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.

Watson-Jones Anatomical Approach for Open Reduction and Internal Fixation of Proximal Femoral Fractures without Image Intensifier in a Low-Resource Setting

Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas over the world.

High drug loading hydrophobic cross-linked dextran microspheres as novel drug delivery systems for the treatment of osteoarthritis

Drug delivery via intra-articular(IA)injection has proved to be effective in osteoarthritis(OA)therapy,limited by the drug efficiency and short retention time of the drug delivery systems(DDSs).Herein,a series of modified cross-linked dextran(Sephadex,S0)was fabricated by respectively grafting with linear alkyl chains,branched alkyl chains or aromatic chain,and acted as DDSs after ibuprofen(Ibu)loading for OA therapy.This DDSs expressed sustained drug release,excellent anti-inflammatory and chondroprotective effects both in IL-1βinduced chondrocytes and OA joints.Specifically,the introduction of a longer hydrophobic chain,particularly an aromatic chain,distinctly improved the hydrophobicity of S0,increased Ibu loading efficiency,and further led to significantly improving OA therapeutic effects.Therefore,hydrophobic microspheres with greatly improved drug loading ratio and prolonged degradation rates show great potential to act as DDSs for OA therapy.

Pattern of Mortalities among Orthopaedic and Trauma Admissions in Irrua

Background: There are many reports from different parts of the world addressing different aspects of surgical mortality. However, none has been done in this centre as it relates to orthopaedics and trauma admissions. Such data are invaluable to health planning and epidemiological monitoring. Objective: To retrospectively review all mortalities arising from orthopaedics and trauma admission as they present to Irrua specialist Teaching Hospital (ISTH) Irrua from Jan 2005-Dec 2014. Method: Medical records of case mortalities among orthopaedic and trauma admissions over ten years (Jan 2005-Dec 2014) were retrospectively reviewed. Results: Over this period, 2129 admissions and 45 deaths were recorded, with an overall crude mortality rate of 2.11%. No death was recorded among the paediatric age group. Thirty-four patients (75.56%) died from trauma (fracture) related diagnosis, majority of which were from head injury followed by infection 5 (11.11%), tumours 4, (8.89%) and disc herniation 2 (4.44%). Males were more affected 77.78% and median age at death was 44 years. Medical co-morbidities were found in 37.77% of the deceased patients. Conclusion: Patients with trauma related cases particularly head injuries, topped the list of mortalities. Young and middle aged adult males were most affected. Need for manpower development, investment in diagnostic and therapeutic facilities and preventive measures is emphasised.

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.

Phenylboronic-tannin nanocolloids that scavenge subchondral reactive oxygen microenvironment and inhibit RANKL induced osteoclastogenesis for osteoarthritis treatment

The excessive reactive oxygen species (ROS) accumulation and overactivated osteoclastogenesis in subchondral bone has proved to be a major cause of osteoarthritis (OA). Scavenging of ROS microenvironment to inhibit the osteoclastogenesis is highly valued in the therapeutic process of osteoarthritis. Despite the excellent ability of polyphenolic colloidal to scavenge reactive oxygen species and its affinity for macrophages, the preparation of polyphenolic colloidal nanoparticles is limited by the complex intermolecular forces between phenol molecules and the lack of understanding of polymerization/sol-gel chemistry. Herein, our work introduces a novel poly-tannin-phenylboronic colloidal nanoparticle (PTA) exclusively linked by ROS-responsive bondings. Nanocolloidal PTA has a uniform particle size, is easy and scalable to synthesize, has excellent scavenging of ROS, and can be slowly degraded. For in vitro experiments, we demonstrated that, PTA could eliminate ROS within RAW264.7 cells and impede osteoclastogenesis and bone resorption. RNA sequencing results of PTA-treated RAW264.7 cells further reveal the promotion of antioxidant activity and inhibition of osteoclastogenesis. For in vivo experiments, PTA could eliminate the ROS environment and reduce the number of osteoclasts in the subchondral bone, thereby alleviating the damage of subchondral bone and symptoms of osteoarthritis. Our research, by delving into the formation of polyphenol colloidal nanoparticles and validating their role in ROS scavenging to inhibit osteoclastogenesis in subchondral bone, may open new avenues for OA treatment in the future.

Injuries Associated with Auto-Tricycle Crashes in an African City: Incidence and Pattern

Purpose: The aim of this study was to determine the incidence and pattern of injuries resulting from auto-tricycle crashes among patients in a tertiary referral centre in Ghana. Methods: Data were retrospectively extracted from hospital records of patients who got involved in auto-tricycle crashes and presented to the Accident and Emergency Centre of the Komfo Anokye Teaching Hospital (KATH), over a one-year period using a structured questionnaire. The gathered data were then entered into an electronic database and then analysed with SPSS version 20.0. Results: The incidence of injury following auto-tricycle crashes over the one-year period was 5.9% (95% CI: 4.9% - 7.0%) with a case fatality rate (FR) of 3.8% (95% CI: 1.3% - 8.7%). All the mortalities resulted from head and neck injuries and none of the patients involved wore a crash helmet. Only 5% of those studied wore crash helmets and were all drivers. Closed fractures accounted for 58% of the injuries, followed by open fractures, 28%. The most commonly fractured bones were the tibia/fibula, followed by the femur and then radius/ulna. The most common mechanism of injury was auto-tricycle toppling over (29%). Passengers were the most injured (48%), followed by drivers (37%) and pedestrians (15%). Most (72%) injuries among participants involved a single body part. On the injury severity scale, most (61%) of patients had minor trauma and 38% had major trauma. Conclusion: Auto-tricycle crashes account for 5.9% of injuries at the study site with a case fatality rate of 3.8%. Passengers had a higher injury rate (48%) than drivers (37%). Fractures of the tibia/fibula were most commonly associated with auto-tricycle crashes. Injuries to the head and neck were responsible for the deaths in the study participants and non-use of a crash helmet was associated with mortalities.

Disseminated cysticercosis incidentally diagnosed in a patient of low backache:A case report and concise review of literature

Disseminated cysticercosis is an uncommon presentation of a common disease.Asymptomatic disseminated cysticercosis is rarely reported in literature.Here,we are reporting a case of asymptomatic disseminated cysticercosis incidentally diagnosed in a patient of low backache. Magnetic resonance imaging of lumbosacral spine and neuroimaging done subsequently during the course of evaluation revealed diffuse cysticercosis involving abdominal,paraspinal,pelvic and gluteal muscles along with neurocysticercosis.Such a disseminated cysticercosis was diagnosed incidentally in this patient of low backache with right sciatica and radiculopathy at L5-S1 prolapsed intervertebral disc and was subsequently managed by L5-S1 interlaminar fenestration and discectomy.

Ankle Arthroscopy: A Complimentary Adjunct in the Diagnosis and Management of Ankle Fractures

Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may arise as a result of untreated ligamentous or chondral injuries. This study aims to correlate acute arthroscopic ankle findings with the Lauge-Hansen fracture pattern classification. We further aim to compare subjective functional outcomes at least one year following surgery between patients who have received Open Reduction and Internal Fixation (ORIF) alone, versus ORIF plus arthroscopy. This is a retrospective case series of patients who have undergone ankle fracture ORIF +/- arthroscopy from July 2014 to July 2017 inclusive. Each patient’s presenting radiograph was classified according to the Lauge-Hansen ankle fracture classification with subsequent correlation to intra-operative arthroscopic findings. Functional outcome at a minimum of one year was evaluated with the American Academy of Orthopaedic Surgeons (AAOS) metric. Twenty two patients underwent ankle ORIF plus arthroscopy (Group A) with a further 26 patients receiving ORIF alone (Group B). 1 in 3 supination-external-rotation type II (SER II) injuries possessed a concomitant syndesmosis injury or osteochondral lesion (OCL) on arthroscopy. 1 in 3 patients with an SER IV injury had an osteochondral lesion. The mean AAOS score achieved for Group A was 89.6 (±7.9) with the mean score for Group B being 82.0 (±13.7). In conclusion, ankle arthroscopy aids the diagnosis and treatment of ligamentous and osteochondral injuries not evident on plain film with subsequent superior short-term outcomes.

Biomechanical characteristics of bone in streptozotocin-induced diabetic rats:An in-vivo randomized controlled experimental study

AIM: To investigate the in vivo effects of type Ⅰdiabetes on the mechanical strength of tibial bone in a rodent model.METHODS: The biomechanical effect of diabetes on the structural integrity of the tibia in streptozotocin induced diabetic Wistar rats was analysed. Induction of diabetes was achieved by an intra-peritoneal injection and confirmed by measuring serial blood glucose levels(> 150 mg/d L). After 8 wk the tibiae were harvested and compared to a control group. Biomechanical analysis of harvested tibiae was performed using a threepoint bending technique on a servo hydraulic MTS 858 MiniB ionix frame. Maximum force applied to failure(N), stiffness(N × mm) and energy absorbed(N/mm) were recorded and plotted on load displacement curves. A displacement control loading mode of 1 mm/min was selected to simulate quasi-static loading conditions. Measurements from load-displacement curves were directly compared between groups.RESULTS: Fourteen streptozotocin induced diabetic Wistar rats were compared against nineteen non-diabetic controls. An average increase of 155.2 g in body weight was observed in the control group compared with only 5 g in the diabetic group during the experimental study period. Levels of blood glucose increased to 440.25 mg/d L in the diabetic group compared to 116.62 mg/d L in the control group.The biomechanical results demonstrate a highly significant reduction in the maximum load to failure from 69.5 N to 58 N in diabetic group compared to control(P = 0.011). Energy absorption to fracture was reduced from 28.2 N in the control group to 23.5 N in the diabetic group(P = 0.082). No significant differences were observed between the groups for bending stiffness.CONCLUSION: Streptozotocin-induced diabetes in rodents reduces the maximum force and energy absorption to failure of bone, suggesting a predisposition for fracture risk.

Osteoarticular sequlae of small pox:a case report

Small pox has been eradicated completely but its unique pathology and sequlae still come across in routine clinical practice.Osteoarticular changes following small pox infection has been elaborated in literature.We present a similar but rare patient with osteomyelitis variolosa and joint deformity involving elbow,wrist joints and humerus fracture.The condyles were typically elongated as central portion of distal humerus absorbed.Fracture united uneventfully following stabilization with dynamic compression plate and bone grafting.Patient showed satisfactory elbow function at the end of last follow-up.

Surgical site infection and clinical microbiology in orthopaedics surgeries in a rural hospital

Infection and Clinical Microbiology in Orthopae-dics Surgeries in Wound infections resulting from contaminationduring major orthopaedics surgery continues to bea vital issue.In this study,speci mens of pus,draining fluids or suspected pus fromthe woundsof surgical patients who had been undergone majororthopaedics surgical procedure were cultured.Objective of present study was to analyze

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.

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.

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.

A Rare Case of Fish Bone Penetrating Injury to Radius Causing Osteitis and Non-Healing Sinus

Penetrating injury to radius or any other bone by fish bone is a rare kind of injury. Commonly metallic sharp objects, bullets, sharpnels, glass particles, hard wooden pieces are the causes of penetrating injury to bones. Radio-opaque objects are easy to detect and thus retrieval is relatively simpler than the radiolucent objects. Non-biological foreign bodies do not incite any reaction in the host bone whereas biological foreign bodies of either plant or animal origin cause hypersensitivity reaction. Osteitis along with excessive formation of new bones may be presented as a part of host reaction to the foreign body. We are presenting here an interesting case of a fisherman boy who sustained penetrating injury to radius by fish bone resulting in osteitis and a chronic non-healing sinus with watery discharge.

Unusual Combination of Monteggia, Radius Shaft, and Scaphoid Fractures

A rare combination of an ulnar fracture with posterior dislocation of the head of the radius and fracture of the radius shaft concomitant with an ipsilateral scaphoid fracture is presented. To the best of our knowledge, no such case has been reported. The mechanism of this fracture combination is discussed with respect to its role in producing the Monteggia type II fracture. Treatment consisted of a combination of closed and open reduction with external fixation.

Short arm cast is as effective as long arm cast in maintaining distal radius fracture reduction:Results of the SLA-VER noninferiority trial

BACKGROUND Distal radius fractures(DRFs)are a common challenge in orthopaedic trauma care,yet for those fractures that are treated nonoperatively,strong evidence to guide cast treatment is still lacking.AIM To compare the efficacy of below elbow cast(BEC)and above elbow cast(AEC)in maintaining reduction of manipulated DRFs.METHODS We conducted a prospective,monocentric,randomized,parallel-group,open label,blinded,noninferiority trial comparing the efficacy of BEC and AEC in the nonoperative treatment of DRFs.Two hundred and eighty patients>18 years of age diagnosed with DRFs were successfully randomized and included for analysis over a 3-year period.Noninferiority thresholds were defined as a 2 mm difference for radial length(RL),a 3°difference for radial inclination(RI),and volar tilt(VT).The trial is registered at Clinicaltrials.gov(NCT03468023).RESULTS One hundred and forty-three patients were treated with BEC,and 137 were treated with AEC.The mean time of immobilization was 33 d.The mean loss of RL,RI,and VT was 1.59 mm,2.83°,and 4.11°for BEC and 1.63 mm,2.54°,and VT loss were respectively 0.04 mm(95%CI:-0.36-0.44),-0.29°(95%CI:-1.03-0.45),and 0.59°(95%CI:-1.39-2.57),and they were all below the prefixed noninferiority thresholds.The rate of loss of reduction was similar.CONCLUSION BEC performs as well as AEC in maintaining the reduction of a manipulated DRF.Being more comfortable to patients,BEC may be preferable for nonoperative treatment of DRFs.

The Effect of the COVID 19 Pandemic on Elective Surgical Services in Jos, North Central, Nigeria

Background. The COVID 19 pandemic affected healthcare delivery systems worldwide. There was a redistribution of health care resources in order to deal with the effects of the pandemic, with a corresponding consequence on other clinical services rendered. The extent of this effect on other non COVID 19 related services has been reported in other centres worldwide. In our own setting, health care resources are limited with suboptimal access even in normal situations. Objective. We sought to evaluate the effects of the COVID 19 pandemic on elective surgical services in our hospital. Methods. This was a cross sectional comparative study carried out at the Jos University Teaching hospital, (North central, Nigeria) of the elective surgical services rendered during the first wave of the COVID 19 pandemic lockdown covering the period April to June 2020 with a corresponding period of the preceding year 2019. Data was obtained from the hospital records department, theatres and service areas for clinic attendance, elective surgeries and ward occupancy. The paired sample t-test was used to compare the assessed variables across the three months of both years with a level of significance of P < 0.05. Results. There was mean clinic attendance of 2859.33 ± 223.36 covering the three months in 2019 as against a mean attendance of 648.67 ± 578.24 covering a similar period in 2020, P = 0.037. The elective surgical procedures carried out across the surgical specialties over the period in 2019 gave a mean of 352.33 ± 44.60 as opposed to 64.001 ± 7.32 over the corresponding period in 2020, P = 0.018. Ward occupancy over April to June 2019 was a mean 297.33 ± 18.58 across the various surgical wards and 158.33 ± 25.70 in the same period in 2020, P = 0.007. Conclusion. There was a significant reduction in the elective surgical services rendered in the hospital during the first wave of the COVID 19 pandemic compared to a corresponding period in the preceding year. This decline in elective surgical services would have negatively affected the access to health care. Thus measures to clear the backlog of elective surgical procedures would be required.

An Update on Traumatic Joint Dislocations in Nigeria

Trauma has assumed a pre-eminent epidemic proportion in the hierarchy of diseases afflicting the growing populace in Nigeria. Research into traumatic dislocations is relatively small. Road traffic accident is the commonest cause of traumatic dislocation in Nigeria currently. Human factors and collapse of road infrastructures are the major reasons. Young, productive, adult males are still the most affected while the rarity among children is again highlighted. Careful and detailed evaluation of patients is advised as certain conditions can mask the presence of a dislocation. Lack of diagnostic and therapeutic facilities in most centres in Nigeria makes this difficult, with clinicians resorting to clinical evaluation only and probably supported by only plain X-rays in some cases. Most cases are amenable to closed surgical management. Identification of long term complications is a major challenge, because of the poor follow up culture of our patients. Good road design and maintenance, enforcement of road regulations, manpower development and improvements in diagnostic and therapeutic facilities in all centres will reduce the burden of traumatic dislocations on the populace.