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.

Early Functional Outcome of Posterior Spinal Decompression for Lumbar Spinal Stenosis at a Tertiary Health Institution, South East Nigeria

Background: Surgical treatment of lumbar spinal stenosis by posterior spinal decompression may be indicated if non-surgical management for the symptoms of low back and lower limbs radicular pains is unsuccessful and/or in patients with persisting or worsening neurological deficits. It has been reported to be an effective treatment modality in well selected patients. This procedure is however not without possible complications which can adversely affect the outcome of treatment in the affected patients. This prospective study was therefore undertaken to evaluate the early functional outcome of posterior spinal decompression for lumbar spinal stenosis at our health institution. Method: All patients with symptomatic lumbar spinal stenosis admitted for posterior spinal decompression and who met the inclusion criteria were recruited with their written informed consent. The patients’ pain severity and functional disability were assessed preoperatively with visual analogue scale (VAS) and Oswestry Disability Index (ODI). The VAS and ODI were also used to reassess the patients postoperatively, at 2 weeks, 6 weeks and 12 weeks respectively. All intraoperative and/or postoperative complications were documented and the results were analyzed. Results: The patients’ mean preoperative lower back pain and leg pain VAS score was 8.26 ± 1.46 while the mean preoperative ODI was 62.4% ±13.56. The commonest combination of spinal decompressive procedure done in the patients was laminectomy + foraminotomy in 10 (25% patients). The most common decompressed spinal level was L4/L5 (89.7%);while almost equal number of patients had either one spinal level or two-spinal level decompression (43.6% and 46.1% respectively). Postoperative pain assessment showed a mean VAS of 3.79 ± 1.15, 2.55 ± 1.27 and 2.00 ± 1.41 at 2 weeks, 6 weeks and 12 weeks respectively (p = 0.000). Functional outcome assessment with ODI was 34% ± 11.79%, 24% ± 10.75% and 18.12% ± 10.61% at 2 weeks, 6 weeks and 12 weeks respectively (p = 0.000). The commonest surgical complication seen was dura tear which occurred in nine patients (23.1%). Conclusion: There was significant reduction in low back and radicular pains with consequent functional improvement in majority of the patients who had posterior spinal decompression for lumbar spinal stenosis at our health institution. There were few complications of which dura tear was the commonest.

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.

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.