers who had isolated posterolateral reconstruction between December 2014 and June 2017. Seven patients were surgically treated for isolated injuries and were available for follow-up, average age being 25.4 (range 18–32) years. All patients were treated with the fibular-based technique. Six patients had semitendinosus autograft and one had quadriceps tendon autograft. Results: The mean follow-up was 16.4 months. The average post-operative Lysholm score was 92.14 points (range 80–100); the results were excellent in six knees and good in one knee. The average time for return to play was 10 months. There were one case of superficial site infection and one case of hardware irritation necessitating screw removal. One patient did not return to play. Conclusion: Fibular-based technique showed good results in terms of clinical outcome, restoring stability to the knee for isolated PLC injuries. Larger studies will be required to evaluate this in the future.

Keywords: Knee surgery, ligament, posterolateral corner


 Mini-open Latarjet Operation for Recurrent Anterior Shoulder Dislocation: An Early Outcome Study

S.O. Salami

Department of Orthopaedics. Grandville Medical and Laser, Lagos, Nigeria. E-mail: [email protected]

Introduction: Surgical stabilisation of the shoulder is indicated when there is failure of conservative management. Arthroscopic stabilisation is currently the preferred option, but several studies have shown that success depends heavily on good patient selection. The Latarjet operation has been found to be useful in patients with bony glenoid defect and cases of recurrent dislocation following arthroscopic surgery. There has been a renewed interest in the last few years. We present 13 consecutive cases treated by initially arthroscopic evaluation then mini-open Latarjet operation. Materials and Methods: This is a retrospective review of 13 consecutive patients operated between January 2015 and July 2017. We describe our surgical technique in detail and outline post-operative care. Patients with minimum of 1 year of follow-up were included in this study. Results: Thirteen patients met the inclusion criteria. There were ten males and three females, with an age range of 22–44 years and mean age of 31.7 years. The average duration of symptoms was 7.9 years. The mean follow-up time was 18.7 months. At minimum of 1-year follow-up, the average Rowe score was 79.6. There was no redislocation. Conclusion: The Latarjet operation is still a viable option in a patient population with delayed presentation. Careful attention to surgical technique and post-operative rehabilitation is required to ensure optimum outcomes. Longer follow-up is needed to determine the late outcome.

Keywords: Laterjet, shoulder, shoulder instability


 Slipped Upper Femoral Epiphysis Treated with the Dunn Osteotomy

C. G. Iwegbu

Department of Orthopaedics and Trauma, DELSUTH, Oghara, Delta State, Nigeria. E-mail: [email protected]

Slipped upper/capital femoral epiphysis is a not uncommon pathology affecting adolescent children in the 10–16-year age bracket. It is actually a slip of the proximal femoral metaphysis off the epiphysis at the physis, with the epiphysis remaining in the acetabulum. I present seven cases managed by me some years ago at King George Hospital, Ilford, UK, using the Dunn femoral neck osteotomy. The aim is to show the operative technique I used and my results. The patients were aged between 11 and 14 years. Four of them were females and three were males. Their lesions were graded as moderate to severe using the Loder and Southwick classifications. The trochanteric osteotomy approach was used. A triangular subcapital osteotomy was carried out which resulted in spontaneous reduction of the epiphysis. Fixation was achieved under direct vision using Knowles pins or cancellous screws. Excellent results were achieved in all seven patients. The follow-up period was 3–5 years. The conclusion is that in experienced hands, the results of Dunn’s osteotomy can be gratifying.

Keywords: Dunn osteotomy, Knowle’s/ cancellous pins, slipped upper femoral epiphysis


 Management of Post-traumatic Kyphotic Deformity of the Thoracolumbar Spine: The Dala Experience

M. A. Shobode, K. Abubakar, M. M. Chiroma, M. Mamman, T. A. Waheed, J. E. Onuminya, M. K. Abubakar, O. O. Ekundayo, O. O. A. Salami1, G. H. Ibraheem

Department of Clinical Services, National Orthopaedic Hospitals, Dala, Kano, 1Department of Clinical Services, National Orthopaedic Hospitals, Igbobi, Lagos, Nigeria. E-mail: [email protected]

Background: Post-traumatic kyphotic deformity often follows a neglected vertebral compression fracture, particularly of the thoracolumbar or lumbar spine. The loss of anterior vertebral height (>50%) with disruption of the posterior osseoligamentous complex is responsible for the deformity. Surgery is indicated in patients with excess and unacceptable local/regional kyphosis, impairment of function, mechanical instability and painful adjacent compensatory deformities such as thoracic hypokyphosis and lumbar lordoscoliosis of hyperlordosis. Objective: To describe the peculiarities of this pathology, the need for surgery and its principles, the factors to consider in surgical planning and the outcome of treatment in our centre. Materials and Methods: We present our findings in a clinical audit of 18 patients between January 2016 and June 2018. They were aged 26–49 years. All were males. Records were retrieved from the surgical outpatient unit, the operating room and the surgical wards. Imaging studies (orthogonal plain radiographs, computed tomographic scan and magnetic resonance imaging) were used in the initial assessment and measurement of kyphotic angle using the Gardner’s and Cobb’s methods. American Spinal Injury Association (ASIA), Oswestry Disability Index and EuroQol 5d were used as outcome measures. SPSS 17 (IBM SPSS Chicago, Illinois) was used to analyse the data. Results: Eighteen male patients aged 26–49 were reviewed. All presented late (average duration was 10 months) with fixed kyphotic deformities of the thoracolumbar spine with an average regional kyphotic angle of 30°. Fifty per cent presented as ASIA B, 25% presented as ASIA A, while ASIA C and D were 12.5% each. None had full functions. T11 (2) and T12 (4) were involved in six patients, while L1 was involved in ten patients. Surgical aims included restoration of sagittal balance by correcting local biomechanics and invariably the sub-jacent/super-jacent compensatory deformities and decompression of neural tissues. Twelve patients had single-stage posterior approach with anterior column support and posterior transpedicular screw-rod construct (transpedicular decancellation osteotomy - 5 and vertebral column resection - 7); four had single-stage combined anterior and posterior approach (540° reconstruction with smith Peterson osteotomy, pedicle screws-rod construct and anterior corpectomy - 2; 360° reconstruction with SPO, pedicle screws-rod construct and anterior corpectomy). The mean ODI pre-operatively was 46% with a significant improvement to 24% post-operatively. Conclusions: Post-traumatic kyphotic deformities often complicate poorly treated or neglected thoracolumbar spine injuries. Restoration of sagittal balance is key.

Keywords: Kyphotic deformity, post-trauma, thoracolumbar spine


 Correction of Deformities around Knee Joint by Ilizarov Method

Mahmoud Felafel

Consultant Bone Lengthening And Deformity Correction, Egypt. E-mail: [email protected]

Background: Normal leg alignment is the goal of treatment of knee deformities. The Taylor spatial frame (TSF) and the Ilizarov method are able to do gradual realignment of angulation and translation in the coronal, sagittal and axial planes, therefore, the term six-axis correction. Methods: We retrospectively reviewed our cases done in Abuja from 2012 to 2018, with complex deformities around knee joint with or without limb length discrepancy, treated by Ilizarov Method and TSF; we got excellent results (normal mechanical axis) in almost all cases with few complications; all deformities treated with percutaneous osteotomy and gradual correction with the Ilizarov method and TSF. The minimum follow-up after frame removal was 6 months. Results: In patients with varus and valgus deformities for whom the goal of alignment was neutral mechanical axis, we got accurate correction of mechanical axis deviation. In the proximal tibia, the medial proximal tibial angle improved from 60° to 89° in patients with a varus deformity and from 96° to 85° in patients with a valgus deformity. In the distal femoral deformities, we also got correction of the mechanical distal lateral femoral angle up to 89°. Conclusions: Gradual correction of all tibial and femoral deformities with the TSF was accurate with few complications.

Keywords: Complex deformities, ilizarov, taylor spatial frame


 Traumatic Spinal Cord Injury in Northern Nigeria: Cautionary Notes about Falls from Baobab/Ebony Trees

M. A. Shobode, K. Abubakar, M. Mamman, T. A. Waheed, O. O. Ekundayo, J. E. Onuminya, M. K. Abubakar, A. A. O. Salami, M. A. Shobode

Department of Clinical Services, National Orthopaedic Hospital, Dala, Kano, Nigeria. E-mail: [email protected]

Background: Road traffic injury accounts for over 60% of the pathomechanics of spinal cord in our environment. Authors have reported falls from a palm tree in parts of Nigeria. Due to the threats of deforestation in northern parts of Nigeria driving herders further southward, trees that grow in seasonally arid areas (Savannah belt) and bear leaves during the dry seasons have served as source of feeds for animals. This trend, however, is not without consequences in some individuals. Objectives: To present the clinico-epidemiological profile including the injury types and the outcome of management. Methods: Thirty-one patients with spinal cord injury resulting from fall from the Baobab or Ebony trees were studied between January 2016 and June 2018. Clinical presentations and injury characteristics – types and level of injury – and associated injuries were recorded. American Spinal Injury Association (ASIA) Impairment Scale grade was used to classify the cord injury. Treatment modalities were also documented. Plain radiographs, computed tomographic scan and magnetic resonance imaging scan were used to assess the injuries. SPSS version 17 software (IBM, SPSS Chicago, Illinois) was used to analyse the data. Results: All 31 patients were males aged 26–48 years (mean of 37). Over 70% of the cases occurred during the dry seasons. Three deaths were recorded, two of which occurred while being resuscitated at the emergency room with suspected cervical spine injuries. Sixteen patients were seen within 48 h of injury. About 75% had received unorthodox care before arriving at the hospital, and most were brought in with no spine protection device. Sub-axial cervical spine injury was reported in over 80% of the patients. All had neurologic involvement with over 80% presenting with complete cord injury (ASIA A). Eighteen patients were treated surgically, while ten were managed non-operatively with skull traction. Conclusions: The productive age group is mostly affected. Late presentation was common. Conventional bone setters held sway in the initial care of these patients. Most patients are increasingly being offered operative stabilisation for ease of rehabilitation and early mobilisation.

Keywords: American Spinal Injury Association Impairment Scale, Baobab/Ebony trees, operative stabilisation, spinal cord injury


 Slipped Capital Femoral Epiphysis: A 10-year Review of Cases Treated by Open Reduction and Realignment Osteotomy

A. E. Bassey, K. M. Onuoha, B. Akinola, K. K. Ekwe, F. E. Ogedegbe, A. Adedapo

Department of Orthopaedics, Cedarcrest Hospitals, Abuja, Nigeria. E-mail: [email protected]

Background: Slipped capital femoral epiphysis (SCFE) is a common hip disorder affecting adolescents during the period of growth spurt. They typically present with hip pain with or without difficulty in bearing weight, and severity is based on the degree of slip radiologically. Moderate-to-severe slips can be treated with open reduction and realignment osteotomies. Objective: To determine the pattern of presentation of patients with moderate-to-severe SCFE, treatment offered and outcome. Methodology: This was a retrospective case series of patients presenting over 10 years and severity was determined radiologically. All patients were treated with open reduction and realignment osteotomies (Fish, sub-trochanteric). Patients were followed up and monitored for complications. Results: Six patients had unilateral SCFE while one was bilateral, making a total of 7 patients (8 hips). One had a Southwick angle of 47° while others had angles over 50°. All were females with a mean age of 12 years, with majority (67.5%) on the left side. The most common symptom was hip pain (85.6%) lasting 3–18 months. All were on crutches and could not weight bear without them. Six were treated with sub-capital osteotomy while two hips had sub-trochanteric osteotomy. All patients were followed up for an average of 22 months and none had complications. Conclusion: Adolescent females in our environment present more commonly with severe, unstable, SCFE which can be diagnosed clinically and confirmed radiologically. Prompt treatment with open reduction and realignment osteotomies via the sub-capital or sub-trochanteric types affords the best outcomes.

Keywords: Open reduction, realignment osteotomy, slipped capital femoral epiphysis


 Seat Belt Syndrome: An Emerging Trend in Modern-day Nigeria – A Case Report

K. M. Onuoha, I. Onwuka, B. Akinola, I. Anosike, K. K. Ekwe, F. E. Ogedegbe, A. Adedapo

Department of Orthopaedics, Cedarcrest Hospitals, Abuja, Nigeria. E-mail: [email protected]

Introduction: 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. Case Presentation: A 42-year-old male presented to our hospital 15 h after a head-on collision with an oncoming vehicle. He was a driver of a saloon car and was seat belted 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 tomographic 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. Conclusion: 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 among car users in Nigeria, there will be a rise in seat belt syndrome; thus, the need for increased awareness and possibly a classifications system.

Keywords: Emerging trend, Nigeria, seat belt syndrome


 Bilateral Anterior Fracture-Dislocation of Shoulders following New-onset Seizure: A Case Report

K. M. Onuoha, O. Ajiboye, K. K. Ekwe, F. E. Ogedegbe, S. A. I. Salawu, A. Adedapo, B. Akinola

Department of Orthopaedics, Cedarcrest Hospitals, Abuja, Nigeria. E-mail: [email protected]

Background: Shoulder dislocations following seizure are usually posterior and can be disabling. Anterior dislocations following seizure are rare and more seldom are bilateral anterior fracture dislocations. Following proper assessment, this pathology can be treated surgically with good outcome. Case Report: A 40-year-old male presenting with bilateral anterior fracture-dislocations of the shoulder following a new-onset seizure was evaluated and X-rays revealed a right three-part fracture of the right proximal humerus with anterior dislocation and a left four-part fracture of the proximal humerus with anterior dislocation. He subsequently had open reduction and internal fixation with the proximal humeral interlocking system (PHILOS) plate, had rehabilitation and discharged with a satisfactory outcome. Conclusion: Bilateral anterior fracture-dislocation following seizure disorder is a rare condition that warrants proper evaluation. Treatment with the PHILOS plate and rehabilitation affords good outcome.

Keywords: Bilateral, fracture-dislocation, shoulder


 Arthroscopic Treatment of Osteochondritis Dissecans of The Knee-A Case Report

Itakpe S.E, Babalola R, Laiyemo E.A, James O.O, Nwashili R

Department of Orthopaedics, National Orthopaedic Hospital, Igbobi, Lagos, Nigeria. E-mail: [email protected]

Background: Osteochondritis dissecans is an uncommon orthopaedic disorder of unknown aetiology. It is a cause of debilitating knee pain in the adolescent age group. Early detection with imaging and arthroscopic treatment affords return to pre pathology activity level. Case Report: We present the case of an eleven year old male student who presented with a three month history of left knee pain which severely hampered his participation in school sports. Clinical evaluation and magnetic resonance imaging revealed osteochondritis dissecans of the medical femoral condyle (Clantons type II). He subsequently had left knee arthroscopy with microfracture of the lesion with resolution of symptoms. Conclusion: Arthroscopy has obviated the need for arthrotomy in the management of this condition. Excellent outcomes are achieved with arthroscopic treatment.

Keywords: Arthroscopy, microfracture, osteochondritis dissecans


 Surgical Management of Multiligamentous Knee Injuries at The National Orthopaedic Hospital Igbobi-A Case Series

Itakpe S.E, Babalola R, Laiyemo E.A, Aniebo C, Williams O

Department of Orthopaedics, National Orthopaedic Hospital, Igbobi, Lagos, Nigeria. E-mail: [email protected]

Background: Multiligamentous knee injuries are complex knee injuries with significant effect on mobility and activities of daily living. Surgical management has proven superior to non operative modalities. We aim to evaluate surgical treatment of these injuries in our practice. Methodology: We reviewed retrospectively cases that presented at the NOH Igbobi and had surgical management between June 2016 and May 2018. Patients with two or more knee ligament injuries were reviewed. Primary outcome measures were the postoperative Lysholm and WOMAC scores. Results: A total of seven patients were reviewed. 57.1% were high energy injuries. All patients had surgery over three months post Injury (mean 6 months). Improvement in both post operative Lysholm and WOMAC scores was noted. Residual knee stiffness and common peroneal nerve palsy were noted complications. Conclusion: Early surgical intervention is advocated as outcomes are poorer with delayed interventions seen in chronic cases.

Keywords: Knee injuries, management, multiligamentous, surgical


 Auto Tricycle Injuries and the Vulnerability of Occupants and Pedestrians in a Developing Country: A Multi-Centre Pilot Study

Omoke N, Lasebikan O.A, Onyemechi N.O, Ajali N

National Orthopaedic Hospital, Enugu, Enugu State, Nigeria. E-mail: [email protected]

Background: Auto tricycle is an emerging common means of public transport in Nigeria. This study aimed to determine the scope and type of collisions and injuries from auto tricycles crashes in Nigeria, and identify potential areas for interventions to facilitate injury prevention. Patients and Method: This was a pilot study of all the patients with auto tricycle injuries that visited emergency rooms of three Nigerian tertiary hospitals over 18-month period. Results: There were 210 victims; auto tricycle -other vehicle collisions, lone auto tricycle collisions and auto tricycle- pedestrian collisions accounted for injuries in 67.2%, 19% and 13.8% of them respectively. Preponderance of collisions at nighttimes (60%), and on intra-city roads (86.7%) was observed. The rate of severe injury was significantly higher on inter-city than intra-city roads (32.11% vs. 9.3%, P < 0.001), and in daytime than nighttimes (16.7% vs. 6.0%, P < 0.043). The lower extremity (50%), head (38.6%) and upper extremity (30.4%) were the three top anatomical regions involved. The case fatality rate was 1.4%: head injury accounted for two third of the mortality. .Of the 207 survivors (98.6%), 196(93.3%) were treated and discharged, 6 (2.9%) discharged self against medical advise and 2 (1%) were transferred. Conclusion: In Nigeria, the auto tricycle has come to stay as a means of transportation and vulnerable road users are not immune to auto tricycle related injuries and its associated morbidity and mortality. Preventive strategies based on the observed pattern might reduce auto tricycle collisions and associated injuries.

Keywords: Auto tricycle, injuries, occupants, pedestrians