Background: Implant removal represents one of the most common operations in bone and joint surgery. After fracture union, the implant loses its purpose and continues to exist only as a foreign object inside the patient's body and the question arises whether the implant should be removed, and if so, why and when. While early implant removal increases the risk of re-fracture, delayed removal may result in more difficult and extensive operating procedures, due to a stronger bony integration and overgrowth on implants. This will provide essential information needed for hospital policy formulation. Aims and Objectives: The aim of this study is to determine the prevalence, indications and outcomes following orthopaedic implant removal and to proffer appropriate solutions. This will provide essential information needed for hospital policy formulation. Patients and Methods: This is a retrospective study of all cases of implant removal performed in the Orthopedic Unit of Federal Medical Center and Surgery Department of Sir Yahaya Memorial Hospital all in Birnin Kebbi, Kebbi State, North-western Nigeria from January 2011 to December 2017. Case notes of the patients were retrieved and relevant information was extracted and analysed. Results: A total of 113 implants were removed from 111 patients. There were 78 males and 33 females, with a male to female ratio of 2.4:1. The peak age group is the 36–45 years. The longest duration of implant was from 13 to 18 months. Plate and screws constituted 76 (67%) of all implants removed. The femur was involved in 49 (43.3%) cases. Patient's request constituted 46 (41.5%) of the indications. There was retained hardware in 6 (5.4%) cases while external fixation (17, 15.3%) was the most common additional procedure performed. Conclusion: Most of the implants stayed for more than a year. Plate and screws were the most common implants removed. The femur was the most involved bone. Patient's request was the most common indication for removal. Retained hardware was the most common post-operative complication while external fixation was mostly performed as an additional procedure.

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Fracture-dislocations of the shoulder are grave injuries. These injuries rarely are caused by electrocution injuries. The diagnosis of these injuries is tricky. Missed diagnosis of these injuries is common due to inadequate radiological examination. We report two cases of fracture-dislocation of the shoulder following accidental electrocution injuries. Our case report includes two patients who injured their shoulder joints after suffering accidental electric shock injuries. Our first patient was an 80-year-old female who suffered an anterior fracture-dislocation of the shoulder and second patient was a 28-year-old male who suffered a posterior fracture-dislocation. Both the patients were treated by osteosynthesis using the deltopectoral approach. Our patients had a good function of their shoulders at the end of 1-year follow-up. Fracture-dislocations of the shoulder pose a significant diagnostic threat and are often missed due to inadequate radiographs. These injuries can be successfully treated by early diagnosis and anatomical fixation of the fracture. Avascular necrosis of the head of the humerus is the significant complication to these injuries.

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Broad narrative review. To review and summarise the current literature on the management of tuberculosis (TB) spine. A thorough review of literature was performed on the epidemiology, aetiology, pathophysiology, pathology, clinical features and management of TB spine. Spinal TB accounts for half of skeletal TB and remains a common cause of public health concern in the developing world. The thoracic spine segment is the most affected. Patient commonly present with back pain and gibbus. The diagnosis involves demonstrating Mycobacterium tuberculosis on microscopy or culture as well as characteristic histology findings. Magnetic resonance imaging is the gold standard imaging modality. Medical therapy with anti-TB agents is the mainstay of treatment. Surgery is supplementary and indicated in selected cases. Spinal TB carries a good prognosis when detected and treated early. Delays can be associated with the development of complications including difficult-to-manage deformities. Multi-drug anti TB chemotherapy remains the bedrock of treatment. Surgery is supplementary and when indicated, takes the form of abscess drainage, debridement and fusion with or without instrumentation.

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Introduction: Monoarticular arthritis which means inflammation, (infective or non-infective) of single synovial joint is a huge burden in the health care system. Chronic monoarthritis is characterized by its progressive onset and slow development, commonly presenting with mild inflammatory signs. The clinical presentation is usually nonspecific especially in the early stages. To evaluate the role of clinical, hematological and immunological features in the diagnosis of peripheral large joint monoarthritis and its correlation with radiographic studies and histopathological studies of the same. Materials: A total of 30 patients of a monoarticular joint disease were studied in which conventional radiography, MR imaging, arthroscopy and synovial biopsy as techniques for its diagnosis were compared. Results: The mean age in the present study was 21.23 years with a preponderance of male patients. MRI was found to have high sensitivity (87.5%) and specificity (85.7%) in the diagnosis of chronic inflammatory synovitis. Arthroscopy wasfound to have a sensitivity of 83-85% and specificity of 85-86% in diagnosing both inflammatory and infective synovitis. Conclusion: MRI is recommended as additional techniques in the initial diagnostic evaluation when radiography yields negative results. When assessed together with ahistopathological examination of the synovium and mycobacterial cultures, MRI imaging forms a powerful tool in diagnosing tubercular synovitis early. Arthroscopic joint evaluation should be used wherever feasible for a complete evaluation of the knee joint along arthroscopic guided biopsy. Not only does it increase the diagnostic yield of the biopsy but can also diagnose other associated conditions.

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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.

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Background: Literature is replete with the reports of adverse impacts of smartphones on physical, psychological and mental health of users. Hence, the knowledge of the risks associated with smartphones and the proper ergonomics adopted during its usage may be an important preventive tool. This study investigated the knowledge and practice of proper ergonomic posture during smartphone use by undergraduate students of a university medical college. Materials and Methods: A cross-sectional analytical survey involving 231 undergraduate students of a university college of medicine. The instrument was a 21-item self-administered questionnaire adapted from previous studies and comprised of four sections. Section A collected information on the sociodemographic data of participants; Section B, on smartphone use by participants; Section C, on their knowledge of proper ergonomic posture during smartphone use and Section D, on their practice of proper ergonomic posture. Data were presented using the descriptive statistics of mean and percentages with the level of significance at P ≤ 0.05. Results: Almost a third of the respondents 66 (28.6%) use their phones 4–6 h daily, whereas nearly one-third of the respondents use their phones for >12 h daily. Furthermore, majority of the respondents 124 (56.7%) have poor knowledge of proper standing ergonomic posture, 194 (84.0%) have poor knowledge of proper sitting ergonomic posture, whereas 149 (64.5%) have poor knowledge of proper wrist ergonomic posture. More than half of the respondents 126 (54.7%) do not have good practice of proper ergonomic posture when using smartphones. Conclusion: Medical college students possess poor knowledge or practice of proper ergonomic posture during smartphone use. Furthermore, more than half of the respondents do not practice proper ergonomic posture while using their smartphone.

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Purpose: Globally, Orthopaedic Surgery is not left out in the trend towards subspecialization in the surgical specialties. This study aims to determine the current perception and practice of subspecialization in Orthopaedics by the Nigerian Orthopaedic surgeon and to make recommendations on the way forward. Methods: A questionnaire was designed and distributed among Orthopaedic surgeons of different cadres. One hundred and twenty (120) questionnaires were sent out and 107 of those were recovered. Their responses were collated and the resulting data was analyzed using the IBM SPSS version 21. Results: One hundred and three (103, 96.3%) of the respondents were males and 4 (3.7%) were females. Eighty-eight (88, 82.2%) were consultants; 98 or 91.6% worked in government facilities. Thirty-eight (38, 35.5%) said they were subspecialists. Ten (10) had subspecialty training 6 months or longer. Nine (9) had more than 75% of their practice in their subspecialty. Twelve (12) subspecialists were satisfied with their level of knowledge while eleven (11) were satisfied with their output. Most of the respondents (103, 96.3%) desired that the subspecialty training should be made mandatory while 102 (95.3%) wanted it incorporated into the regular Orthopaedic training in Nigeria. Conclusions: There is need to standardize the definition and training of Orthopaedic subspecialists in Nigeria, in order to improve the quality of practice and enhance the output and satisfaction among subspecialist surgeons. Postgraduate training in Orthopaedic subspecialties is advocated.

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Background: Burns is quite common and often associated with deleterious consequences. The incidence, mortality and morbidity from burns are decreasing in most developed countries over the years, but in the developing countries, the burden of burn injuries continue to pose a significant challenge. Various factors have been attributed to this persisting trend. This study aim is to highlight the pattern of presentation, care and outcome of injuries from burns from a regional trauma registry in Nigeria. Methods: Retrospective evaluation of data from a regional trauma registry in Port Harcourt Nigeria prospectively collected over a seven-year period (from January 2007 to December 2013). Descriptive and inferential statistics of the results are presented. Results: The result showed that 601 cases of burns were recorded during the period under observation. Males between the age group (20-29) years were the most involved (n = 223 {37.1%}) and flame burns (n = 380 {63.2%}) arising mainly from explosions of petroleum products (n = 333 {55.4%}) was the most commonly seen. The overall mortality recorded was 34%, but the median lethal burn surface area at which 50% of the victims died was about 40%. Most of the deaths occurred in the first week following burns. The common early complications were fluid and electrolyte derangement (n = 280 {46.6%}), while burn scarring was a common complication among survivors. Conclusion: Burns remains a significant contributor to high trauma mortality and morbidity in the region. Inadequate infrastructure, human and material resources and some persisting cultural beliefs and practises contribute to the poor outcome of burns.

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Background: Outcome assessment of joint replacement procedures allows providers and patients to evaluate the quality of services delivered, thereby adding value to the services provided. Objective: The study is to describe the pattern of presentations of our patients with hip osteoarthritis who had undergone cementless total hip replacement (THR), assess the outcome using the Harris Hip Score (HHS), and identify any variables that affect the outcome. Patients and Methods: The study was carried out at Davidson and Judith Consultants Clinics, Enugu, Nigeria. A total of 72 THRs, in 62 patients, carried out between 2008 and 2013 were reviewed. These patients were assessed using preoperative HHS (pre op HHS) and postoperative (post op HHS) administered at 1 year and 5 years. Results: There were 62 patients and 72 cementless THRs. Ten (16.13%) patients had bilateral conditions; 25 (40.32%) patients had right THR, while 27 (43.55%) patients had left THR. Twenty (32.26%) patients were males and 42 (67.74%) were females. Male:female is 1:2.1 patients. The most common cause from the study is still primary osteoarthritis which accounts for 51.6%, while the least is avascular necrosis (AVN) of the head of femur seen in hemoglobinopathy (22.58%). Those following idiopathic AVN are slightly higher (22.58%), while posttraumatic is 25.81%. The comparison of means of HHS shows pre op HHS and post Op HHS at 1 year has P = 000 (P < 0.05). Pre op HHS and post op HHS at 5 years has P = 0.000 (P < 0.05). The comparison of HHS means for gender shows male pre op HHS and female pre op HHS at 1 year has P = 0.341 (P > 0.05). The comparison of HHS means for morbidity shows comorbidity post op HHS and no comorbidity post op HHS at 1 year had P =0.320 (P > 0.05). Conclusion: Our patients presented at a younger age with secondary osteoarthritis secondary to hip joint affectations such as trauma and AVN and they benefited from our intervention with very low complication rate.

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Background: Reduced bone density if left untreated is a known precursor of osteoporosis, a silent disease with increased morbidity. In the developing country, fragility bone fractures occur in the general population, and health-seeking behaviour is low. An incredibly high level of ignorance is observed. Methodology: A descriptive cross-sectional study was carried out to determine the bone mineral density (BMD) among patients who visited a specialist clinic for screening for osteopenia using the unigamma dual energy X-ray absorptiometry (DXA) machine. 54 participants were selected for this study having met the inclusion criteria. Data were analysed using SPSS version 22 with P = 0.05. Results: BMD of 54 women whose ages ranged 42–86 were analysed. Twenty-eight (51.9%) were obese while 7 (13.0%) had normal weight. 50 (92.6%) had low BMD. BMD of the right and left femora correlated more with age (P = 0.015 and 0.008, respectively). Mild and severe osteopenia were found mostly in the left femoral neck and left femoral ward, respectively, while moderate osteopenia was more common in the right greater trochanter. In this population, diagnosis of loss of bone mass by DXA examination is best on the left femur. Conclusion: Reduced BMD was present in most participants. It is advised that Nigerian women have their baseline bone density test to avoid unnecessary preventable fractures later in life. More awareness programmes is advised in the future.

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Background: The knowledge of the normal posterior tibial slope (PTS) is important for orthopaedic surgeons during joint replacement surgeries. Inadequate tibial cuts to replicate the normal tibial slope would lead to the tibial plate loosening or restriction of complete flexion. The tibial slope varies with age, gender, race and the ethnicity. We studied the tibial slope in the South Indian population. Aim: The aim of the study was to evaluate the PTS in a Southern Indian population and compare with the different known values across geographical and ethnic variations. Materials and Methods: The prospective study was conducted using the plain radiographs of the knee joint of 290 adult patients (age ranging from 18 to 81 years old with skiagrams showing complete epiphyseal fusion around the knee) collected over a period of 1 year from 10^th January 2017 to 5^th January 2018. Collected data were analysed statistically using SPSS (Statistical Package for the Social Sciences software) version 21 software. Results: The PTS varied between −5° and 21° with a mean value of 10.3771° ± 4.59482°. The mean PTS in males was 10.1232° ± 4.69607° and in females was 10.8825° ± 4.36616°. The mean PTS was highest (12.279) in the patients aged between 61 and 75 years of age and was least (8.243) in patients aged more than 75 years of age. There was a significant variation (P = 0.01) in the mean PTS in each age group of our study population [Table 1]. Conclusion: The tibial slope has been reported to vary in different ethnic subsets. In this study, the PTS varied between −5° and 21° with a mean value of 10.3771° ± 4.59482°. There was no statistical significant gender-based variation in the PTS. The PTS was lower than the PTS of the American, Nigerian and Chinese Populations but higher than the French population. We attempt to publish our results of the anatomical variation of the tibial slope in the Indian subcontinent.

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Knee ankylosis is a common complication of knee trauma and infection that poses a serious challenge to orthopaedic surgeons regularly in their practice. This study highlights the success of the use of Ilizarov device in the management of fibrous ankylosis of the knee. A 37-year-old nurse with a fibrous ankylosed knee that had a range of movement (ROM) of 0°–40° was successfully treated with Ilizarov device, indomethacin (analgesics) and physiotherapy. Her ROM of the affected right knee improved to 0°–140° and after a follow-up period became 0°–90°. She was very happy with the outcome. There was no associated knee pains afterwards. Ilizarov device, together with adequate analgesia and physiotherapy, can successfully treat knee ankylosis.

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Introduction: Surgical emergency is a medical condition for which immediate or urgent surgical intervention is required. This includes acute trauma and other life- or limb-threatening conditions that may cause a loss of life or permanent deformity if surgical interventions are not applied immediately. The accident and emergency (A and E) room is the first point of call for patients with such surgical emergencies. This study is an audit of surgical emergency deaths in the A and E of the Lagos University Teaching Hospital (LUTH). Methodology: This was a retrospective study. It involved analysis of the records of patients who were attended to at the A and E room of LUTH, Idi-Araba, Lagos state. The period of study was 12 months. Data obtained were analysed using Microsoft Excel 2010 (Microsoft Corporation, Redmond, Washington, USA). Results: The crude mortality rate was 8.3%. The overall male:female ratio was 2:1. The average age at death for both sexes was 46.5 ± 17.5 years. The age ranged from 6 to 87 years. Trauma was the cause of death in 99 cases (52.4%), with a male:female ratio of 5.2:1. Traumatic brain injury was the largest contributor of death overall, with a male:female ratio of 6.6:1. The average age of females who died following trauma was 6 years younger than that of the males. More patients involved in trauma died within 24 h of presentation. The overall average age at death for trauma-related deaths was 38.9 ± 17.2 years. However, the overall average age at death for malignancy-related causes was 53.9 ± 13.5 years. The male:female ratio for malignancy as a cause of death was 1:2.3. More deaths occurred within ages 20 and 39 years, accounting for almost half (46.8%) of the total deaths. Breast carcinoma was the major (45.3%) cause of death among the malignancy-related causes of death, with all but one case occurring in women. Conclusion: Mortality at the surgical department of A and E is still high compared to centres of other Western countries. The general populace needs orientation to reduce risk factors for trauma, especially brain injury. The government also needs to improve facilities available at the trauma centre.

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Introduction: Extensor tendon injury is one common hand injury occurring in young individuals. Extensor tendons are superficially located with minimal amount of subcutaneous tissue that predisposes the extensor mechanism to more complex tendon injuries. Surgical repair of extensor tendon requires an exact knowledge of anatomy, careful adherence to some basic surgical principles, sound clinical judgment, strict atraumatic surgical technique and a well planned postoperative programme. Aim and Objectives: We conducted this study to find out common causes of extensor tendon injuries, evaluation of hand function after repair of extensor tendon injuries and evaluation of effect of time elapsed between onset of injury to tendon repair on the final outcome. Methodology: The functional outcome after tendon repair was assessed by calculating Total Active range of Motion (TAM). Results: We concluded that the higher percentage of excellent and good cases is might be attributable to strong and meticulous repair in which more aggressive physiotherapy was tolerated by the patients and the tendons should be repaired preferably primarily.

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Background: The management of open fractures has been of great challenge to surgeons over the years, and these fractures are often associated with considerable patient morbidity and high socioeconomic consequences. Epidemiological studies are of great importance in the management of these conditions as the information obtained will be used to define priorities and enhance the understanding of this challenging subgroup of traumas. Objective: The aim of this study was to define the epidemiological profile of patients who were managed for open fractures of the long bones at a teaching hospital in South East Nigeria. Materials and Methods: This was a retrospective and descriptive epidemiological study involving open fractures of the long bones managed at a teaching hospital in the southeastern part of Nigeria over a period of 3 years, from January 2014 to December 2016. Data which were collected from patients' case notes were subjected to descriptive analysis, and the results were presented with simple frequency tables, percentages and charts. Results: Seventy patients with 73 fractures were treated for open fractures within the period of the study. The male to female ratio was 4.3:1, and the peak age incidence was 20–29 years (30%). The most common cause of the injury was motor vehicle accidents (82.9%), of which 64.3% of cases were as a result of motorbike accidents. The leg bones were the most affected site (63%) while the Gustilo type III fractures were the most common injuries (67.1%). The average time interval from injury to presentation was 10 h. Wound infections were the most frequent complications observed, followed by delayed union. Conclusion: Open fractures are challenging conditions which affect mainly the young and active males in our society. The victims often present late which affects the management outcome. The burden of open fractures can be minimised in our society by efforts aimed at reducing the menace of motorbike operators, the latter being the most common cause of the injury.

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Background: Road traffic trauma is a leading cause of death and disability in persons aged below 45 years. It has a global distribution, but its incidence and impact are greatest in low- and middle-income countries. Establishing pattern of injuries arising from traffic collisions and the outcome of such injuries helps to plan interventions effective in reducing the incidence, mortality and morbidity from road traffic crashes (RTCs). Methods: Data of patients presenting with injuries from RTCs from a trauma registry which was prospectively developed from a dedicated trauma centre based in south-south region of Nigeria were collected and analysed. Descriptive and inferential statistics of data of patients with injuries resulting from traffic collisions from the trauma registry seen between 1 January 2007 and 31 December 2012 were generated and presented. Results: During the study period, 61,820 (65.6%) patients presented with injuries resulting from RTCs. Majority of the patients were males aged between 20 and 40 years. Most of the patients (n = 51,620, 83.5%) presented after 1 h of the incident. Only about 5.2% (3215) of the victims were brought to the hospital by some type of ambulance. Majority of the patients had of injury involving the exterior in 77% (n = 47,601) and the extremities in 23.5% (n = 14,500) of the cases, respectively, but mortality was <1%. Conclusion: RTCs contributed significantly to the trauma burden in Port Harcourt, Nigeria. Delayed presentation, and improper transportation methods of injured victims to hospitals, may have contributed to poor outcome of some of the injuries.

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Introduction: Chronic low back pain (LBP) is one of the most common musculoskeletal conditions worldwide. It can be quite severe, affecting physical, social, occupational and even psychological well-being. This study describes the coping mechanisms commonly employed in patients with chronic LBP and its relationship to perceived stress. Methods: In this descriptive hospital-based study, Brief Cope Scale and the Perceived Stress Scale (PSS) were administered to 100 patients with chronic LBP. Variables analysed were sociodemographic characteristics, dimensions of the Brief Cope Scale and the PSS. Logistic regression was used to determine predictors of perceived stress. Data were analysed using IBM SPSS version 20, and the threshold for statistical significance was set at 0.05. Results: Sample was comprised of 59 females and 41 males with an age range of 18–72 years (x̄= 42.7 ± 16.2). The most common spinal pathologies were lumbar spondylosis (n = 39), canal stenosis (n = 18) and facet joint arthritis (n = 16). The average perceived stress score for the entire sample was 28 (standard deviation [SD] = 6.94), and the coping mechanisms most employed were religion (x̄ = 6.9, SD = 1.77), planning (x̄ = 6.4, SD = 1.34) and emotional support (x̄= 6.0, SD = 1.54). After logistic regression, instrumental support, self-blame, active coping, religion, positive reframing and venting emerged as predictors of perceived stress. Conclusion: Coping styles are an important determinant of perceived stress in patients with chronic LBP. Due consideration should be given to the stress experienced by patients with chronic LBP, and their clinical care should include stress management to improve outcome.

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Background: The Ponseti method is generally acknowledged to be the gold standard for congenital clubfoot treatment, worldwide. Although this treatment is considered to be cheap and effective, some patients in less affluent climes are unable to afford the treatment, which includes wearing of braces until the age of 4 years. Objectives: This study documents the experience of running a clubfoot clinic with the financial support from three rotary clubs for 2 years and aims to review the impact of the sponsorship and recommend a replication of this model in similar settings. Materials and Methods: This is a retrospective study of patients treated in our clubfoot clinic adopted by the rotary clubs from 20^th September 2017 to 20^th August 2019. Age at presentation, sex, laterality, Pirani score, number of casts to correction, brace compliance and complications were recorded prospectively in the International Clubfoot Registry hosted by The Center for Bioinformatics and Computational Biology at the University of Iowa, USA, and analysed using Microsoft Excel software. Results: A total of 136 patients were treated, 81 (60%) of which had bilateral deformities, totalling 217 feet. There were 71 males and 65 females, with a male-to-female ratio of 1:0.9. The age at first visit ranged from 0 to 10 years. The largest number, 74 patients (54.4%), was aged between 0 and 3 months, but only one was aged above 10 years, at presentation. Using the Pirani score, 71% had severe deformities (Pirani score of 4 and above). The tenotomy rate was 29%. The average number of casts to correction was 4.6. Sixty-eight patients received braces at subsidised rates of 50% of the cost. Only 5% of the feet relapsed after correction. Conclusion: The rotary club intervention in our clubfoot clinic was associated with an increase in the annual number of patients attending the clinic, but the relapse rates remained the same as with previous studies.

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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.

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Introduction: The calcaneum is repeatedly subjected to static and dynamic stresses especially in the weight-bearing positions during walking, working or running and this is reflected in the trabecular pattern within the calcaneus. There are six radiological angles associated with this bone notably the Böhler (tuber joint) angle (BA) and Gissane's angle (GA), and they vary in different ethnic population. Aim: This is to determine the calcaneal angles among the ethnic Igbos of South Eastern Nigeria, determine the relationships between these angles, determine any correlation with gender and age, compare the values of the BA and GA to that of other populations and discuss the clinical implications of the determined values. Methodology: A 5-year review of all lateral views of X-rays of the foot and ankle done at Federal Teaching Hospitals, Abakaliki, Nigeria, from 1^st January 2012 to 31^st December 2016, was done. Drawing and mathematical sets were used to measure the six radiological angles on the lateral views of plain X-ray films of the ankle and subjected them to descriptive and inferential statistics. Results: There were 120 patients, 65 males and 55 females. The calcaneal angles among the ethnic Igbos of South Eastern Nigeria showed the following: BA: 32.58 ± 4.98, GA: 121.22 ± 6.11, calcaneal compression angle: 30.00 ± 3.01, talocalcaneal angle (TCA): 22.58 ± 5.28, calcaneal pitch angle: 17.35 ± 3.79 and apical angle (AA): 67.24 ± 7.27. There was no relationship between these angles. The TCA and AA showed a correlation with gender and age and other angles did not. There was a statistically significant difference between BA values in this study and that of Ugandan and American populations (P < 0.05). There was a statistically significant difference between the GA values in this study and that of Turkish, New Zealand and Indian populations. Conclusion: These determined values would be a useful tool in the management of patients of Igbo extraction with of the foot pathology.

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Background: Chronic low back pain (CLBP) is a common health problem that is often associated with physical disability and reduced quality of life. Functional disability is the inability to perform age-approximate physical, mental and social activities of daily living. It is, therefore, pertinent to determine the prevalence of disability in patients with CLBP as this will help clinicians to look out for risk factors associated with disability and thus facilitate management decisions. Aim: The aim of this study is to determine the prevalence and level of disability in patients with CLBP. Patients and Methods: Patients with CLBP observed at the orthopaedic clinic of Benue State University Teaching Hospital, Makurdi from June 2016 to February 2017 were recruited for this study. A designed questionnaire was used to collect data. Oswestry low back pain disability questionnaire was used to assess the level of disability. Results: A total of 126 patients with CLBP were evaluated, consisting of 45 males (35.7%) and 81 females (64.3%) with a male:female ratio of 1:1.8. The prevalence of disability in patients with CLBP in this study was 78.6%. 66 (52.4%) of patients had a moderate disability, 32 (25.4%) of patients had a severe disability, 27 (21.4%) of patients had mild or no disability and only one patient (0.8%) was crippled. There was a significant association between the age and level of disability (P = 0.001). Conclusion: Disability in patients with chronic back pain is a common health problem in our environment. Determination of disability prevalence will create more awareness for the need to assess risk factors and evaluate the effectiveness of various treatment options.

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Hip dysplasia is abnormal development of the hip joint resulting in joint incongruity and characterised by a shallow acetabulum, inadequate femoral head coverage and femoral and acetabular version abnormalities. Childhood hip dysplasia is uncommon in this environment because of child swaddling practices. Adolescent onset forms are however not uncommon and present in adulthood more frequently than is recognized for total hip arthroplasty. Clinical and radiologic evaluation is key for diagnosis and surgical planning. The pathologic abnormalities on both sides of the hip joint present formidable challenges to total hip arthroplasty which remains the mainstay of treatment for end-stage arthritis secondary to adult hip dysplasia. Posterior approach is preferred in our unit as it provides excellent acetabular exposure and enables assessment of sciatic nerve integrity when addressing leg-length discrepancy common in this condition. Leg lengthening more than 3–4 cm should, however, be avoided with arthroplasty for this condition. We outline technical tips for successful total hip arthroplasty for this condition. This study aims to describe total hip arthroplasty in the setting of adult hip dysplasia. The objectives are to describe the pathologic changes in adult hip dysplasia, the evaluation of these patients and surgical technique.

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Acute or chronic back and neck pain is a major social, economic and healthcare issue in all communities. Nearly 80% of the population experiences backache during their lifetime. Percutaneous laser disc decompression (PLDD) is one of the minimally invasive methods for treating low back pain. There have been numerous reports of its use since the first case in 1986, and the indications are expanding daily. We present a case of a 38-year-old banker with chronic prolapsed intervertebral disc who had 7-year history of recurrent low back pain from prolapsed L4–L5 intervertebral disc with radiculopathy. She had PLDD procedure in our clinic under local anaesthesia as day case. After the procedure, the patient was observed for 4 h and discharged home. She felt significant pain relief after the operation and was placed on a lumbar corset for a week. The pre-surgery assessment using Oswestry Low Back Pain Disability Index was 58% (severe disability) but was reduced to 26.7% (moderate disability) after 3-month post-surgery follow-up. At 12-month follow-up, the Oswestry score was 16% and the patient outcome was good according to MacNab's criteria. PLDD is safe and effective for the treatment of low back pain seen in the post-operative result of this presented case.

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Background: Increasingly, more patients are obtaining medical information from the Internet with which they are confronting their physicians. Very few studies have been reported from developing countries concerning physician's attitude to such patients, and to our knowledge, none has been reported from Sub-Saharan Africa. This study looked at the attitude of Nigerian orthopaedic surgeons to such patients. Methods: This was a questionnaire-based interview of orthopaedic surgeons and their trainees at the 2013 annual conference of the Nigerian Orthopaedic Association in Lokoja, Nigeria. It was supplemented by an online Google form survey. Results: One hundred and twelve questionnaires were returned, and seven were incompletely filled and were discarded, leaving 105 for analysis. About 94.3% of the respondents have had previous encounters with e-patients. The mean attitude score was high (3.64 ± 0.46, the highest obtainable was 5.0). Consultants and orthopaedists in semi-urban settings scored higher than other categories. The physician's self-esteem and efficacy of using the Internet correlated highly with their attitude to e-patients. Similarly, self-esteem, the frequency of using the Internet and the experience of the way e-patients have been presenting their information (print, verbal or electronic) were the significant predictors of physicians' attitude to e-patients. Conclusion: Orthopaedic surgeons and their trainees practising in Nigeria frequently encounter patients with Internet-based medical information at consultations. Most of them have high positive attitudes towards these patients. There is a need for these doctors to become skilled in online information handling to become better at guiding such patients.

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Seat belt syndrome is a term used collectively for all injuries associated with the use of seat belts during motor vehicular accident. It usually presents with seat belt sign with associated intra-abdominal, thoracic, pelvic and spinal injuries. A 42-year-old male presented to our hospital 15 h after a head-on collision with an oncoming vehicle. He was the driver of a saloon car and was seatbelted at the time of the accident. He sustained multiple injuries which included blunt abdominal injury, multiple rib fractures and right femoral fracture. Examination revealed the seat belt sign on both anterior chest and abdominal walls and progressive abdominal distension with right femoral fracture. Chest, brain and abdominal computed tomography scans confirmed the diagnosis. He subsequently had an exploratory laparotomy and damage control orthopaedics in which an external fixator was applied to the right femur and a locked intramedullary nail thereafter. He recuperated and discharged home 26 days after the accident. Patients who present with a seat belt sign on the anterior chest or abdominal wall following a motor vehicle accident should be managed with a high index of suspicion for seat belt syndrome. Thus, the presence of any of the injuries mentioned should warrant a search for other associated injuries. With increase in the compliance of seat belt use amongst car users in Nigeria, there will be a rise in seat belt syndrome, There is need to create more awareness about seatbelt syndrome and a classification system would help to know its severity.

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