Broad narrative review. To review and summarise the current literature on the management of tuberculosis (TB) spine. A thorough review of literature was performed on the epidemiology, aetiology, pathophysiology, pathology, clinical features and management of TB spine. Spinal TB accounts for half of skeletal TB and remains a common cause of public health concern in the developing world. The thoracic spine segment is the most affected. Patient commonly present with back pain and gibbus. The diagnosis involves demonstrating Mycobacterium tuberculosis on microscopy or culture as well as characteristic histology findings. Magnetic resonance imaging is the gold standard imaging modality. Medical therapy with anti-TB agents is the mainstay of treatment. Surgery is supplementary and indicated in selected cases. Spinal TB carries a good prognosis when detected and treated early. Delays can be associated with the development of complications including difficult-to-manage deformities. Multi-drug anti TB chemotherapy remains the bedrock of treatment. Surgery is supplementary and when indicated, takes the form of abscess drainage, debridement and fusion with or without instrumentation.

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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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Background: Outcome assessment of joint replacement procedures allows providers and patients to evaluate the quality of services delivered, thereby adding value to the services provided. Objective: The study is to describe the pattern of presentations of our patients with hip osteoarthritis who had undergone cementless total hip replacement (THR), assess the outcome using the Harris Hip Score (HHS), and identify any variables that affect the outcome. Patients and Methods: The study was carried out at Davidson and Judith Consultants Clinics, Enugu, Nigeria. A total of 72 THRs, in 62 patients, carried out between 2008 and 2013 were reviewed. These patients were assessed using preoperative HHS (pre op HHS) and postoperative (post op HHS) administered at 1 year and 5 years. Results: There were 62 patients and 72 cementless THRs. Ten (16.13%) patients had bilateral conditions; 25 (40.32%) patients had right THR, while 27 (43.55%) patients had left THR. Twenty (32.26%) patients were males and 42 (67.74%) were females. Male:female is 1:2.1 patients. The most common cause from the study is still primary osteoarthritis which accounts for 51.6%, while the least is avascular necrosis (AVN) of the head of femur seen in hemoglobinopathy (22.58%). Those following idiopathic AVN are slightly higher (22.58%), while posttraumatic is 25.81%. The comparison of means of HHS shows pre op HHS and post Op HHS at 1 year has P = 000 (P < 0.05). Pre op HHS and post op HHS at 5 years has P = 0.000 (P < 0.05). The comparison of HHS means for gender shows male pre op HHS and female pre op HHS at 1 year has P = 0.341 (P > 0.05). The comparison of HHS means for morbidity shows comorbidity post op HHS and no comorbidity post op HHS at 1 year had P =0.320 (P > 0.05). Conclusion: Our patients presented at a younger age with secondary osteoarthritis secondary to hip joint affectations such as trauma and AVN and they benefited from our intervention with very low complication rate.

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Introduction: The calcaneum is repeatedly subjected to static and dynamic stresses especially in the weight-bearing positions during walking, working or running and this is reflected in the trabecular pattern within the calcaneus. There are six radiological angles associated with this bone notably the Böhler (tuber joint) angle (BA) and Gissane's angle (GA), and they vary in different ethnic population. Aim: This is to determine the calcaneal angles among the ethnic Igbos of South Eastern Nigeria, determine the relationships between these angles, determine any correlation with gender and age, compare the values of the BA and GA to that of other populations and discuss the clinical implications of the determined values. Methodology: A 5-year review of all lateral views of X-rays of the foot and ankle done at Federal Teaching Hospitals, Abakaliki, Nigeria, from 1^st January 2012 to 31^st December 2016, was done. Drawing and mathematical sets were used to measure the six radiological angles on the lateral views of plain X-ray films of the ankle and subjected them to descriptive and inferential statistics. Results: There were 120 patients, 65 males and 55 females. The calcaneal angles among the ethnic Igbos of South Eastern Nigeria showed the following: BA: 32.58 ± 4.98, GA: 121.22 ± 6.11, calcaneal compression angle: 30.00 ± 3.01, talocalcaneal angle (TCA): 22.58 ± 5.28, calcaneal pitch angle: 17.35 ± 3.79 and apical angle (AA): 67.24 ± 7.27. There was no relationship between these angles. The TCA and AA showed a correlation with gender and age and other angles did not. There was a statistically significant difference between BA values in this study and that of Ugandan and American populations (P < 0.05). There was a statistically significant difference between the GA values in this study and that of Turkish, New Zealand and Indian populations. Conclusion: These determined values would be a useful tool in the management of patients of Igbo extraction with of the foot pathology.

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Introduction: Management of non union of long bones can be challenging and frustrating for the orthopaedic surgeon. In sub Saharan Africa, the bulk of surgeries done by the orthopaedic surgeon may include a significant number of non union of long bones. This is largely because of the strong affinity for seeking treatment from the traditional bone setter as the first on call following fractures in most cases. The orthopaedic surgeon frequently gets to manage the complications arising from such treatment. In managing such cases, adjunctive therapies targeted at increasing union rates which are available to surgeons elsewhere are frequently lacking. Methodology: The study was aimed at determining the outcome of surgeries done for non union of long bones in our institution. It was a retrospective study spanning a 3 year period, from April 2013 to March 2016, involving 80 patients who presented with non union of any of the 3 long bones which had not previously been surgically managed. The patients had surgery with plate / screw construct or a solid intramedullary nail. Outcome measures analysed included occurrence of union, time to union and occurrence of complications with each treatment method for the 3 long bones. Results: We recorded a union rate of 79.2% for all 3 long bones. Majority of the femoral non unions were nailed while the humerus was more commonly plated. The humerus did better with plating than it did when nailed, though nailed non unions were observed to unite faster. Femoral non unions united better when nailed than when plated, though the difference was not statistically significant. Complications rates were higher following plating for femoral non unions. Complications following humeral non union plating were also higher than observed for nailing, with radial nerve palsy occurring in 23.5% of platings. Tibial non unions demonstrated high union rates irrespective of treatment method used. Conclusion: In conclusion, management of non union of long bones is still a challenge with a recurrence rate of 10.8%. Humeral non unions do better when plated as opposed to the femur. Tibial non unions do well with either plating or nailing.

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Introduction: Surgical emergency is a medical condition for which immediate or urgent surgical intervention is required. This includes acute trauma and other life- or limb-threatening conditions that may cause a loss of life or permanent deformity if surgical interventions are not applied immediately. The accident and emergency (A and E) room is the first point of call for patients with such surgical emergencies. This study is an audit of surgical emergency deaths in the A and E of the Lagos University Teaching Hospital (LUTH). Methodology: This was a retrospective study. It involved analysis of the records of patients who were attended to at the A and E room of LUTH, Idi-Araba, Lagos state. The period of study was 12 months. Data obtained were analysed using Microsoft Excel 2010 (Microsoft Corporation, Redmond, Washington, USA). Results: The crude mortality rate was 8.3%. The overall male:female ratio was 2:1. The average age at death for both sexes was 46.5 ± 17.5 years. The age ranged from 6 to 87 years. Trauma was the cause of death in 99 cases (52.4%), with a male:female ratio of 5.2:1. Traumatic brain injury was the largest contributor of death overall, with a male:female ratio of 6.6:1. The average age of females who died following trauma was 6 years younger than that of the males. More patients involved in trauma died within 24 h of presentation. The overall average age at death for trauma-related deaths was 38.9 ± 17.2 years. However, the overall average age at death for malignancy-related causes was 53.9 ± 13.5 years. The male:female ratio for malignancy as a cause of death was 1:2.3. More deaths occurred within ages 20 and 39 years, accounting for almost half (46.8%) of the total deaths. Breast carcinoma was the major (45.3%) cause of death among the malignancy-related causes of death, with all but one case occurring in women. Conclusion: Mortality at the surgical department of A and E is still high compared to centres of other Western countries. The general populace needs orientation to reduce risk factors for trauma, especially brain injury. The government also needs to improve facilities available at the trauma centre.

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Background: Reduced bone density if left untreated is a known precursor of osteoporosis, a silent disease with increased morbidity. In the developing country, fragility bone fractures occur in the general population, and health-seeking behaviour is low. An incredibly high level of ignorance is observed. Methodology: A descriptive cross-sectional study was carried out to determine the bone mineral density (BMD) among patients who visited a specialist clinic for screening for osteopenia using the unigamma dual energy X-ray absorptiometry (DXA) machine. 54 participants were selected for this study having met the inclusion criteria. Data were analysed using SPSS version 22 with P = 0.05. Results: BMD of 54 women whose ages ranged 42–86 were analysed. Twenty-eight (51.9%) were obese while 7 (13.0%) had normal weight. 50 (92.6%) had low BMD. BMD of the right and left femora correlated more with age (P = 0.015 and 0.008, respectively). Mild and severe osteopenia were found mostly in the left femoral neck and left femoral ward, respectively, while moderate osteopenia was more common in the right greater trochanter. In this population, diagnosis of loss of bone mass by DXA examination is best on the left femur. Conclusion: Reduced BMD was present in most participants. It is advised that Nigerian women have their baseline bone density test to avoid unnecessary preventable fractures later in life. More awareness programmes is advised in the future.

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Background: The femur is one of the principal load-bearing bones of the lower extremity. Femur fractures are among the most common fractures encountered in orthopaedic practice. Open femur fractures are always as a result of high-velocity injury and almost invariably associated except for isolated gunshot injuries with multiple traumas. The aim of the study is to determine the pattern of presentation of open femur shaft fractures, associated injuries and outcome of treatment. Patients and Methodology: A 10-year retrospective study done at National Orthopaedic Hospital, Enugu, from 2007 to 2016. Patients' folders were retrieved from the Medical Records Department; patients' biodata, cause of the injury and other relevant information were collated from the folders and their management followed up for 1 year. Data analysis was done with Statistical Product and Services Solution Version 22. Results: A total of 62 cases were reviewed. Treatment outcome of 50 patients that completed their management was analysed. The age range with the highest frequency was 21–30 years. Associated injuries were recorded in 77.4% of the patients. Thoresen's combined excellent and good outcome was observed in 63.3% of the patients at a minimum of 1-year follow-up. Conclusion: Open femoral shaft fractures are more common in the younger age groups and usually associated with high frequency of associated injuries. The outcome of treatment of these fractures in our environment is good despite the limited resources usually encountered in a developing nation like ours.

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Background: The Ponseti method is generally acknowledged to be the gold standard for congenital clubfoot treatment, worldwide. Although this treatment is considered to be cheap and effective, some patients in less affluent climes are unable to afford the treatment, which includes wearing of braces until the age of 4 years. Objectives: This study documents the experience of running a clubfoot clinic with the financial support from three rotary clubs for 2 years and aims to review the impact of the sponsorship and recommend a replication of this model in similar settings. Materials and Methods: This is a retrospective study of patients treated in our clubfoot clinic adopted by the rotary clubs from 20^th September 2017 to 20^th August 2019. Age at presentation, sex, laterality, Pirani score, number of casts to correction, brace compliance and complications were recorded prospectively in the International Clubfoot Registry hosted by The Center for Bioinformatics and Computational Biology at the University of Iowa, USA, and analysed using Microsoft Excel software. Results: A total of 136 patients were treated, 81 (60%) of which had bilateral deformities, totalling 217 feet. There were 71 males and 65 females, with a male-to-female ratio of 1:0.9. The age at first visit ranged from 0 to 10 years. The largest number, 74 patients (54.4%), was aged between 0 and 3 months, but only one was aged above 10 years, at presentation. Using the Pirani score, 71% had severe deformities (Pirani score of 4 and above). The tenotomy rate was 29%. The average number of casts to correction was 4.6. Sixty-eight patients received braces at subsidised rates of 50% of the cost. Only 5% of the feet relapsed after correction. Conclusion: The rotary club intervention in our clubfoot clinic was associated with an increase in the annual number of patients attending the clinic, but the relapse rates remained the same as with previous studies.

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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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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 10^th January 2017 to 5^th 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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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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Background: Literature is replete with the reports of adverse impacts of smartphones on physical, psychological and mental health of users. Hence, the knowledge of the risks associated with smartphones and the proper ergonomics adopted during its usage may be an important preventive tool. This study investigated the knowledge and practice of proper ergonomic posture during smartphone use by undergraduate students of a university medical college. Materials and Methods: A cross-sectional analytical survey involving 231 undergraduate students of a university college of medicine. The instrument was a 21-item self-administered questionnaire adapted from previous studies and comprised of four sections. Section A collected information on the sociodemographic data of participants; Section B, on smartphone use by participants; Section C, on their knowledge of proper ergonomic posture during smartphone use and Section D, on their practice of proper ergonomic posture. Data were presented using the descriptive statistics of mean and percentages with the level of significance at P ≤ 0.05. Results: Almost a third of the respondents 66 (28.6%) use their phones 4–6 h daily, whereas nearly one-third of the respondents use their phones for >12 h daily. Furthermore, majority of the respondents 124 (56.7%) have poor knowledge of proper standing ergonomic posture, 194 (84.0%) have poor knowledge of proper sitting ergonomic posture, whereas 149 (64.5%) have poor knowledge of proper wrist ergonomic posture. More than half of the respondents 126 (54.7%) do not have good practice of proper ergonomic posture when using smartphones. Conclusion: Medical college students possess poor knowledge or practice of proper ergonomic posture during smartphone use. Furthermore, more than half of the respondents do not practice proper ergonomic posture while using their smartphone.

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Distraction osteogenesis has been one of the most remarkable achievements in musculoskeletal surgery. It is the sheet anchor for the process of limb lengthening and internal bone transport as well as gradual deformity correction. It has revolutionised the management of limb deficiencies and bone loss. Since its conception over a 100 years ago, it has gone through several stages of evolution brought on by an increasing understanding of the underlying principles that govern the successful application of the concept as well as technological advancements in the field of limb reconstruction surgery. The result of this has been a significantly changing outlook for many musculoskeletal conditions. This review looks at the historical perspectives of this concept, noting the contributions of the pioneers in this field of surgery. Its evolution and the principles governing the various aspects of distraction osteogenesis are discussed in detail. The various methods in use today and its application in modern-day orthopaedics are also critically reviewed.

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Periprosthetic joint infection (PJI) is one disaster too many and will remain a never-ending topic as long as joints are replaced all over the world. The objective was to review current literatures on the pathology, management and prevention of PJI. This is a descriptive review of the current literatures on the definition, epidemiology, risk factors, pathology, classification, diagnosis, treatment and prevention of PJI. PJI is one of the most common causes of revision arthroplasty with increasing incidence. The risk factors are patient, staff and environmental mediated, and they are grouped into modifiable and non-modifiable risk factors. The modifiable risk factors are controllable. In general, PJI can be early or late, and this provides a guide to treatment. Arriving at a diagnosis can be clinical, laboratory, radiological or a combination, with newer trends geared towards identifying the exact organism causing the infection. Preventing PJI is the goal of every arthroplasty surgeon. The diagnosis of PJI remains a problem, and the optimal method of treatment is a subject of debate. Therefore, preventive measures should be topmost on every surgeon's mind.

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