Early Treatment Outcome of Humeral Shaft Fracture Non-Union in Adults: Comparative Study of Plating versus Interlocking Nailing

Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3rd of the humeral shaft (60%). Failed TBS treatment was the commonest indication for the osteosynthesis (71%). More patients had plating (53%) compared to 47% who had LIMN. Most patients (93.4%) had union between 3 to 6 months irrespective of fixation type with no significant statistical difference between the union rate of DCP and LIMN (p value 0.06) with similar functional outcome and complication rates irrespective of the type of fixation. Conclusion: This study showed that the success rates in term of fracture union, outcome functional grades and complication rates were not directly dependent on the types of the fixation: plating or locked intra-medullary nailing.

Early Clinical and Functional Outcome of Primary Total Knee Replacement with Posterior Cruciate Substituting Prosthesis for Primary Knee Osteoarthritis Using 2011 Knee Society Score

Background: Primary knee Osteoarthritis (OA) is the commonest articular disease in middle age and elderly people. Primary total knee replacement (TKR) is a known world-wide standard and definitive treatment of primary knee OA following failed adequate non-operative management. It is of clinical importance to assess the clinical and functional outcome of TKR to prognosticate the severity of primary knee OA. The new (2011) knee society scoring system (nKSS) is both surgeons and patients’ assessment tool for the treatment outcome of TKR. Study Design: Prospective interventional analytical study. Aim and Objective: The aim of the study was to determine early clinical and functional outcome of primary total knee replacement in patients with primary knee osteoarthritis using nKSS. The objectives were: 1) To determine the pre-operative nKSS and post operative nKSS;2) To determine relationships between pre-operative nKSS and post operative nKSS at 6 weeks, 3, 6, 9 and 12 months;3) To determine the complication rates in patients undergoing primary TKR in the study centre. Methods: A prospective interventional study of 59 patients aged 51 to 70 years who had 67 Total Knee Replacements (TKRs) participated in the study between November 2015 to June 2018 at National Orthopaedics Hospital, Lagos, Nigeria. Patients’ sociodemographic data, pre-operative and post-operative nKSS system were recorded at 6 weeks, 3, 6, 9 and 12 months during follow up. The data were analyzed using Statistical Package for Social Science (SPSS). Results: There were 41 females and 18 males (M:F = 1:2.3). There were total of 67 TKRs with 31 right TKRs, 20 left TKRs and 8 staged bilateral TKRs. The participants’ age ranged from 51 to 70 years with the mean age of 59.5 (±8.5) years. Four patients did not complete the study due to various reasons. The remaining 55 participants completed the study period with progressive improvement of their post-operative nKSS at 6 weeks, 3, 6, 9 and 12 months post-operatively when compared with pre-operative nKSS (P value 0.5). Conclusion: This study revealed improved early clinical and functional outcome of primary total knee replacement in primary knee osteoarthritis using nKSS in all the studied patients. There is no significant negative effect of lower pre-operative nKSS (and its components) on the post-operative nKSS outcome.

The Incidence and Association of Mental Depression with Symptomatic Lumbar Degenerative Disc Disease and Treatment Outcome

Study Design: Prospective analytical study. Objectives: The aim was to determine the association between mental depression and symptomatic Lumbar Degenerative Disc Disease (LDDD) in patients with no previous background of mental disorder. We also aimed at determining the incidence of mental depressions in patients with LDDD and the effects of the treatment on the mental depression. Methodology: One hundred and sixty patients with no prior history of mental or behavioral disorders who presented with low back pains arising from LDDD and met inclusion criteria were studied. The clinical findings and Depression Screening Test pro-forma were completed for each. The extracted information was analyzed using Statistical Package for Social Science (SPSS) version 24.0. The statistical significance was set at P Results: One hundred and fifty-three patients completed the study, with a male to female ratio of 1:1.5 and the mean age of the patients was 48.5 years. The marital status was 4.4% single, 86.9% married, 3.8% divorce/separate and 5% widow/widower. Their levels of education were: no formal education (10.00%), primary school level (8.10%), secondary level (27.50%) and Tertiary level (54.40%). Conclusions: This study showed the incidence of mental depression in 32% of the patients with LDDD. We also noted a statistically significant relationship between symptomatic LDDD and level of mental depression with significant improvement in the level of depression at 6th month after treatment. Hence, assessment of the patients’ mental health is important in the management of LDDD.