Prosthetic joint infection is a dreaded complication of Total Joint Arthroplasty. Prevention, which is far more cost effective, should be of paramount importance to the arthroplasty surgeon. Proper patient selection and preparation as well as strict asepsis and antisepsis are the basic principles of prevention.

Abstract Background and aims: Non-specific neck pain (NsNP) constitutes a burden to the bearers and a management challenge to physiotherapists globally. Effectiveness of neck stabilisation and dynamic exercises in the management of NsNP has been documented, but it is not clear which exercise regimen is more effective in alleviating its associated pain, depression and anxiety. This study was carried out to compare the effectiveness of neck stabilisation and/or dynamic exercises on pain intensity, depression and anxiety among patients with NsNP. Methods: Eighty-nine consenting individuals with NsNP participated in this single-blind, randomised controlled trial. They were recruited from the outpatient physiotherapy clinics of the National Orthopaedic Hospital in Dala, Kano State, Nigeria. Participants were randomly assigned into one of three intervention groups: neck stabilisation exercise group (NSEG; n=30), neck dynamic exercise group (NDEG; n=28) and neck stabilisation and dynamic exercise group (NSDEG; n=31). Treatment was administered thrice weekly for 8 consecutive weeks. Variables were assessed at baseline, at the end of the fourth and eighth weeks. Pain intensity was assessed through the use of a visual analogue scale, while depression and anxiety were evaluated using both the Beck Depression Inventory and Beck Anxiety Inventory. The data was analysed using descriptive statistics, multivariate analysis of variance (MANOVA) and post hoc tests with Bonferroni adjustment at the p=0.05 significant level. Results: Ages of participants in NSEG (46.8±12.4 years), NDEG (48.6±11.6 years) and NSDEG (45.1±13.4 years) were comparable. The comparison for NSEG, NSDEG and NDEG within groups revealed that there was significant difference in pain intensity, depression and anxiety scores from baseline, in the fourth and eighth weeks of the study – (F=62.40, p=0.001, F=13.91, p=0.001 and F=20.93, p=0.001); (F=11.92, p=0.001, F=8.75, p=0.004 and F=9.70, p=0.001) and (F=36.63, p=0.001, F=11.99, p=0.001 and F=6.59, p=0.001), respectively. A group comparison of the pain intensity, depression and anxiety scores of participants in the NSEG, NSDEG and NDEG at the baseline of the study revealed that there were no significant differences in the pain intensity and depression and anxiety scores among the three groups: p=0.159, 0.58 and 0.179, respectively. At week 4 of the study, however, a significant difference in pain intensity and anxiety scores across the three groups was recorded – p=0.018, p=0.011, respectively, but no significant difference was noted in depression scores (p=0.93). At week 8 of the study, it was determined that there were significant differences in pain intensity and depression scores p=0.001 and p=0.041, but no significant dissimilarities in the anxiety scores. Post hoc revealed that only pain was significant and lay with NSEG. Conclusions: The study concluded that the stabilisation, dynamic and stabilisation, plus dynamic exercises were effective in relieving pain and reducing depression and anxiety in patients with NsNP. However, stabilisation showed a more marked effect than the combination exercises of stabilisation plus dynamic exercises, and dynamic exercises in reducing pain intensity in patients with NsNP. Implications: It is recommended that stabilisation exercises be chosen over stabilisation plus dynamic exercises, or dynamic exercise, while treating patients with NsNP. However, both are effective.

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AIMS AND OBJECTIVES This case report is aimed at increasing awareness of fibrodysplasia ossificans progressiva, emphasizing the cardinal features comprising congenital great toe abnormality, initial soft tissue masses, eventual heterotopic ossifications with progressive limitation of joint movements and at reiterating the need to avoid unnecessary and potentially harmful surgical procedures in these patients. PATIENT AND METHOD We present a case report of an 11-year-old girl with characteristic heterotopic ossifications and bilateral hallux valgi deformities with previous history of biopsies. Excision of right axillary bony masses caused deterioration in her shoulder movements. RESULT The patient was not improved by the surgical procedure. CONCLUSION Orthopaedic surgeons and other health care workers need to be aware of this condition and avoid potentially harmful procedures like biopsies, excisions and surgical releases in these patients.

Background: The aim of this study was to compare the efficacy of Povidone-Iodine (PI) and Chlorhexidine-Alcohol (CHG-A) skin preparation solutions in orthopaedic and trauma surgery. Methods: This prospective randomised study described the bacterial skin flora and compared the bacterial clearance rates by PI and CHG-A in patients undergoing clean orthopaedic surgery at an African tertiary hospital. Results: There were 50 patients in each group. A baseline positive culture rate of 76.8% was found. Coagulase-negative staphylococcus was the commonest aerobe (42.9%) while Propionibacterium species was the commonest anaerobe (17.3%). The aerobic positive culture rate reduced from 60% to 22% after PI preparation and from 49% to 6.2% after CHG-A preparation (p=0.026). The anaerobic culture rate reduced from 54% to 44% after PI preparation and from 53.1% to 43.8% after CHG-A preparation (p=0.435).The mean log pre-preparation and post-preparation aerobe counts were 7.85/cm2 and 7.50/cm2 respectively in the PI group and 7.62/cm2 and 7.65/cm2 respectively in the CHG-A group (p=0.715). The mean log pre-preparation and post-preparation anaerobe counts were 8.06/cm2 and 7.96/cm2 respectively in the PI group and 7.86/cm2 and 7.84/cm2 respectively in the CHG-A group (p=0.335). Conclusion: This study did not demonstrate an overall superiority of chlorhexidine-alcohol over povidone-iodine skin preparation solution or vice versa. This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source (including a link to the formal publication), provide a link to the Creative Commons license, and indicate if changes were made.

BACKGROUND:Road traffic injuries are major public health problems and a leading cause of death and injury around the world. Approximately 1.2 million people are killed each year in road crashes worldwide, with up to 50 million more injured. Over 95% of these deaths and injuries occur in the low- and middle-income countries of the world. The aim of this study is to evaluate the impact of the use of seat-belts in reducing the severity of injuries from road traffic crashes and to determine the compliance and awareness of the importance of the use of seat-belts among Nigerian motorists.PATIENTS AND METHODS:The injury patterns and outcome of care in 140 patients who were seen at the emergency department of our tertiary hospital were evaluated. Initial care and resuscitation was carried out on all patients using the advanced trauma life support protocol.RESULTS:A total of 81 (57%) patients used seat-belts, while 59 (42.1%) did not. Nineteen (13.6%) patients died as a result of their injuries; 4 (21.1%) of these had used seat-belts, while 15 (79%) had not (P = 0.001). The mortality rate of 79% for patients who did not use seat-belt was statistically significant.CONCLUSIONS:The seat-belt is an effective safety tool that not only saves lives, but also significantly reduces the severity of the injury that a vehicle occupant may have sustained if they were not wearing the device. More public enlightenment is needed to increase the awareness and compliance of use of seat-belts among Nigerian motorists.

Background : Operative fixation of ankle fractures is becoming popular in developing countries. The concern however is the outcome of care. The objective was to evaluate the results of open reduction and internal fixation (ORIF) of fractures of the ankle in our hospital. Methods : All cases ORIF of fractures of the ankle at the University College Hospital (UCH), Ibadan between March 2010 and December 2012 were recruited into the study. The indications for surgery, techniques of fixation, time interval between injury and presentation as well as outcome measures like time to union, complications and functional outcomes were evaluated. Results : Seventy patients who had ORIF of ankle fractures were studied. Twenty-one (30%) were open fractures while forty-nine (70%) were closed. Sixty (85.7%) patients presented within the first week of injury, 4 (5.7%) after 4 weeks, 4 (5.7%) after 6 weeks and 2 (2.9%) after 52 weeks. Time to union averaged 12.6±4.1weeks. Complications included wound infection 14.3%, wound dehiscence with exposed implants 2.9%, malunion 8.6% and non union 5.7%. Good to excellent functional outcomes were achieved in 77.1% of the patients. Conclusion : ORIF is a viable option in the treatment of ankle fractures.

CONTEXT Reconstruction of mandibular defect is a challenge to the head and neck surgeon because of associated functional and esthetic problems. Our experience with the use of nonvascularized iliac crest bone graft is hereby reported. AIM The aim was to report our experience with the use of nonvascularized iliac crest bone for mandibular defect reconstruction at University College Hospital, Ibadan. Nigeria. SETTINGS AND DESIGN A retrospective descriptive study was performed. MATERIALS AND METHODS Cases of mandibular reconstruction with iliac crest bone graft between January 2001 and December 2007 were included in this study. Grafts were secured with either a stainless steel wire or a titanium plate. Preoperative diagnosis, postoperative follow-up records including investigations, diagnosis of graft infection and subsequent treatment modalities were extracted from the available records. STATISTICAL ANALYSIS USED Descriptive variables were analyzed with SPSS version 14. RESULTS A total of 47 patients had mandibular defect reconstruction with nonvascularized iliac crest block bone during the study period. Thirty-eight patients had graft secured with transosseous wire [NVIBw] while 9 had a titanium plate [NVIBp]. The male:female ratio was 26:21 while the mean age of the patients was 24.6±4.25 years. Ten patients (21.3%) developed persistent graft infection during the postoperative period. All cases of infection occurred in patients who had transosseous wiring and analysis showed that 60% of the infected grafts revealed mixed microbial isolates containing Klebsiela spp, Pseudomonas Aeurogenosa, and E coli. Six (60%) of the infected grafts were removed as a result of unabated infection while 4 (40%) were successfully treated by exploration and pus drainage. CONCLUSIONS Nonvascularized iliac crest bone graft provides an affordable and less technical choice for mandibular reconstruction with minimal complications in a resource-limited economy.

Long-Term Mechanical Low-Back Pain (LMLBP) is a growing public health concern characterized by exacerbated nociceptive sensations, decreased physical performance, impaired psychosocial functioning and work disability. LMLBP has remained resistant to most therapeutic approaches and constitutes a challenge to clinicians and researchers worldwide. This study evaluated the effects of static and dynamic back extensors endurance exercises on physiological and psychosocial variables in patients with LMLBP treated with McKenzie Protocol (McKP). A single-blind controlled trial was carried out. Eighty four patients who met the eligibility criteria were consecutively recruited from the Physiotherapy Department, Obafemi Awolowo University (OAU) Teaching Hospital and the OAU Health Centre, Ile-Ife respectively and were randomly assigned to one of three groups; the McKP Group (MPG), McKP and Static Endurance Exercise Group (MPSEEG) and McKP and Dynamic Endurance Exercise Group (MPDEEG). Treatment was applied thrice weekly for eight weeks and outcomes were measured in terms of physiological variables of: pain intensity, static and dynamic muscle endurance, and muscle fatigue; and psychosocial variables of activity limitation, participation restriction, fear-avoidance behaviour, pain self-efficacy belief, belief of consequence of back pain and general health status at the end of 4th and 8th week of study, using Quadruple Visual Analogue Scale (QVAS), Biering-Sorensen test, repetitive arch-up test, Borg scale, Roland – Morris Back Pain Questionnaire (RMBPQ), Oswestry Low-back Disability Questionnaire (OLBDQ), Fear-avoidance Beliefs Questionnaire (FABQ), Pain Self-Efficacy Questionnaire (PSEQ), Back Belief Questionnaire (BBQ) and SF-36 questionnaire. Data were analyzed using descriptive and inferential statistics of One-way analysis of variance (ANOVA), repeated measures of ANOVA, Friedman’s ANOVA, Kruskal-Wallis test and multiple comparisons post-hoc tests at 0.05 alpha level. Sixty seven participants aged 51.8 ± 7.35 years completed the study comprising of 25, 22 and 20 in MPG, MPSEEG and MPDEEG respectively. The groups were comparable in age, physical characteristics and baseline outcome measures (p>0.05). Within-group comparison across the 3 time-points of the study revealed that the different treatment regimens had significant effects on the physiological and psychosocial variables (p < 0.05). The different regimens were comparable in their Mean Change (MC) scores on QVAS (p=0.579), OLBDQ (p=0.755), BBQ (p=0.176), FABQ – physical (p=0.627) and FABQ-work (p=0.077) at week four; and QVAS (p=0.883), RMBPQ (p=0.129), OLBDQ (p=0.630), BBQ (p=0.904), FABQ – physical (p=0.785) and work (p=0.154) at week eight respectively. Post-hoc analysis showed that MPSEEG had significantly higher MC in static (60.7 ± 17.1 seconds; p = 0.001) and dynamic endurance (18.1 ± 10.1 repetitions; p = 0.001) scores respectively, while MPDEEG had higher MC in PSEQ (43.5; p=0.001) and in all domains of SF-36 scores (p = 0.001). All the treatment regimens were effective at improving physiological and psychosocial variables in patients with Long-Term Mechanical Low-Back Pain. McKenzie protocol and static endurance exercise led to increased back extensors endurance capability while Mckenzie protocol and dynamic endurance exercise led to higher improvement on pain self-efficacy and general health status. It is recommended that static and dynamic endurance exercise be combined with McKenzie protocol in patients with long-term mechanical low-back pain to derive maximum benefit.

Background : Radiological imaging is mandatory, when investigating patients with low back pain (LBP). A minimum of three plain radiographic views of lumbosacral spine are routinely requested for by the attending clinicians. Objective : This study is therefore carried out to determine if only one view will be sufficient in the initial screening of patients with low back pain. Materials and Methods : The antero-posterior (AP) and lateral plain radiographs of patients referred to the radiology department on account of low back pains in an eighteen month period (June 2007 to November 2008) were reported by two certified radiologists. The findings were subjected to statistical analysis. The Kappa agreement for the two independent reports was between 0.602 and 0.908. Results : The radiographs for 638 patients were reviewed. 365 (57.2%) were females and 273 (42.8%) were males. The age ranged from 20 years to 85 years with a mean of 56.4 years. Within the age group of 20-69 years, females were found to significantly present earlier than men with LBP (P< 0.041). The AP view had a significantly higher rate of reported normal findings that the lateral view (P<0.000). Osteophytic outgrowth was the commonest finding in both views although the rate of detection was higher on the lateral view, as with the other abnormal findings.Conclusion : This study shows that the lateral radiographs show significantly more findings than AP on plain radiographs. It is therefore recommended that lateral radiograph is adequate in the initial screening of patients with low back pain.

Aims and objectives: This study was done to find out factors that contribute to development of Non-union of long bone fractures in this environment and the outcome of operative intervention. This is a prospective hospital based study. Patients and methods: All patients with Non-union of long bone fracture that presented in the hospital since January 1997 were recruited into the study. The data included causative factors, treatment given before presenting in the hospital, type of surgical procedure and result of treatment. The study was completed in December, 2005. Results: 78 patients presented with 87 Non-union of long bones. A male, female ratio of 1.6:1 was encountered while 69.2 per cent of the patients were below the age 55years. Road Traffic Accident accounted for 68 fractures (78.2 per cent) while duration of injury before presentation varies from 6 months to 22 months. Atrophic non-union occurred in 60 cases (69.0 per cent) and hypertrophic non-union in 21 cases. Non-union of the femur occurred in 33 cases (37.9 per cent) humerus in 24 cases (27.6 per cent), tibia in 16 cases (18.4 per cent), radius and ulna in 14 cases (16.1 per cent). The initial treatments of the fresh fracture in the 78 patients with non- union were by the traditional bonesetters in 51 patients (65.4 per cent) while the remaining fractures were treated by plaster of paris in hospital. Open reduction and internal fixation using plate and screws with bone grafting was the most common procedure for treating the non-union in most cases. Union was achieved in the entire patients following surgical intervention. Conclusion: Important factor that appears to contribute to non-union of long bone in this environment is soft tissue interposition between the fracture ends of the bone, which is found in all fractures with more than one diameter displacement. Another factor is interference with periosteal blood supply from disruption of soft tissue envelope as a result of high energy injuries which is also responsible for the displacements that were observed in these fractures. The treatment by traditional bone setters which entails daily massage of the fracture creating a macro movement at the fracture site is also an important contributing factor.

AIMS AND OBJECTIVES:To audit methods of mandibular defect reconstruction used in our institution.MATERIALS AND METHODS:A retrospective study of mandibular bone reconstruction at the University College Hospital Ibadan between January 2001 and December 2007. Relevant records were retrieved from patients' case notes and operation register. Comparative analysis of various methods of reconstruction was done by assessing treatment outcomes such as restoration of continuity and stability, graft infection, extrusion and fractures.RESULTS:Only 65 of the 82 patients that had mandibular continuity defect during the study period had reconstruction. Ameloblastoma accounted for 67% [n=55] of pathologies that required mandibular resection. Methods of reconstruction included non vascularised iliac bone anchored with either stainless steel wire (NVIBw) [n=38] or titanium plate (NVIBp) [n=9], titanium reconstruction plate [n=4] Steinman pin [n=12], rib graft [1] and acrylic plate temporisation [n=1]. The findings showed that titanium plate and NVIBp had the least complications in terms of infection, graft extrusion, fracture and wound dehiscence. NVIBw and Steinman pin had the highest infection rates.CONCLUSION:We recommend the use of NVIBp and titanium reconstruction plate as they have the least complication rate. We also advocate future prospective study.

OBJECTIVE:This study compared efficacy of combinations of Back Muscles Endurance Exercise (BMEE) and McKenzie Exercise (ME) and McKenzie Back Care Education (MBE) in the management of long term mechanical Low Back Pain (LBP).SUBJECTS AND METHODS:A single-blind randomized controlled comparative trial was employed. Seventy three participants mean age 45.3 ± 8.1 years were recruited for the study but only 53 completed the study. Participants in group A were treated with a combination of BMEE, ME and MBE. Group B: A combination BMEE and MBE. Group C: A combination of ME and MBE. Group D: MBE only. Participants were seen thrice weekly for 8 weeks. They were measured for pain intensity, lumbar flexibility, activities limitation and self esteem. Data were analysed using descriptive and inferential statistics of F-test. Significance was set at 0.05 alpha-level.RESULTS:At the end of the study, the four treatment groups had significant reduction in pain intensity p<0.05. Post hoc analysis showed groups A, B, and C had significantly greater reduction than D, and groups A and C had significantly greater reduction than B. Groups A, B and C also had significant improvement in activities limitation p<0.05. Post hoc analysis showed groups A, B and C had significantly greater improvement than D, and group B significantly greater improvement than C.CONCLUSION:Combination physiotherapy regimens proved effective in the management of long- term mechanical LBP. Regimen A is recommended in managing long-term mechanical LBP.

Orthopaedic implant surgery is often regarded as risky in developing countries due to likely hardware infection and the perception that the technical know-how are unavailable. The outcome of operative fixation of fractures at our centre was evaluated to determine whether this should be an option in our environment or not. All open reduction and internal fixation of fractures done at our hospital between September 1995 and December 2008 were reviewed. Details of the fractures, indications for surgery, fixation technique and outcome measures were recorded. A total of 524 fractures in 456 patients out of 1003 long bone fractures operatively stabilised during the period. About 15% were open fractures while a quarter of fractures involved the femoral shaft. Mean age of patients was 34.0 years. Traffic injuries accounted for 64% of cases. Average follow up period was 11.1 months. Plate osteosynthesis was employed in 330 cases (63.0%). Associated injuries and infective wound complications prolonged hospital stay. Complication rate was 21.0%, joint stiffness in 7.8% and chronic osteomyelitis in 3.8%. Open fractures and multiple long bone fracture stabilisation were associated with increased risks of chronic osteomyelitis. Although plate osteosynthesis remains the mainstay of long bone fracture stabilisation at our centre due to the lack of instrumentation for closed nailing, our results are comparable to those from other parts of the world. Open reduction and internal fixation is a recommendable option in treatment of fractures and nonunions in the 3rd world if standard precautions are observed.

Traumatic injuries affecting bones of the hand and forearm often require peripheral nerve blocks for analgesia and surgical intervention. The successful use of subclavian perivascular block as a sole anaesthetic for orthopaedic surgery has not been reported in our environment. We report the use of this technique for open reduction and internal fixation of a left midshaft humeral fracture. The trunk of the brachial plexus was localized by a Polystim II nerve stimulator. Complete sensorimotor block was achieved within 15 minutes and surgery lasted 55 minutes without complications. This technique obviated the use of general anaesthesia with its risks. The surgeon and the patient were satisfied with the quality of the anaesthesia.

Back pain is (BP) is recognized as an important problem in pregnancy. Theobjectives of this study were to examine the prevalence and pattern of back pain (BP) in pregnancy. A survey of 2,187 pregnant women attending ante-natal clinics in selected Medical facilities in Ibadan and Ogbomoso, Nigeria was carried out using pre-tested close-ended questionnaire. Information on prevalence, pattern and characteristics of back pain in pregnancy were obtained. Data obtained was analyzed using both descriptive and inferential statistics of mean, standard deviation, and inferential statistics of independent t-tests and chi-square tests. One thousand and eight (52.5%) of the 1919 included subjects had back pain in pregnancy. The mean age of those with and without back painwas 26.8 ± 5.3 and 27.1 ± 5.4 years respectively. Mean number of pregnancy was higher in subjects with back pain than those without back pain. The pain site among the 1008 subjects with back pain was low back in 669 subjects (66.4%), posterior pelvic in 242 subjects (24.0%) and high back in 97 subjects (9.6%). Among the subjects with back pain, 315 (31.3%) and 53 (5.3%) were in their first and sixth pregnancies respectively. Postural modification relieved the back painin about 50% of the subjects across the three back pain groups duringpregnancy. It was concluded that back pain is a common and real complaint in pregnancy. It is therefore recommended that rather than dismiss it as trivial, back pain in pregnancy should be attended to as part of ante-natal care. (Afr. J. Biomed. Res. 9: 149 – 156)Keywords: Back pain; Pattern; Pregnancy

INTRODUCTIONDeath rates in the accident and emergency department may be a reflection of the quality of care in the hospital. Trauma related mortality is a significant cause of preventable death.METHODA retrospective study was conducted in the accident and emergency department of the University College Hospital Ibadan (Nigeria) using the hospital records to determine the pattern of mortality over one year.RESULTFive thousand one hundred patients attended the accident and emergency department in the year reviewed. One hundred and sixty eight (3.3%) mortalities were recorded .There were 97 males and 71 females with mean ages of 49+/-37.8 and 42+/-30.7 years respectively. 46% of the patients had medical (non-trauma non-surgical) related diagnoses. Trauma constituted 31% of the mortalities with an average probability of survival of 80% at presentation. Head injury and multiple long bone fracture were the commonest causes of trauma related mortalities.CONCLUSIONTrauma is a preventable cause of death. The poor outcome of the trauma patients underscores the need to equip the attending doctors in the emergency room with basic skills in trauma care.