Summary Septic arthritis of the hip joint in two children, originally thought to be cases of acute abdomen is presented. In one case, the discovery of extra-peritoneal purulent fluid at surgery, obviated the need for laparotomy and in the other, the true nature of the disease became apparent one week after laparotomy. These cases illustrate the maxim that any painful movement of the hip joint with associated unexplained fever should raise suspicion of septic arthritis. The close relationship of the hip joint to the pelvis sometimes confuses hip diseases with pelvic pathologies.

Background: Birth injuries are not uncommon in newly born babies. Such injuries which are sometimes first detected by the parents after discharge of the baby from the hospital, often cause a lot of anxiety regarding the causes and prognosis. Objective: To describe the presentation of birth injuries, their treatment and prognosis. Design: A retrospective hospital-based study. Patients and Methods: Children aged one day to three weeks who were seen at the Orthopaedics and Trauma Department of the University College Hospital, Ibadan between January 1998 and December 2002 constituted the subjects of this review. Their case notes were retrieved and data extracted from them. Results: Thirty four babies comprising 18 males and 16 females were identified. Only 14 (41 percent) of them were delivered in the hospital. Twenty five (73.5 percent of the 34 were delivered by spontaneous vaginal delivery with vertex presentation while only seven (20.6 percent) and two (5.9 percent) were delivered by breech and Caesarean sections, respectively. There were 36 injuries of which brachial plexus injuries accounted for 24 (66.7 percent), while fractures accounted for the remaining cases. The fractures involved the clavicle in seven (58.3 percent) cases, the humerus in three (25 percent) and the femur in two (16.7 percent). A majority (79.2 percent) of those with brachial plexus injury made full recovery within 11 months while all the fractures healed within six weeks. Conclusion: The results show that most of the babies who suffered brachial plexus injury and fractures of the femur and humerus at birth, recovered fully with prompt management.

Mandible resection and subsequent defect created lead to aesthetic and functional abnormalities. The surgical reconstruction of the defect is a major challenge in maxillofacial surgery. Lack of appropriate facilities and the high cost of newer modalities made the use of non-vascularized iliac bone graft in reconstruction of mandibular defect an attractive option in our environment. The technique of harvesting iliac crest graft is highlighted in this prospective study involving 37 iliac crest grafts for mandibular defect reconstruction between 1999 and 2006. Ameloblastoma was the most common indication for mandibular resection in 27 patients (73 percent), while 24 patients (64.9 percent) had hemimandibulectomy which is the most common type of mandibulectomy. A graft take rate of 91.1percent was achieved in this study. Graft site infection was the most complication with overall incidence of 27.0 percent. Most of the infections were superficial and responded to antibiotic use and local wound care. Donor site complications were few in the study. We recommend the use of autogenous iliac bone graft for reconstruction of mandibular bone defect in our environment Key Word: Mandible resection, iliac bone graft,

A total of 17 Children with acute osteomyelitis presenting to division of orthopaedics and trauma surgery is presented. The male:female ratio is 1:1:3, mean age of 6.12 years. The median time of illness before presentation is 8 days. The Tibia bone is the most common site of infection (52.9%) while multifocal infection occurs in 35.3% of the patient. Staphylococcus aureus is the most common isolate (47.1%) while Salmonella typhi occurred in 23.5% of the patients, all with sickle cell disease. There was positive bone aspirate in all the patients while all patient had surgical intervention with sequential intravenous - oral antibiotic therapy with an excellent outcome in 94.1%. Surgical intervention appears to be essential to cure of acute osteomyelitis in addition to antibiotic use.

Background and purpose of study: Open fractures are difficult to treat particularly because of the risk of infective complications. The rudimentary emergency rescue services in a developing country like ours with attendant delays in presentation of patients amongst other factors would suggest a dismal outcome for open tibial fractures in Nigeria.Patients and methods: Ninety two patients with 98 open tibial fractures who presented to the University College Hospital(UCH), Ibadan over a 12-month period were reviewed. The aetiology and severity of these fractures were explored as well as thetreatment outcomes.Result: The mean age was 33.3 years (peak 21-40 years) with men being 2.4 times at risk. Eighty three percent were from roadtraffic injuries; pedestrian crashes led other traffic injuries with 32% of cases. A quarter of the patients presented after 8 hours of injury. Three quarters of the fractures occurred in the shaft. Gustilo type IIIb injuries was the commonest (36.7%). The methods of treatment included plaster cast (71.5%), external fixation (15.7%), plating and primary amputation (5.7% each), and intramedullary nailing (1.4%). Average time to union was 26.2 ± 12.7 weeks. Forty six late complications occurred in 32 fractures (there were 6 cases of chronic osteomyelitis).Conclusion: The incidence and severity of open fractures in our environment calls for urgent steps geared towards reducing theincidence of road crashes. The provision of standard, prompt and affordable emergency as well as definitive health care facilitiesfor the victims should be a priority.

Background: Commuting by the motorcycle (‘Okada’) has become a menace in Nigeria due to injuries from preventable crashes. This study elucidates the pattern of injuries and the burden of disease from motorcycle crashes presenting in our facility.Patients and methods: Patients presenting to our tertiary hospital following motorcycle crashes over a 17-month period were studied prospectively.Results: A total of 167 patients with mean age 33.4 years were evaluated; 82.2% were aged 21 years and above. Male: female ratio was 3:1. Over three-quarters of patients presented the same day. Motorcycle-carcollision was the commonest mechanism (44.7%). Limb injuries occurred in 83.2% of cases, while 43 (25.8%) had head and neck injuries. None of the cyclists wore a helmet at the time of the crash. 67.6% of the caseswere managed conservatively. A mortality rate of 2.9% was recorded.Conclusion: Commercial motor cycling no doubt eases domestic transportation in our country. However, the economic effect as well as the morbidity and mortality arising from motorcycle crashes calls for strict laws to regulate its use by government. Licensing of riders and enforcement of traffic laws including the use of crash helmet should stem the rising tide of preventable morbidity and mortality currently associated.Keywords: motor-cycle (okada) injuries, road crashes

Osteoarthritis is a degenerative as well as an inflammatory disorder of joints. The joint inflammation in this disease (as with inflammation in other organs of the body) leads to the production of acute phase proteins like C-reactive protein (CRP) along with the release of cytokines and neutrophils. The lysosomes released from the activated neutrophils result in the production of large amounts of free radicals which are harmful to the human body. Antioxidants on the other hand are substances that when present even in low concentrations avidly react with and annihilate free radicals before oxidative damage is inflicted on vital components of the cells. This case-control study was aimed at investigating the influence of age; body mass index, total antioxidant status (an indirect measure of total free radicals) and c-reactive protein (an acute phase reactant) on symptomatic osteoarthritis of the knee. Thirty five subjects with clinical and radiological features of osteoarthritis of the knee were recruited from the Orthopaedic clinic of the University College Hospital, Ibadan. Twenty healthy age-matched controls were recruited from the Surgical Outpatient Clinic of the same hospital. Informed consent, biodata and body mass indices were obtained after which venous blood samples were obtained from each subject. Total plasma antioxidant status (TAS) was estimated spectrophotometrically by the Koracevic method while the CRP concentration was measured using Humatex CRP kit® (Human GmbH, Germany). The mean ages of the test and control groups were 58.8±12.0 and 52.3±7.9 years respectively. Osteoarthritic patients demonstrated significantly higher (p<0.05) BMI (32.2±6.9 kg/m2) compared to controls (26.1±3.4 kg/m2). The mean TAS was significantly lower (p <0.05) in the test (1.09±0.38 mmol/l) compared to the controls (1.61±0.09 mmol/l). CRP was positive in 19 (54.3%) of the test subjects but negative in all the control. There was an inverse correlation between the BMI and TAS (p <0.05) as well as between age and TAS (p <0.05). This study shows that Nigerian patients with symptomatic osteoarthritis of the knee tend to be obese and have a lower total antioxidant status. Antioxidant supplementation of the diet as a means of minimizing the severity of osteoarthritis and other free radical-mediated diseases in older Nigerian adults is advocated. Keywords: Osteoarthritis; anti-oxidants; c-reactive protein; acute phase reactants; Nigeria.

Chronic osteomyelitis is a debilitating disease that is fairly common in developing countries. Various operative techniques have been adopted in the management of this disease but there have been few reports of their use in Africa. In this report, we present our experience of the use of a modified two-staged Belfast operation in patients with chronic osteomyelitis in Ibadan, Nigeria. An important modification of the procedure was the substitution of gentamicin beads (Septopal) with ceftriaxone-polymethylmethacrylate (PMMA) beads at the saucerised segment of bone at the first stage. Thirty-four patients with chronic osteomyelitis had the two-stage Belfast operation in 35 long bones; of these, 32 patients had ceftriaxone-PMMA antibiotic beads inserted at the saucerised segment of bone at the first stage, while the other two patients had gentamicin beads inserted. One of the two patients who had gentamicin beads had a residual collection of pus at second stage surgery but, following a repeat debridement, the cavity was rid of infection. There was recurrence of infection in three patients (8.6%) who had a suction drain inserted at the first stage and in six patients (17.1%) who had no suction drain at the first stage. The locally produced ceftriaxone-PMMA beads were found to be as efficient as the commercially available gentamicin beads in eluting antibiotics locally, thereby eliminating the residual infection in the bone cavities after the first stage. Another important outcome was a fourfold saving in cost in choosing to use ceftriaxone-PMMA beads rather than gentamicin beads.