Background: Ankle fractures are fairly common worldwide but there is scanty literature on the man-agement of these fractures from sub-Saharan Africa. This study provides a broad picture of the prac-tices of orthopaedic surgeons in Nigeria in managing ankle fractures. Consequently, these practices can be updated, areas for further research highlighted and subsequently, guidelines developed con-cerning the contextual management of these fractures in Nigeria.Methods: This survey was carried out using online and hard copy questionnaires, distributed at an annual conference of the Nigerian Orthopaedic Association and sent to three regional centres of orthopaedic practice, respectively. The data was analysed to determine frequencies.Results: There were 114 male and 16 female respondents. Sixty-one percent of the respondents preferred the Danis-Weber classification. While fifty-six percent of the cohort noted that most of these patients present to traditional bone setters before seeking orthodox care, seventy percent con-sidered arrival to hospital in 1 – 4 weeks post injury to be the norm. The Ottawa ankle rules are ap-plied by most (56%) of the participants. About a sixth (17.5%) of our cohort apply syndesmosis screws routinely, while twenty-eight percent of them do not remove these screws. The commonest post-operative complications encountered were chronic pain, flap necrosis and local sepsis. Sixty percent of the surgeons regarded post-operative physiotherapy as beneficial.Conclusions: While a preference for traditional bone setter care and delayed presentation ham-pers formal care of ankle fractures, orthopaedic surgeons in Nigeria tend to apply nonoperative ap-proaches. Patient assessment and any surgical intervention are usually based on modern principles.

Background: The impact of artificial intelligence (AI) has been compared to that of the Internet and printing, evoking both apprehension and anticipation in an uncertain world. Objective: This study aimed to explore the perceptions of medical students and faculty members from ten universities across Nigeria regarding AI. Methods: Using Google Forms and WhatsApp, a cross-sectional online survey was administered to clinical year medical students and their lecturers from ten medical schools representing all the six geopolitical zones of Nigeria. Results: The survey received 1003 responses, of which 708 (70.7%) were from students and 294 (29.3%) were from lecturers. Both groups displayed an average level of knowledge, with students (Median:4, range −5 to 12) significantly outperforming lecturers (Median:3, range −5 to 15). Social media (61.2%) was the most common form of first contact with AI. Participants demonstrated a favourable attitude towards AI, with a median score of 6.8 out of 10. Grammar checkers (62.3%) were the most commonly reported AI tool used, while ChatGPT (43.6%) was the most frequently mentioned dedicated AI tool. Students were significantly more likely than lecturers to have used AI tools in the past but <5% of both groups had received prior AI training. Excitement about the potential of AI slightly outweighed concerns regarding future risks. A significantly higher proportion of students compared to lecturers believed that AI could dehumanise health care (70.6% vs. 60.8%), render physicians redundant (57.6% vs. 34.7%), diminish physicians’ skills (79.3% vs. 71.3%) and ultimately harm patients (28.6% vs. 20.6%). Conclusion: The simultaneous fascination and apprehension with AI observed among both lecturers and students in our study mirrors the global trend. This finding was particularly evident in students who, despite possessing greater knowledge of AI compared to their lecturers, did not exhibit a corresponding reduction in their fear of AI.

The liver and lung are the usual sites of distant metastasis from colorectal tumours. Bone metastasis in patients with colorectal carcinoma is considered extremely rare. It often signifies the terminal phase of colon carcinoma with a median survival of less than ten months. High index of suspicion is required, and the possibility or risk of osseous metastases arising from primary lesion in the colon should be borne in mind when assessing bony lesions that present initially as metastasis of unknown origin. We present a case of adenocarcinoma of the colon which remained undiagnosed until patient reported with a pathological fracture of the humerus and paraparesis

Background: Trauma is a worldwide problem that results in significant morbidity and mortality in developing countries. Objective: This study looks at the demography of trauma from data abstracted from a Nigerian trauma registry and considers the peculiarities of a low-resource setting from this perspective. Methods: Trauma registry data from January 2013 to June 2014 were analyzed. Results: A total of 542 patients were included in the study. The mean age of the patients was 33.43 ± 12.79 years; the median time from injury to arrival at the hospital was 3 h (interquartile range IQR 1 – 5.1 h); three-quarters of the patients sustained their injuries on the road-tricycles were rarely involved in road traffic injuries (RTIs) (6.9% of RTIs) but were used in transporting a third of the patients whose data on means of transportation were captured. There were 15 (2.7%) deaths in the first 24 h period postinjury covered by the study – 13 (86.7%) of these patients had head-and-neck injury. About half of the assault injury (50.5%) was from persons known to the victim. The shock indices suggested that a majority of the patients were not at a high risk of mortality. Conclusion: Most of the trauma patients at our hospital were in low- to middle-income categories. The median time to arrival of injured patients was 3 h (IQR 1 – 6 h). Most injuries occurred on the road because of RTIs. The involvement of tricycles in accidents was uncommon, but they were used fairly commonly by lay responders in transporting the injured victim to hospital. A high proportion of assailants were known to the victim. The use of trauma registries provides essential data for prioritizing limited resources and can guide a contextualized approach to reducing trauma and improving trauma patient care.

Background: Computed tomography (CT) remains the gold standard in imaging evaluations of traumatic brain injury (TBI). TBI on its own has become a major concern in developing countries with its untoward effects. Objectives: The objective was to appraise the craniocerebral computed tomograms of patients who had TBIs. Materials and Methods: A retrospective study of patients who underwent craniocerebral CT on account of head injury in the University of Uyo Teaching Hospital, Uyo, Nigeria, from November 13, 2013 to May 31, 2019 was done. The duration was regardless of the disjointed periods of service interruption. Patients' demographic and CT features were evaluated with application of simple analysis of data. Results: Two hundred and thirty-two patients were evaluated with minimum and maximum ages of 6 months and 78 years, respectively. Males were predominant with a ratio of 2.74: 1. Most affected age ranges were 30–39 years (23.27%) and 20–29 (22.84%). Normal brain CT was seen in 44 patients (18.97%). The most frequent lesion in patients with abnormal CT was intracranial hemorrhages (n = 188, 81.03%). Here, extra-axial hemorrhages (n = 100, 53.19%) supersede intracerebral hemorrhages (n = 88, 46.81%). Half of the intracerebral hemorrhages were multiple. Calvarial fractures were seen in 34.48% (n = 80) of patients. The most common localization was the facial bones (n = 24, 30.00%), whereas the least site was the occipital bone (n = 4, 5.00%). Fifteen percent of the patients had multiple fractures which also included base of the skull. Conclusion: TBIs commonly occur among young active males. The most frequent lesion is intracranial hemorrhages with extra-axial bias.

Background: Low back pain (LBP) is the most common musculoskeletal disease in adults. The data on LBP from Sub-Saharan Africa are inadequate. The aim of this study was to assess the prevalence and analyze the predictors of LBP among hospital staff in a Nigerian tertiary hospital. Materials and Methods: The study participants were recruited using an opt-in approach, with the aim of including representative numbers from each professional cadre. Each participant gave formal consent. Ethical clearance was obtained. Results: Five hundred and sixty-three participants with the mean age of 36.0 ± 8.3 years and 62% female were interviewed. The point prevalence of LBP was 234 (42% [95% confidence interval [CI]: 37%–45%]). Profession was a significant predictor of LBP (P = 0.001) – nurses (53% [95% CI 43%–63%]), administrative officers (49% [95% CI 40%–59%]), engineers (50% [95% CI 24%–76%]), and health information staff (50% [95% CI 26%–75%]) had the highest prevalence. In univariate regression, female gender, increasing age, body mass index ≥25 kg/m2, and frequently adopting a bending posture, were significantly associated with LBP, while in multivariate regression, only the female gender was a significant predictor. Conclusion: The pattern of both the professions at risk, due to the well-known mechanisms of poor ergonomics, and the marked risk for the female gender, in the hospital setting, suggest underresourced work and societal environments as the underlying factors-more research is needed.

Objective: Compare the results of administering the DREEM questionnaire in two Nigerian medical schools offering traditional and student-centred curricular respectively, to identify any differences in the learning environment and appreciate advantages of the more modern curriculum.Methods: A survey design was used. Data was analysed using the DREEM scoring rubric. The independent t-test was used to compare results. Setting: The DREEM questionnaire was administered to final year medical students at two participating centres. Participants: Final year students of a teacher-centred and a student-centred medical school. Results: There were 138 respondents – 50 (96.2% of the final year students) from the teacher centred school and 88 (59.1% of the final year students) from the student-centred school. The mean total DREEM score was 117+22.3 in the former and 119 +23.6 in the latter (p = 0.798). Mean age of students in the teacher centred school was 28 ± 5.28 years, while that of the student-centred school was 23 ± 1.83 years (p < 0.05). Conclusion: The mean total DREEM score proximity between the schools suggests that the younger students using a more student-centred curriculum have less of an appreciation of their improved learning environment than is expected. Thus, the hidden curriculum could be lagging behind the written one. The older students in the teacher centred environment have a more mature appreciation of their learning climate. Funding: Personal sourcesKeywords: medical education, Nigeria, curriculum, DREEM

Background. Self-directed learning (SDL) is the essential mechanism of lifelong learning, which, in turn, is required for medical professionals to maintain competency because of advancing technology and constantly evolving disease care and contexts. Yet, most Nigerian medical schools do not actively promote SDL skills for medical students. Objective. To evaluate the status of SDL behaviour among final-year students, and the perceptions of faculty leadership towards SDL in a Nigerian medical school. Methods. A mixed research method was used, with a survey consisting of a validated Likert-based self-rating scale for SDL (SRSSDL) to assess students' SDL behaviour. Focus group discussions with selected faculty leaders were thematically analysed to assess their perceptions of SDL. Results. The medical students reported moderate SDL behaviour, contrary to faculty, who considered their students' SDL behaviour to be low. Faculty leadership further defined SDL as the self-motivated student demonstrating initiative in learning under the guidance of teachers, who use interactive forums for teaching. Furthermore, teachers and students should partner towards the goal of ensuring that student learning takes place. Teachers expressed concerns about SDL methods in medical schools owing to the fear that this will require medical students to teach themselves medicine without expert guidance from teachers. Conclusion. This study suggests that final-year students have a low to moderate level of SDL behaviour. The index faculty are willing to develop teacher-guided self-motivated learning for their students, rather than strict SDL. Faculty should be concerned about this behaviour and should encourage SDL in such a way that students realise its benefits to become lifelong learners. Further study of the perceptions about self-regulated learning are recommended.

The Cape Town Trauma Registry (CTTR) was developed as a minimum data set for low-resource settings and was applied in a southern Nigerian tertiary hospital. Based on the outcome of the study, the CTTR was modified to produce the Uyo Trauma Registry. Using the CTTR, data was obtained prospectively from injured patients who presented to the Accident and Emergency Department of the University of Uyo Teaching Hospital over a 7 week period in June and July 2012. The final data set was determined based on the ease of capture of each item and its relative importance to injury surveillance. The goal for satisfactory data capture was chosen as ≥ 80%. The Uyo Trauma Registry has 19 patient-variable items and may be the first locally relevant hospital based injury surveillance tool in Nigeria. The Uyo Trauma Registry has provided the resource constrained setting in Nigeria with a simplified tool in order to sustainably obtain trauma data and thus engage in objective locally relevant efforts at injury prevention and improved care of the injured patient.

Purpose Our aim was to assess the basic musculoskeletal competency of pre-internship graduates from Nigerian medical schools. Methods We administered the Freedman and Bernstein basic musculoskeletal competency examination to 113 pre-internship graduates from seven Nigerian medical schools over a three year period from 2008 to 2010 at the University of Uyo Teaching Hospital. Five specialist residents took the examination to test criteria relevance. Results All graduates failed this test, obtaining scores ranging from 7% to 67%. The duration of the orthopaedic posting, and observation of operative fracture fixation, were not significant determinants of the score. The two final-year specialist residents each had a marginal pass in the examination. Conclusion Basic musculoskeletal competency among pre-internship Nigerian medical-school graduates is inadequate.

Background: The commonest mode of public transportation in Uyo is by motorcycle. There are two sizes of motorcycle in common use – the big one (Qlink or Skygo model, made in China) and the small one (C90, made in China). The study was carried out to determine if there is a lower risk of RTI severe enough to be brought to the hospital, attributable to using a small motorcycle. Methods: Motorcycle RTI victims admitted at the Accident and Emergency department of the University of Uyo Teaching Hospital (UUTH), were reviewed prospectively over a 15 month period. Three community visual surveys of the proportion of small to large motorcycles were also conducted. Results: A total of 131 RTI victims were reviewed over 15 months. The visual surveys of motorcycles in Uyo revealed that the mean proportion of small to large is 38 to 62, a ratio of 1:1.6. Eighty-three (63.3%) of the 131 RTI’s involved motorcycles. 74 of these occurred in large motorcycles. There was a statistically significant relationship between motorcycle size and occurrence of an RTI severe enough to be brought to hospital. Conclusion: There is a lower risk of RTI severe enough to be brought to hospital, from using a small motorcycle.

In a resource poor country like ours, left-over ceftriaxone-impregnated beads produced intraoperatively for treating chronic osteomyelitis need not be wasted. The possibility of keeping them on the shelf for use for indigent patients and also in the treatment of open fractures that often present late in our environment was considered. Thus, it became necessary to evaluate the shelf life of these antibiotic beads when stored as dry or wet beads at tropical room temperature.

Neurotrauma or cranio-spinal trauma is the most common pathology in multiple injuries, causing significant morbidity and mortality. Majority of cases result from road traffic accidents. In one of Nigeria’s centres for neurosurgery, we evaluated our local etiological patterns to ascertain the impact of motorcycles, the most commonly used mode of intra-city transportation, on neurotrauma. This is a retrospective study of all consecutive neurotrauma patients presenting in our unit in the first 30 months after the commencement of neurosurgical services. The data were collected for each patient with a structured proforma, and were analyzed. A total of 1055 neurosurgical cases were attended to in our service in the period under study, out of which 138 had congenital anomalies and 917 had acquired diseases. Among the acquired cases, 785 had trauma but only 748 (95.3%) of them had complete re-cords, with 658 (88%) cases of head injury, 61 (8.1%) cases of spinal injury, and 29 (3.9%) concomitant head and spinal injuries. These are distributed thus: road traffic accidents 537 (71.8%), falls 120 (16.0%), assaults 47 (6.3%), missiles 20 (2.7%), falling objects 11 (1.5%), deceleration/acceleration injuries 7 (0.9%), sports/recreational activities 3 (0.4%) and birth trauma 3 (0.4%). Majority were males 569 (76.1%), and in the 15-40year age group 376 (50.3%). Of the 537 cases of road accidents, those related to motorcycles were 367 (68.3%), motor vehicles 169 (31.5%) and bicycle 1 (0.2%); and none of the motorcycle cases wore a protective helmet at the time of the accident. Most of the cases were treated conservatively 559 (74.7%), and the mortality rate from all neurotrauma cases was 17.7%. Neurotrauma is the major reason for neurosurgical consultations in our service, affecting mostly the young male age group, and most cases result from motorcycle accidents caused by the poor compliance with traffic regulations. There is an urgent need to stringently control the use of motorcycles to reduce the morbidity and mortality amongst Nigerian youths. Key words: Head, injury, spinal, road, traffic, accidents.

Background: Spinal injury is a major cause of morbidity and mortality worldwide. Road traffic accident is the main aetiologic factor, affecting mostly the male gender in the >15 – 40-year age group. The aim of this study was to establish our local hospital patterns of spinal injury and compare them with published reports. Methods and Patients: A prospective study of all spinal injury patients treated in our service in the two-year period, April 21, 2006 – April 20, 2008 was undertaken. Data collection was done using a structured proforma from the time of admission into our service to the time of discharge, and subsequent follow-up in the few cases that kept to their appointment. Data was then collated and simple data analysis done. Results: Spinal injury was diagnosed in 62 of our 826 patients, mostly males, aged >15-40years 28 (45.2%), and road traffic accident was the main aetiologic factor with an unusually high case incidence from motorcycles. There were neurological deficits in 49(79%) and cervical cord injuries were the most common. Evaluation of the injuries was mostly with plain radiography, and treatment was non-operative in all cases. Complete cord injuries remained without improvement, and complications were mostly pressure ulcers, with no incident of deep venous thrombosis. Mortality was 13(21%). Conclusion: Spinal injury was an important indication for neurosurgical consultations in our service. Complete cord injuries were more common than incomplete injuries contrary to other previous reports, and the case incidence from motorcycles was remarkably high.

BACKGROUND:Femoral shaft fractures are common presentation in our trauma units. It is obvious that all these fractures cannot be treated conservatively due to the pressure on trauma beds and thus a suitable method of internal fixation that is feasible in the environment has had to be adopted.OBJECTIVE:This study is a report of our experience with plate fixation of femoral shaft fracture in our environment.DESIGN:A retrospective hospital based study.PATIENT AND METHOD:All patients with femoral shaft fractures stabilized with plates and screws between 1997 and 2004 at the University College Hospital were reviewed. The case notes were retrieved and data extracted from them; all case notes entry gave sufficient information.RESULTS:The fracture pattern showed 56 cases (35.4%) of Type 32-A, 45 cases (28.5%) of Type 32-B and 57 cases (36.1%) of Type 32-C using AO classification. The outcome of treatment was excellent to good in 125 fractures (77.2%). The average time of healing was 20 weeks (range 16-48). Fracture related complications occurred in nine fractures (5.7%) which included deep infection in four fractures (2.5%) and implant failure in five fractures (3.2%).CONCLUSION:Femoral shaft plating gives good result if the principles of fixation is carefully followed and in developing countries where initial cost of procurement of equipments for closed nailing may not be forth coming, it thus provide a safe efficient and low cost method of fixation of femoral shaft fracture.

OBJECTIVE:To highlight the dangers inherent in the practice of traditional bone setting in south western Nigeria as evidenced by the preventable complications that accompany treatment of fractures, joint dislocations and limb deformities by traditional bonesetters (TBS).METHOD:Twenty-five consecutive patients with fractures, dislocations and limb deformities who had been previously managed by TBS and who subsequently presented to the University College Hospital, Ibadan (on account of complications from treatment at the TBS) between 15 October 1999 and 31st March 2000 were evaluated.RESULT:Fourteen patients had fracture non-union or malunion necessitating open reduction and internal fixation. Two patients with wet gangrene of the extremities had amputations.CONCLUSION:Traditional bone setting is an ancient trade practiced in Nigeria and most developing countries without government regulations and they lack guidance. The complications that accompany these practices are unacceptable and it is imperative that there should be legislation to curb their activities and save the unsuspecting public from further harm or even death.