Profile of Geriatric Trauma in a Developing Country

Geriatric trauma patients require special consideration. They frequently have comorbidities and reduced physiologic reserves, influencing treatment decisions and outcomes. Hence, a comprehensive approach is fundamental to ensure better results. The authors retrospectively evaluated the profile of 332 cases of geriatric trauma over ten years (January 2010-December 2019) at National Orthopaedic Hospital Enugu, in South-East Nigeria. The mean age of patients was 74.78 years (SD = 8.69), with females presenting at a later age than men (76.05 vs 73.69 years), p = 0.013. The commonest mechanism of injury was ground-level fall (47.59%), with proximal femoral fractures being the most common (41.27%). Only 47% of geriatric patients presented to a hospital within 24 hours following injury, and the mean duration of admission was 28 days. Approximately 77% of patients had operative care, and 68.67% expressed satisfaction with the outcome of their management. The mortality rate was 2.11%. In conclusion, most geriatric fractures require surgical intervention and education to facilitate early hospital presentation is needed.

The Antiseptic Efficacy of Povidone-Iodine in Reducing Early Surgical Site Infections in Orthopaedic Implant Surgeries

Background: Surgical site infection (SSI) is a dreaded nightmare for the Orthopaedic surgeon. Preoperative skin cleaning with antiseptics has been shown to reduce the microbial burden of the skin and results in reduced incidence of SSI. However, the ideal skin cleaning agent remains to be established. Aim: To compare the efficacy of Povidone-Iodine/Povidone-Iodine (PI-PI) combination with that of Chlorhexidine-Gluconate/Alcohol (CG-A) combination in re-ducing SSI in Orthopaedic surgeries. Methods: This was a prospective, randomized, double-blinded, controlled study. Subjects that met the selection criteria and gave consent were randomized into PI-PI group (test group) and the CG-A group (control group). Both the patients and the assessors for SSI were blinded to the group a participant belongs. Blocking was done on the type of surgery to cancel the confounding effect of surgery type on SSI. Standard perioperative protocols were applied to both groups. Assessment for features of SSI was done on the 3rd day, 7th day, 14th day, 6th week and 12th-week postoperative period. The diagnosis of SSI was made based on the Centers for Disease and Control (CDC) guidelines. Results: We recruited 124 patients for this study, 62 males and 54 females. The mean age of the subjects was 37.5 years (SD = 14.7 years). Sixty-two subjects were randomized into each group. There was no significant difference in the distribution of the genders in the study arms. Other possible confounders such as duration of hospital stay, use of drains, the surgeon involved and age were evenly distributed in the two groups. Eight patients did not complete the study. The overall incidence of SSI in the study was 2.6%. Subjects in the control group had an SSI of 3.4% while those in the PI-PI group had a rate of 1.8%;however, this was not significant, p = 0.579. Conclusion: Both CG-A and PI-PI combinations are equally efficacious as preoperative skin antiseptic in Orthopaedic implant surgeries.

Evaluation of Peripheral Neuropathy in Diabetic Adults with and without Foot Ulcers in an African Population

Background: Foot ulcers frequently precede lower extremity amputations (LEA) in diabetic subjects. Peripheral neuropathy (PN) is a strong risk factor for diabetic foot ulceration. Majority of diabetic patients with PN are asymptomatic;hence foot ulceration may be the first clinical presentation. Early detection of PN can forestall the development of foot ulcers through active preventive strategies. Few studies have been done to assess PN in diabetic individuals in Africa. The study aims to evaluate the incidence and risk factors for PN in diabetic adults with and without foot ulcers in an indigenous African population. Method: This cross-sectional study involved 90 diabetic adults, 45 with foot ulcers and 45 without foot ulcers. Assessment of PN was done with the Michigan Neuropathy Screening Instrument (MNSI), the 10 g Semmes-Weinstein monofilament (SWM) and the 128-Hz vibrating tuning fork (VTF). Demographic data were collected by questionnaire. Associations between PN and risk factors such as age, alcohol consumption, duration of diabetes, cigarette smoking, BMI, height and sex were also investigated. Results: There were 59 males (65.6%) and 31 females (34.4%) in the study. The mean age of the subjects with foot ulcers was 59.62 years (SD = 6.47), while those without ulcers was 57.47 years (SD = 6.94). Forty-two subjects (93.33%) with foot ulcers have PN using the MNSI, while 33 subjects without foot ulcers (73.33%) have PN. Both the SWM and the VTF showed a high positive correlation with themselves and with the MNSI. Advancing age, duration of diabetes, alcohol intake, hyperglycaemia and cigarette smoking showed a significant association with peripheral neuropathy, while BMI, height and sex did not. Conclusion: The incidence of PN is quite high in diabetic adults in Africa. This calls for early screening and aggressive control of risk factors to prevent the development of diabetic foot ulceration.

The Bacteriological Profile of Surgical Site Infections in Orthopaedic Implant Surgeries in South-East Nigeria

Background: Knowledge of the common bacteria that cause surgical site infection (SSI) and their antibiotic sensitivity is mandatory if treatment of surgical infection is to be successful. The threat of the emergence of resistant strains of bacteria is ever-present. Hence, a sensitivity directed therapy is paramount for the successful eradication of organisms with minimal risk of development of antibiotic resistance. Aim: The aim is to identify the common bacteria that cause SSI in orthopaedic implant surgeries in our hospital. Method: This is a prospective longitudinal study that includes all orthopaedic surgeries involving the use of implants within one year. Patients that had major orthopaedic surgeries involving implant were followed up and their wounds inspected for signs of SSI on postoperative days 3, 7, 14, 42 and 90. Wound swab was taken for microscopy, culture and sensitivity analysis from those who had wound infection, based on the CDC guidelines. Results: One-hundred and sixteen patients met our inclusion criteria and were included in the analysis. There were 62 males and 54 females. The mean age of the participant was 39.62 years (SD = 15.02 years). Fracture fixation with plates and screws was the most common implant surgery done. The incidence of SSI was 2.6%, and Escherichia coli was the most common isolated pathogen. All the SSIs were superficial incisional type, and the infection was monomicrobial in 67% of cases and polymicrobial in 33%. All of the isolated pathogens were sensitive to Imipenem and Gentamycin. Conclusion: Superficial incisional SSI is the most common type of SSI in this study. Escherichia coli is the most frequent pathogen in SSI affecting implant surgeries in our hospital. Gentamycin and Imipenem should be used for the prophylaxis of SSI in our environment.

Assessment of Foot Care Knowledge among Diabetic Amputees at National Orthopaedic Hospital Enugu

Diabetics with unilateral lower extremity amputation (LEA) have an increased risk of contralateral re-amputation. Foot care knowledge and practice has been shown to reduce the incidence of amputation. The study aims to assess the level of foot care knowledge among diabetics with unilateral LEA. Method: A questionnaire based study involving diabetics with unilateral LEA from August 2015 to August 2017. Demographic data and level of foot care knowledge were assessed. Associations between age, gender, educational level, prior amputation and duration of diabetes with level of foot care knowledge were investigated. The presence of peripheral neuropathy in the contralateral leg was also assessed. Results: A total of 64 patients had unilateral LEA within this period, but only 42 patients completed the study. Twenty-four, 24 (57.1%) were males while 18 (42.9%) were females. Mean age was 58.3 years (SD = 12.0). Fifteen, 15 (35.7%) had secondary, 15 (35.7%) had tertiary education, while 3 (7.1%) and 9 (21.4%) had none and primary education respectively. Below knee amputation (BKA) was the commonest (78.6%), and 35.7% have had a prior amputation. Peripheral neuropathy was present in 71.4% of cases. No participant had a good level of foot care knowledge, while 13 (31%) have a fair knowledge and 29 (69%) have poor knowledge. Only 18 (42%) said they have been taught on foot care. Only duration of diabetes and educational level were significantly associated with level of foot care knowledge. Conclusion: Diabetics with unilateral LEA have poor knowledge of foot care and a high prevalence of peripheral neuropathy. Efforts at education of these susceptible cohorts should be intensified.