Early experience with open heart surgery in a pioneer private hospital in West Africa: the Biket medical centre experience.

INTRODUCTION:
More than forty years after the first open heart surgery in Nigeria, all open heart surgeries were carried out in government-owned hospitals before the introduction of such surgeries in 2013 at Biket Medical Centre, a privately owned hospital in Osogbo, South-western Nigeria. The aim of this paper is to review our initial experience with open heart surgery in this private hospital.

METHODS:
All patients who underwent open heart surgery between August 2013 and January 2014 were included in this prospective study. The medical records of the patients were examined and data on age, sex, diagnosis, type of surgery, cardiopulmonary bypass details, complications and length of hospital stay were extracted and the data was analysed using SPSS version 16.

RESULTS:
Eighteen patients comprising of 12 males and 6 females with ages ranging between 8 months and 52 years (mean= of 15.7 +/- 15 years) were studied. Pericardial patch closure of isolated ventricular septal defect was done in 7 patients (38.9%) while total correction of isolated tetralogy of Fallot was carried out in 5 patients (27.8%). Two patients had mitral valve repair for rheumatic mitral regurgitation. Sixty day mortality was 0%.

CONCLUSION:
Safe conduct of open heart surgery in the private hospital setting is feasible in Nigeria. It may be our only guarantee of hitch free and sustainable cardiac surgery.

In-situ pinning for Slipped Capital Femoral Epiphysis in blacks: experience in a regional orthopaedic centre.

BACKGROUND:
Slipped Capital Femoral Epiphysis (SCFE) is the commonest pathology affecting the adolescent hip with an incidence of approximately 2 per 100,000 population. Blacks are more commonly affected than Caucasians. Of many treatment options available, in-situ-pinning appears to be the most widely employed.

AIMS AND OBJECTIVES:
To determine the epidemiological pattern and the outcome of in-situ pinning for slipped capital femoral epiphysis in Nigerian adolescents.

PATIENTS AND METHODS:
This is a six-year retrospective review of all the cases of slipped capital femoral epiphysis treated by in-situ pinning between 1st January 1998 and 31st December 2003 at the National Orthopaedic Hospital, Igbobi, Lagos, Nigeria.

RESULTS:
Thirty-one patients with 35 affected hips were managed with in-situ pinning during the period of review. Twenty-one females (67.7%) and 10 males (32.3%) with a F:M ratio of 2.1:1 were affected. The mean age for all the patients was 12.45 years (range 6 – 16; SD ± 1.79). The most common presenting complaint was hip pain seen in 48.4% of cases. Satisfactory results were obtained in 13 hips (37%) while the results in the remaining 22 hips were unsatisfactory. The most common complication was limb length discrepancy.

CONCLUSION:
This study shows that SCFE is not an uncommon condition in orthopaedic practice in Nigeria. The high rate of unsatisfactory results is associated with the severity of the slips and the unavailability of image intensifier at the time of surgery.

Use of non-vascularized autologous fibula strut graft in the treatment of segmental bone loss.

Fractures resulting in segmental bone loss challenge the orthopedic surgeon. Orthopedic surgeons in developed countries have the option of choosing vascularized bone transfers, bone transport, allogenic bone grafts, bone graft substitutes and several other means to treat such conditions. In developing countries where such facilities or expertise may not be readily available, the surgeon has to rely on other techniques of treatment. Non-vascularized fibula strut graft and cancellous bone grafting provides a reliable means of treating such conditions in developing countries.Over a period of six years all patients with segmental bone loss either from trauma or oncologic resection were included in the study. Data concerning the type of wound, size of gap and skin loss at tumor or fracture were obtained from clinical examination and radiographs.Ten patients satisfied the inclusion criteria for the study. The average length of the fibula strut is 7 cm, the longest being 15 cm and the shortest 3 cm long. The average defect length was 6.5 cm. Five patients had Gustillo III B open tibial fractures. One patient had recurrent giant cell tumor of the distal radius and another had a polyostotic bone cyst of the femur, which was later confirmed to be osteosarcoma. Another had non-union of distal tibial fracture with shortening. One other patient had gunshot injury to the femur and was initially managed by skeletal traction. The tenth patient had a comminuted femoral fracture. All trauma patients had measurement of missing segment, tissue envelope assessment, neurological examination, and debridement under general anesthesia with fracture stabilization with external fixators or casts. Graft incorporation was 80% in all treated patients.Autologous free, non-vascularized fibula and cancellous graft is a useful addition to the armamentarium of orthopedic surgeon in developing countries attempting to manage segmental bone loss, whether created by trauma or excision of tumors.

Trauma at a Nigerian teaching hospital: pattern and docu-mentation of presentation.

This study is aimed at identifying the characteristics of injuries and determining the efficiency of documentation of patients’ records in a tertiary hospital where there is no trauma registry. A retrospective case record analysis was conducted of injured patients seen at the Accident and Emergency unit over a 12 month period from January to December 2003.A total of 1078 records of injured patients that attended the A&E were analysed. Their mean age was 31 years (range 3 months to 85 years). Laceration (n = 408) and fractures (n = 266) representing 62.5% of injuries were seen. Injuries to the lower limb occurred in 239 patients, multiple anatomical sites 224, head 224, upper limb 203, the neck 20, and the abdomen 11 patients. Trauma was due to road traffic accident in 977 patients, fall in 39, assault in 14 while burns and firearm injuries occurred in 5 and 7 patients respectively. The mean injury severity score (ISS) was 4. Severe injuries, ISS > 15 occurred in 54 patients with mean ISS of 21, and resulted from RTA in 92.6% of cases. Mortality from severe injuries occurred in 31.5% of cases while overall mortality was 2%. Most deaths were associated with multiple injuries (60.9%) and head injury (30.4%). Incomplete documentation of accident and injury data occurred frequently, from 2% of some data to 100% of others.Lacerations and fractures were the most common injuries. Mortality is due usually to head and multiple injuries. Research into appropriate strategies for prevention of injuries, especially RTA, is required but this must start with the establishment of institutional and regional trauma registries for complete documentation of relevant data.

Problems of amputation surgery in a developing country.

We studied prospectively 87 patients who underwent extremity amputation in the National Orthopaedic Hospital in Lagos in 1995-1996. Trauma from road traffic accident was the most common indication (34/87) with peripheral vascular disease being the least encountered (2/87). Traditional bonesetters’ gangrene accounted for 9/87 cases in circumstances that were largely avoidable. Our study revealed that amputation is still being performed as a life-saving procedure, as 44/87 patients presented with gangrene of a limb. The nonavailability of special investigations such as Doppler ultrasound, arteriography, and CT scan was responsible for a delay in definitive treatment in 28 cases. Poor prosthetic services and the absence of a well-coordinated amputee clinic were responsible for some of the unsatisfactory results. We believe that the availability of specialized diagnostic tools and facilities for microvascular surgery, together with a multidisciplinary approach to the management of the amputee, would considerably change the current gloomy picture of amputation in developing countries such as Nigeria.

Conotruncal Heart Defect Repair in Sub-Saharan Africa: Remarkable Outcomes Despite Poor Access to Treatment.

Background:
The outcome of children born with conotruncal heart defects may serve as an indication of the status of pediatric cardiac care in sub-Saharan Africa (SSA). This study was undertaken to determine the outcome of children born with conotruncal anomalies in SSA, regarding access to treatment and outcomes of surgical intervention.

Methods:
From our institution in Ghana, we retrospectively analyzed the outcomes of surgery, in the two-year period from June 2013 to May 2015. The birth prevalence of congenital heart defects (CHDs) in SSA countries was derived by extrapolation using an incidence of 8 per 1,000 live births for CHDs.

Results:
The birth prevalence of CHDs for the 48 countries in SSA using 2013 country data was 258,875; 10% of these are presumed to be conotruncal anomalies. Six countries (Nigeria, Democratic Republic of the Congo, Ethiopia, Tanzania, Uganda, and Kenya) accounted for 53.5% of the birth prevalence. In Ghana, 20 patients (tetralogy of Fallot [TOF], 17; pulmonary atresia, 3) underwent palliation and 50 (TOF, 36; double-outlet right ventricle, 14) underwent repair. Hospital mortality was 0% for palliation and 4% for repair. Only 6 (0.5%) of the expected 1,234 cases of conotruncal defects underwent palliation or repair within two years of birth.

Conclusion:
Six countries in SSA account for more than 50% of the CHD burden. Access to treatment within two years of birth is probably <1%. The experience from Ghana demonstrates that remarkable surgical outcomes are achievable in low- to middle-income countries of SSA.