Nigerian Journal of Orthopaedics and Trauma

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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.

Background: Neglected dislocation of the elbow joint is mainly seen in developing countries and is not uncommon. It is usually associated with marked reduction in the range of movement and functional impairment. Although it presents a surgical challenge, open reduction is routinely indicated. Materials and Methods: This was a retrospective study over a 3-year period (June 2017 to June 2020) that included patients presenting with a neglected elbow dislocation. A total of seven patients (six females and one male) met the inclusion criteria. A posterior triceps splitting approach was used in all the patients with one patient requiring triceps lengthening. Results: Reduction was achieved in all seven cases. There was a statistically significant difference between the preoperative range of motion (14.29 ± 3.45) when compared to the postoperative range of motion (102.86 ± 16.04). Conclusion: Neglected old elbow dislocation, a pathology seen mainly in developing countries, can be managed by open reduction and cross Kirschner's wire fixation.

Background: Reports on any aspect of management of meniscal injuries are scarce in Nigeria, though the anecdotal experience is that occurrence of meniscal injuries is not rare. Meniscal repair is the preferred option following meniscal injury due to the long-term harmful effects attributed to partial meniscectomies. Meniscal repair in the setting of an isolated meniscal injury is also reputed to give a satisfactory return to preinjury levels of about 91.3%. Meniscectomy has been reported to be associated with long term symptoms and functional limitations. Current treatment trend involves conserving the meniscus where and if possible. Despite this, arthroscopic partial meniscectomy is said to be one of the most common orthopaedic procedures worldwide. Indications for meniscal repairs have been well developed over the years and include factors like duration and pattern of the tear among other features. We present a study of the management of 16 patients who had surgery for meniscal injury over 1 year. Aims and Objectives: To determine the difference in short term outcome for patients who had meniscal injuries following arthroscopic treatment using the Tegner Lysholm score. Materials and Methods: Our work was a retrospective, descriptive study of all our patients who had surgery for meniscal injuries from December 1, 2018 to November 30, 2019. We recruited qualified patients into the study and extracted relevant information from their records. Data retrieved included age, sex, aetiology, presenting complaint, duration before the presentation, intra-operative arthroscopic findings, the treatment offered and the difference in the patient's Tegner Lysholm knee score evaluated preoperatively and at 6 months post-treatment. Results: In the study period, 16 patients had arthroscopic surgery for complaints of persistent knee pain. The majority (75%) of the patients were aged between 20 and 40 years. Most were male (88%) and had their injuries playing football (63%). The presentation was late in most cases (75%), and most of the patients had complex, irreparable tears at arthroscopy. An associated rupture of the anterior cruciate ligament was found in 25% of the patients. Majority of the patients had partial meniscectomy alone. Only two patients (12.5%) qualified for and had meniscal repairs using the outside-in technique. Most of the patients had a poor Tegner Lysholm knee score preoperatively. Post-operatively, at 6 months follow-up, all the patients demonstrated a short-term improvement in the Tegner Lysholm score. Our study indicates that the presentation of meniscal injuries is often delayed in our environment. Most of the patients who present with these injuries do not qualify for meniscal repair as they often have complex, irreparable tears. These patients have partial meniscectomies with short term relief of their complaints. Conclusion: Despite the need for meniscal conservation, partial meniscectomy is still very relevant in our environment.

Background: Open tibial fracture is one of the most common trauma emergencies. Marked delay in presentation is noticed in developing countries, especially sub-Saharan Africa due to poor pre-hospital care, presentation to traditional bone setters and out-of-pocket payment of services. Primary nailing at the time of initial debridement was noticed to have a high prevalence of infection in some series. Delayed primary nailing after a period of debridement and wound care was found to be safe with less complication rate in this study. Objective: The objective of this study is to determine the clinical and radiological outcome of management of Gustilo and Anderson (GA) Type I and II open tibial fracture using delayed primary nailing, especially in patient with delayed presentation. Methodology: Twenty-one (21) patients with open (GA I and II) tibial diaphyseal fracture were recruited into this study. They had initial debridement and a period of wound care before subsequent nailing. All patients had tibial interlocking nailing 5–9 days post-injury using open technique with aid of the external jig system. The patients were followed up for 9 months. Clinical outcome was assessed using Johner and Wruh's criteria at 6 months. The radiologic outcome was assessed using Radiologic union scale for tibia fracture (RUST). Results: The M: F was 4:1 with a mean age of 37.24 ± 13.8 years. Road traffic accident accounted for 85.7% (n = 18). Marked delayed presentation was noted, only four patients (19.1%) presented within 6 h from injury. GA Type II open fracture was the most prevalent fracture type accounting for 81.9% (n = 17). The clinical outcome using Johner and Wuh's criteria at 6 months post-nailing showed 18 patients (86%) had excellent and good outcome. Only one patient (4.8%) had poor outcome. RUST was used to assess the rate of union following the tibial nailing. Fractures were scored at 6 weeks, 12 weeks, 6 months and 9 months. Ten patients (47.6%) were united at 6 weeks, whereas 21 (100%) had achieved union at 9 months. The average time to radiologic union was 17.3 weeks. Seven patients (33.3% n = 7) had complications. Anterior knee pain, superficial surgical site infection (SSI) and delayed union were the complication recorded. Conclusion: Delayed primary nailing of open tibial fracture produces good to excellent outcome with acceptable complication rate, especially SSI.

Introduction: The complications associated with diabetes manifest in a systemic fashion including the musculoskeletal (MSS) system where it leads to a reduction in the quality of life and impacts the mental health of the patient. A study to determine the extent of the musculoskeletal and emotional burden it imposes on the patient may help ascertain the extent of support needed in their care. We thus set out to determine the rate and the clinical factors that are predictive of MSS and emotional disorders in them. Materials and Methods: Self-administered questionnaires which consist of the short MSS functional assessment were given out to diabetic patients at the Endocrinology Clinic of the hospital. Results: The rate of presence of MSS disorder in our series was 66.4%, while the presence of increasing age, presence of MSS disorders, previous bones, and joints surgeries were significantly associated with poor physical, functional, mobility, emotional, and bother index. Conclusion: This study has further shown the huge burden diabetes places on the musculoskeletal system and by extension the mind of the patients. Routine assessment as a form of surveillance for the presence of musculoskeletal and emotional disorders should be incorporated into the clinical management protocol for diabetes.

Context: Traumatic spinal cord injury (TSCI) is a devastating disease, hence the need to identify clinical and radiological injury features that can predict neurological improvement. Aims: This study aims to identify magnetic resonant imaging (MRI) features in cervical TSCI that correlates with neurological status at admission, and also predict early neurological improvement. Settings and Design: This was a prospective cohort study. Subjects and Methods: Admission MRI features of 47 patients with cervical TSCI and their neurological assessments at admission and 3 months post-injury were reviewed prospectively over a period of 18 months. Correlational and regression analyses were done using SPSS^® version 25 software. P < 0.05 was used as the level of significance. Results: Spinal cord oedema and cord contusion (78.0%) constitute the majority of injury patterns seen on MRI. There was a significant association between spinal cord contusion and cord oedema on MRI and incomplete TSCI. Likewise, spinal cord haemorrhage, compression and transection were associated with complete TSCI. Maximum canal compromise (MCC), maximum spinal cord compression (MSCC) and length of cord lesion significantly correlate with American Spinal Injury Association Impairment Scale at admission (P = 0.033, P = 0.015 and P < 0.001, respectively). Increasing values of these variables were found to be independent predictors of complete TSCI. However, length of cord lesion was the only independent predictor of neurological improvement, 3 months post-injury (P = 0.025). Conclusions: Spinal cord haemorrhage, compression, transection and higher values of MCC, MSCC and increased length of cord lesion were predictive of complete TSCI. However, the length of spinal cord lesion was a better predictor of early neurological improvement.

Online since 10^the November 2017.