Nigerian Journal of Orthopaedics and Trauma

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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.

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.

Carpo-metacarpal dislocations are rare lesions, the authors report a case of convergent carpo-metacarpal dislocation of the last four fingers, received urgently and treated by reduction and plastered cuff, it was for us a therapeutic alternative, patient had refused surgical treatment which has been indicated, it is essentially a reduction more pinning. The immobilization lasted one month then a physiotherapy of functional rehabilitation of the removal of the plaster was also carried out. The functional result was satisfactory and professional reintegration was successfully completed.

Background: Ankle arthrodesis is commonly used for the treatment of end-stage ankle osteoarthritis. Many methods have been used for ankle arthrodesis with varying outcomes. A sustained rigid fixation which will enhance healing is the goal of all methods of ankle arthrodesis. The required rigid fixation needed for healing is provided by the method of plating described in this report. The aim of this study is to determine the time to clinical union, time to radiological union and the union rate following the use of double-column plating for arthrodesis of the ankle joint. Methodology: This was a prospective study done at Federal Medical Centre, Birnin Kebbi. All adult patients who had double-column plating for severe osteoarthritis of the ankle joint from April 2015 to March 2018 were included in the study after obtaining their consent. Results: There were 19 patients in the study, one female and 18 males with the mean age of patients treated as 39.6 ± 8.9 years. All patients had post-traumatic osteoarthritis, and double-column plating was used to achieve arthrodesis in all patients. The average time to clinical union was 8.00 ± 0.89 weeks, while the average time to radiological union was 9.75 ± 1.61 weeks. By 6-month post surgery, the union rate was 100%. The complications noticed were broken screws in one patient and pain in adjacent joints in two patients. Conclusion: The use of double-column plating for ankle arthrodesis is a useful method with high union rate and low rate of complications. It is a reliable method for closed, non-infected ankle pathologies that require arthrodesis.

Background: Limb amputations in children are generally an uncommon procedure and are usually associated with significant emotional implications for the patients and their caregivers. Apart from emotional issues, this surgical procedure, which is often life-saving is fraught with challenges in a developing country. The aim of the study was to review indications and challenges posed by presentation and consent time in managing children who need amputation. It is hoped that highlighting the challenges will be helpful in improving care for children who may be involved. Patients and Methods: This was a retrospective study of all children 16 years and below who had limb amputation in Enugu State University of Technology Teaching hospital between January 2015 and December 2019. Results: They were 22 amputations involving 13 (59.0%) males and 9 (41.0%) females, giving a ratio of 1.4:1. Amputations of the lower limb occurred in 15 (68.2%) cases, while the upper limb was involved in 7 (31.8%) cases. Road traffic accident (RTA) 6 (27.3%) and sequalae of Traditional bone setter's (TBS) intervention 6 (27.3%) after trauma were the most common indications for amputation. Delayed wound healing was the most common complication seen. No mortality was recorded, and consent for surgery was the most common challenge encountered. None of the patients was able to acquire prosthesis due to financial constraints. Conclusion: RTA and bone setter's intervention in trauma management leading to gangrene are the most common indications for amputation in children. Comprehensive Child health care plan addressing observed challenges could bring a better outcome in children who may need amputation.

Background: In forensic study, the importance of the patellar morphometry for human identification has been widely accepted, and it also plays a role in the biomechanics of the knee. Aim: The aim of this study is to analyse the morphometric parameters of patella from the cadaver of the Igbo population of South-east Nigeria. Materials and Methods: Parameters from 60 patellae from 30 male cadavers at the museum of the Department of Anatomy University of Nigeria were measured using the Vernier calipers. Results: The determined values of the parameters of the cadaveric knees in centimetres are as follows: PH: M =4.6, SD = 0. 47, PW: M =4.69, SD = 0.29, PT: M =2.66, SD = 0.15, PLH: M = 6.67, SD = 0.67, PLW: M = 2.86, SD = 0.27, WMAF: M = 2.55, SD = 0.18, WLAF: M =2.77, SD = 0.18. The results of the independent sample t-tests indicated that there were no statistically significant differences in the mean values of the parameters of interest between the left and right patella. The result of the Pearson correlations between PH and other parameters indicated there was a very strong positive significant correlation with PW: (r[60] =0.924, P < 0.01), the PW had a strong positive significant correlation with PT (r[60] = 701, P < 0.001), WMAF (r[60] = 763, P < 0.01), and WLAF (r[60] = 700, P < 0.001). The PT had a weak significant positive correlation with PLW (r[60] = 0.338, P = 0.008) and WMAF (r[60] =0.479, P < 0.001). The PLW was weakly significantly positive correlated with WMAF (r[60] = 0.486, P < 0.001) and WLAF (r[60] = 0.403, P = 0.001). The WLAF was strongly significantly positive correlated with WMAF (r[60] = 0.975, P = 0.001). The PH among the Igbo population (M = 4.61, SD = 4.7) was significantly higher than that of Koreans (t[59] = 2.543, P = 0.014) with a small effect size (Cohen's d = 0.33). The PT among the Igbo population (M = 2.66, SD = 0.15) was significantly higher than Korea (t[59] = 22.278, P < 0.01) with a large effect size (Cohen's d = 2.88). Conclusion: This study has established that there are differences with the parameters of interest Igbo ethnic group with that of other populations of interest. The determined values will serve as a guide in the selection of patella component sizes among the studied population.

In general, most comparative studies have reported that successful limb salvage surgeries have better functional outcomes than amputations. This is largely due to the advances in surgical techniques and adjuvant therapy which allows reconstruction such as endoprosthetic replacements (EPR). Clinician-reported outcome measures and patient-reported outcome measures have been utilised to evaluate the benefits of orthopaedic surgical procedures. The most widely used measures in the field of orthopaedic oncology are the Musculoskeletal Tumour Society Score and the Toronto Extremity Salvage Score. The Jury is still out on the evidence basis for the functional outcome of EPR, especially around the knee joint. There is a need for more randomised control trials, systematic reviews or meta-analyses to critically appraise and formally synthesise the best available evidence to provide a statement of conclusion on the functional outcome of EPRs.

Online since 10^the November 2017.