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REVIEW ARTICLE
Pediatric burn care in sub-Saharan Africa
Rene Albertyn, Alp Numanoglu, Heinz Rode
July-December 2014, 3(2):61-67
DOI:10.4103/1597-1112.154921  
Burn injuries in Africa are considered to be a major health care problem. Sub-Saharan Africa has the highest number of pediatric burn admissions in the world. Burn care is complicated by numerous factors such as financial constraints, lack of resources, health care personnel and modern well equipped easily accessible health care facilities. Despite these numerous obstacles, burn care professionals on the continent of Africa have delivered a sterling service. A review of 70 articles published by authors on the African continent revealed information on topics ranging from the management of the HIV + patient, burn prevention strategies and new trends in African burn care.
  4,844 2,939 2
ORIGINAL ARTICLES
Results of percutaneous rush pin fixation in distal third fibular fracture: A retrospective study
Ramji Lal Sahu
January-June 2014, 3(1):17-23
DOI:10.4103/1597-1112.139451  
Aims: Aim of this retrospective study is to evaluate the results of percutaneous rush pin fixation in distal third fibular fractures. Settings and Design: Retrospective study. Materials and Methods: This study was conducted in the Department of Orthopedic Surgery in M. M. Medical College from July 2006 to November 2010. Seventy-eight patients were recruited from emergency and outpatient department, having closed fracture of distal third fibula. Postoperatively all the patients were functionally evaluated as per Kristenson's criteria and the Weber's criteria which included objective criteria, subjective criteria, and radiological evaluation at 3, 6, and 12 months after the surgery. Results: Out of seventy-eight patients, 69 patients underwent union in 90-150 days with a mean of 110.68 days. Touch down weight bearing was started on 2 nd postoperative day. Complications found in four patients who had nonunion, and five patients had delayed union which was treated with bone graft. The results were excellent in 88.46% and good in 6.41% patients. Conclusions: I conclude that the fixation using rush pin in distal third fibular fracture is a safe and effective method of surgery that could be performed easily as well as minimal soft tissue disruption and did not require secondary surgery to remove the wire, and showed sufficient stability after fixation. Therefore, closed reduction and internal fixation with rush rods is one of the good treatment modalities of distal fibular fracture.
  7,261 393 -
EDITORIALS
Trauma care in Africa: The way forward
Charles Mock, Robert Quansah, Olive Kobusingye, Jacques Goosen
January-June 2014, 3(1):3-10
DOI:10.4103/1597-1112.139448  
  6,087 520 5
ORIGINAL ARTICLES
Burn prevention and first aid knowledge: A focus on adolescents in Zaria
Abdulrasheed Ibrahim, Malachy Eneye Asuku, Tukur Dahiru
January-June 2014, 3(1):11-16
DOI:10.4103/1597-1112.139449  
Background: Burns in developing countries accounts for significant morbidity and mortality. Despite the impressive advances in the science of injury-control and prevention, burns have remained the neglected disease of modern society and are still regarded by many as an act of fate and bad luck. The aim of this study was to determine the knowledge of burn prevention and first aid treatment in adolescents as baseline information to develop an effective burn prevention program. Materials and Methods: A survey to ascertain the knowledge of burns prevention and first aid was conducted in 10 junior secondary schools in Zaria. It was divided into three sections; demographic, knowledge of burn prevention practices and first aid treatment at home and a self-report of radio and television viewing habits. Descriptive frequencies were used to describe the student's knowledge of burn prevention and first aid treatment. Chi-square analyses were conducted to identify any significant differences between students who had previous knowledge of burn prevention and those who did not. Results: A total of 335 students from 10 schools took part in the survey. Their age ranged from 10 to 17 years with a mean age of 14.8 years. There were 192 males (57%) and 143 females (43%). Seventy three students (21.5%) had previous knowledge of burn prevention and first aid, compared with 262 (77.3%) who had no previous knowledge of burn prevention. Those who had previous knowledge of burn prevention and first aid for burns were more likely to select the appropriate answers to burn prevention practices and first aid treatment at home (P < 0.0001). Majority of the students indicated that information on television (94.3%) or radio (90.7%) will be helpful in preventing burn injuries. Conclusion: Knowledge deficits exist in burn prevention and first aid knowledge among adolescents in Zaria. The use of the electronic media (television and radio) is suggested as an effective strategy to increase awareness.
  5,247 784 1
Long term outcomes of neglected intracapsular fracture neck in young adults managed by modified double angle barrel plate (DABP) with intertrochanteric valgusosteotomy
S. P. S. Gill, Manish Raj, Pulkesh Singh, Dinesh Kumar, Jasveer Singh, Prateek Rastogi
July-December 2015, 4(2):35-44
DOI:10.4103/1597-1112.179212  
Introduction: Fracture neck of femur in young adult have relatively higher incidence of complications such as nonunion, avascular necrosis (AVN) of femoral head, loss of fixation, screw cut-out, and delayed secondary osteoarthritis. Delayed presentation of these cases in developing countries such as India further compromises the outcome of these fractures. Situations like this in young adult lead to difficulty in fixation by simple cancellous screw because of lack of compression surface area. Replacement surgeries in these cases are a difficult choice in these patients; it is difficult to restrict squatting for lifelong due to social culture and lack of toilets. Now, days also preferences are given to head sparing surgeries and osteosynthesis. Materials and Methods: Cases were selected from the patients attending orthopedics outpatient department and emergency trauma center from August 2006 to August 2012. During this period, total 56 cases of neglected fracture neck femur came to our department. Of these 56 cases, 36 cases qualify for inclusion into this study. Of 36 cases, 22 were female and 14 were male with an age range from 22 years to 48 years and average age of 42 years. Average duration from injury to operative procedure was 4.9 weeks (34 days) and range from 2 weeks to 18 weeks. These cases were operated by modified double angle barrel plate (DABP) with intertrochanteric valgus osteotomy with one cannulated cancellous screw (CCS). Results: Total 36 cases were operated using DABP and trochanteric osteotomy. Final outcomes were evaluated using modified Askin and Bryan criteria. Of these 36 cases, 32 (88.8%) cases gave good to excellent results and completed their full follow-up. Rest four cases were unable to continue with same implant fixation. These were kept in failure group. These four cases showed failure due to loss of reduction, screw cut-out, and secondary collapse of femoral head after AVN. These cases further managed by replacement surgeries. Discussion: Neglected fracture neck femurs are not rare presentation in developing countries. Various modalities of treatment are fibular graft, iliac bone graft, multiple screws with fibular graft, muscle pedicle graft. In our case series, we had done combination of DABP with trochanteric osteotomy with CCS and achieved excellent to good results and this method can be used a primary method for management of neglected femoral neck fracture.
  2,890 3,124 -
Computed tomographic pattern of traumatic head injury at a tertiary hospital in Ibadan, South-Western Nigeria: A 10 year review
Ademola Joseph Adekanmi, Adenike Temitayo Adeniji-Sofoluwe, Millicent Olubunmi Obajimi
July-December 2015, 4(2):45-50
DOI:10.4103/1597-1112.179215  
Background: The World Health Organization has projected that by the year 2020, head trauma from Road Traffic Crashes (RTCs) alone will be the 3 rd leading burden of diseases in developing countries. Computed tomography (CT) is the imaging modality of choice in acute traumatic head injury evaluation and provides an excellent guide to the care of the head injured patient. Aim: The aim of this study was to evaluate the computed tomographic pattern of head injury over a decade. Materials and Methods: This is a 10 year retrospective and descriptive study carried out at the University College Hospital Ibadan, a premier tertiary health institution, which serves as a referral center for cities and towns in South-West Nigeria. All patients with head injury referred to the Radiology Department for cranial CT investigation between January 2003 and December 2012 were recruited into the study. Results: Males accounted for 75.3% of the 2142 head trauma cases with an approximate male to female ratio of 3:1. The mean age of the patients was 34.4 years, and the median age was 32 years (age range: 1-92 years). Patients <39 years accounted for 64.4% of the cases. RTC was the most common etiologic factor accounting for 1,318 head injury cases. Cases due to assault were least seen in 131 (6.3%) of the study population. Abnormal CT findings were present in 77.6% of cases. Intracranial hemorrhage was demonstrated in 1390 patients and was the most common finding. Intraaxial bleeds were present in 60.9%, and the incidence of skull fracture was also high (50.9%). Conclusion: RTC remains the leading cause of head injury but now occurring at an increasing and alarming rate. The most common abnormal CT finding is intraaxial bleeds, followed by skull fractures and extraaxial bleed in decreasing order. A combination of these findings was also frequently recorded.
  3,011 796 -
Analysis of complication of mandibular fracture
Akhiwu Benjamin, Kolo Emmanuel Sara, Amole Ibiyinka Olushola
January-June 2014, 3(1):24-29
DOI:10.4103/1597-1112.139452  
Background: In recent times, the use of wire osteosynthesis with maxillomandibular fixation (MMF) has been replaced by miniplate osteosynthesis. This has been attributed to the complications following the use of the earlier mentioned treatment modality. This however, cannot be said to be the same in developing countries mainly due to inadequate resources. The present study is aimed at identifying the complications associated with the use of wire osteosynthesis and MMF with the aim of determining if despite the said complications, these treatment modalities are still relevant in a resource poor setting. Materials and Methods: A descriptive cross-sectional study of all patients presenting with mandibular fractures to the accident and emergency department and the maxillofacial surgery unit of Aminu Kano Teaching hospital over a 2-year period who consented to participate in the study were recruited. Results: Closed reduction and immobilization was the commonest modality of treatment accounting for 53.10%, while open reduction and internal fixation using wire osteosynthesis accounted for only 34.51%. Majority of the subjects (53.98%) were treated under general anesthesia, while local anesthesia was used in 38.94% of cases. In addition, there was an insignificant association between modalities of treatment and etiology of fracture (χ2 = 18.235; degrees of freedom (df) = 24; P = 0.791, and critical χ2 = 37.65). In terms of complications, about 12.82% of patients who had open reduction as a form of treatment suffered nonunion as against 10% in closed reduction. Malunion, however, was higher in closed reduction (8.33%) than in open reduction which accounted for 5.13%. Not surprisingly, open reduction presented with a high rate of infection of about 28% as against 18.33% in closed reduction. Similarly, closed reduction presented with a higher rate of malocclusion of about 6.67% compared with 5.13% recorded with open reduction. Conclusion: Despite the advent of miniplate osteosynthesis, the relevance of wire osteosynthesis and MMF in a resource poor setting cannot be underestimated.
  3,395 345 -
CASE REPORTS
Comprehensive management of pediatric mandibular fracture caused by an unusual etiology
Divesh Sardana, Krishan Gauba, Ashima Goyal, Vidya Rattan
January-June 2014, 3(1):39-42
DOI:10.4103/1597-1112.139469  
Mandibular fractures in children are rare due to thick adipose tissue, resiliency of bone and protective and care taking nature of the parents. These fractures carry different etiology and treatment considerations with them when compared with similar types of injuries in adults. Furthermore, the associated complications may have long lasting effect on the growth and development of the child's face and developing teeth. The purpose of this case report is to highlight the occurrence of mandibular fracture in 7-year-old caused by horse-kick and its subsequent management by open cap-splint with circum-mandibular wiring.
  3,325 359 -
ORIGINAL ARTICLES
Outcome of delayed miniplate osteosynthesis of maxillofacial fractures in a Nigerian tertiary institution
Olufemi K Ogundipe, Gabriel Elekwachi, Odunayo Babatola
July-December 2016, 5(2):31-35
DOI:10.4103/1597-1112.212628  
Background: This report describes treatment outcome following delayed miniplate osteosynthesis (MPO) of maxillofacial fractures. Materials and Methods: The records of patients who underwent delayed MPO of facial fractures from January 2011 to December 2014 at the Oral and Maxillofacial surgery Unit of the Federal Medical Centre, Owo, Nigeria were retrospectively reviewed. Data retrieved were age, gender, etiology of trauma, site of fractures, and time lapse from injury to treatment. Follow-up at postoperative intervals consisted of clinical and radiographic examinations. Outcome variables such as wound infection, wound dehiscence, malocclusion, hardware failure, fracture stability, and neurosensory disturbance were recorded. Results: Thirty-one patients with 52 facial fractures were treated. There were 18 (58.1%) mandibular, 8 (25.8%) maxillary fracture while 5 (16.1%) fractures occurred in both jaws. All patients had a stable fixation and normal healing. Thirteen complications occurred in 11 patients representing 35.5% of the total. Malocclusion and wound infection were the most common complication. More complications occurred in late treatment group. Conclusion: MPO with or without postoperative intermaxillary fixation is effective in the delayed facial fracture. Treatment delay may increase the incidence of complications.
  1,772 1,840 -
Flexible intramedullary nail is still a cost-effective, minimally invasive treatment for stable tibial diaphyseal fracture - A large scale study
KR Gowtham, MR Nambiar
January-June 2017, 6(1):1-5
DOI:10.4103/ajt.ajt_4_17  
Background: Many times, we come across patients who ask for conservative line of treatment either because of lower socioeconomic status or many people are unable to stay in the hospital for various reasons. Being orthopedicians, mere treatment of fracture should not be our only aim. Our aim also should be to treat patient as a whole. In country like India, especially in rural set-up, economy plays a major role. Hence, we conducted a study to evaluate the cost-effectiveness of flexible unreamed nailing, using Ender nails for the most common long bone fracture, i.e., tibia. Materials and Methods: Nearly 590 patients with diaphyseal fractures were fixed with Ender nails from September 2002 to September 2016. The mean age of the patients was 39 years (range 18–65 years). Inclusion criteria were closed fractures and type 1 compound fractures with relative stable configuration. Exclusion criteria were long oblique and spiral fractures; type 2 and type 3 open fractures. Two Ender nails of 4.5 mm each were passed across the fracture site into the distal fragment. The mean follow-up was 16 months. Results: Average time to fracture union was 11 weeks (range 8–14 weeks). Average peri-operative blood loss was <10 ml and operative time was about 20 min. Average radiation exposure was six shoots. Range of knee movement achieved in most of the cases was >120°. Conclusions: Ender nailing in cases of tibial diaphyseal fractures could achieve reliable fracture stability, better union with least complications. Advantage of low-cost intramedullary device, its easy removal, and less hospital stay makes this even more attractive for the poor patients.
  2,870 724 -
Comparison of clinical, radiological, and functional outcome of closed fracture of distal third tibia treated with nailing and plate osteosynthesis
Ganesh Babu Natarajan, Deebak Kumar Srinivasan, PV Vijayaraghavan
July-December 2014, 3(2):68-72
DOI:10.4103/1597-1112.154924  
Aim: This is a prospective study of 30 patients with distal tibia fracture (Closed extra - articular distal third tibia fractures - 4 to 11cm from tibial plafond) who underwent surgical fixation were included in this study after excluding compound, pathological and paediatric fractures. Materials and Methods: 15 underwent closed intramedullary interlocking nail and 15 were treated with plate osteosynthesis (MIPO). Results: The age distribution ranged from 23 to 68 years with the mean age of 39.4 years. The mode of injury in all patients was due to vehicle accidents. All 30 patients were classified according to AO classification of which 15 belonged to A1, 14 belonged to A2, and 1 belonged to A3. The time of fixation from injury varied from 6 hours to 18 days. Conclusion: Plate osteosynthesis by minimally invasive technique and Intramedullary interlocking nailing are equally effective method of stabilisation for distal tibia fracture when considering the union rates and final functional outcome. However malunion, nonunion and secondary procedures were more frequent after intramedullary interlocking nail. Randomised prospective evaluation of distal tibia fractures may clarify the efficacy of plate versus nail treatment and optimize the patient care.
  2,412 1,055 -
Unstable intertrochanteric fracture in elderly treated with bipolar hemiarthroplasty: A prospective case series
KV Puttakemparaju, N Raghavendra Beshaj
July-December 2014, 3(2):81-86
DOI:10.4103/1597-1112.154930  
Purpose: To evaluate functional results of bipolar hemiarthroplasty for unstable intertrochanteric fracture in elderly patient. Materials and Methods: Between 2005 and 2012 20 elderly patients more than 65 years with intertrochanteric fractures <3 weeks old, having associated medical comorbidities like diabetes mellitus, hypertension, chronic bronchitis and emphysema were included. And patients with open intertrochanteric fractures, poly-trauma, pathological fractures, and aged <65 years were excluded from study. Results: There were 11 male and 9 female patients with mean age of 78.1 years treated by cemented bipolar hemiarthroplasty. The average surgery time was 123 min with an average intraoperative blood loss of 431.5 ml. Eleven patients were transfused a pint of blood. Grade 1 bedsores in two patients healed with regular dressing, regular change of position and antibiotics. One patient developed deep wound infection for whom implant removal and excision arthroplasty was done. Limb length discrepancy was <1 cm in six patients. No case of dislocation, rotational deformities or subsidence of the prosthesis was seen during the follow-up. Functional results were graded as per Harris Hip Scoring System, mean Harris Hip Scorewas 78.2 at 6 months and 83.25 at 24 months. Conclusion: Careful restoration of neck length, offset and version maximizes the stability of the hip joint and increases the durability of the prosthesis which is very essential in achieving a good outcome. The procedure offered faster mobilization, rapid return to pre injury level and gave a lasting solution in elderly patients with intertrochanteric fractures of the femur. Level of Study: Level 4 case series.
  2,905 321 1
The prevalence and pattern of acute compartment syndrome of the limbs in a private orthopedic and trauma center, Southeast, Nigeria: 8 years retrospective study
Thaddeus Chika Agu, Mathew Emeka Orjiaku
January-June 2016, 5(1):10-15
DOI:10.4103/1597-1112.192844  
Background: Acute compartment syndrome of the limb is an orthopedic emergency. The leg compartments, usually following fracture of the tibia are most commonly implicated. Study Design and Setting: This is a retrospective study on the scope of compartment syndrome among patients with limbs traumas who were treated between October 2007 and September 2015 in a private orthopedic and trauma center situated in a highly populated south eastern Nigerian city. Patients and Methods: The medical records as well as data from the operation register master list of patients with limb injuries were studied. Limb injuries considered significant enough for in-hospital treatments with or without other associated system injuries were included while patients with any form of arterial disease or claudication were excluded. Results: A total of 1362 patients met the inclusion criteria. Fourteen patients (1.02%) had acute compartment syndrome. The commonest underlying pathology was fracture of the tibia in eight patients (57%). Two patients (14%) were due to tight traditional bone setters' splints and one (7%) was from burns eschar. There was a slight male predominance and young adults in their primes were mostly affected. Conclusion: Acute compartment syndrome of the limb is not very common. Early clinical diagnoses in the absence of the pressure monitoring equipment is recommended and emergency fasciotomies are necessary to salvage the limbs.
  2,927 162 -
Comparison of outcome of management of unstable pertrochanteric femoral fractures with dynamic hip screw and proximal femoral nail
Hemant Sharma, Deepinder Singh Loomba
January-June 2015, 4(1):21-26
DOI:10.4103/1597-1112.162236  
Context: Pertrochanteric fractures of the proximal femur are a common occurrence among elderly patients. The two types of implants most commonly used for internal fixation of these fractures are dynamic hip screw (DHS) and proximal femoral nail (PFN). However, limited data exist showing comparison between these implants for the treatment of unstable pertrochanteric fractures which are more difficult to manage than the stable ones. Aims: The purpose of this study was to compare the outcome of management between both implants in the treatment of pertrochanteric fractures. Settings and Design: It is a prospective study done at Sri Guru Ram Das Institute of Medical Sciences. Amritsar (Punjab), India. Materials and Methods: Totally, 30 cases of unstable pertrochanteric fractures (Arbeitsgemeinschaft für Osteosynthesefragen [AO] type 31A2 and 31A3) were included and treated using PFN and DHS (15 cases each) from July 2011 to June 2013. Alternate allocation to each implant group was done. Follow-up was for about 6 months. Results were obtained with regard to operation time, blood loss, fluoroscopy, time to union, time to full weight bearing, and the requirement for revision surgery. Functional scoring was done using the Salvati and Wilson hip score. Statistical Analysis Used: Clinical and radiological data were analyzed using the statistical software epi-info version 3.5.1 released in August 2008. Results: Patients who underwent fixation by PFN had a shorter operation time, lesser blood loss, and returned to full weight bearing earlier than those who had DHS. However, more fluoroscopic exposure was recorded in PFN than DHS. Time to union was more or less the same. Patients who underwent PFN fixation had better Salvati and Wilson hip scores than those with DHS. Conclusions: In unstable pertrochanteric fractures, PFN definitely holds an edge over DHS.
  2,741 240 -
Injury epidemiology at a trauma center in Southwest Nigeria
Adetunji M Toluse, Oluwatosin O Idowu, Olorunfemi O Ogundele, Adekunle O Egbewole
January-June 2016, 5(1):1-4
DOI:10.4103/1597-1112.195446  
Background: Trauma is a leading cause of emergency room visits in Nigeria and results in significant morbidity and mortality. Aims: This study aimed to identify the demographics, pattern, and outcome of injuries in patients seen within a year. Settings and Design: A prospective cross-sectional study design was employed of consecutive patients at a new Trauma Centre in Ondo State, Southwest Nigeria. Patients and Methods: Convenient sampling of consecutive patients seen at the Accident and Emergency (A and E) Department over a 12-month period from February 2014 to January 2015 was done prospectively, and entered into a structured pro forma. Statistical Analysis: Data collected were analyzed using Statistical Package for Social Sciences version 16. Simple frequency, Chi-square test, and Spearman correlation were done. Outcome measures were mortality and duration of hospital stay. Results: A total of 657 patients that attended the A and E were recruited and analyzed. The mean age was 33 ± 16 years. Four hundred and fifty (68.5%) were young adults (age range 15-45). Five hundred and two (767.5%) were males. Trauma due to road traffic crash accounted for 68.5% of the injuries. Gunshot, fall from height, assault, burns, and occupational injuries accounted for the rest. The injury severity score (ISS) ranges were 1-9 (60.4%), 10-15 (15.1%), 16-24 (18.6%), and >25 (5.9). Five hundred and forty (82.2%) were discharged within 2 weeks of admission. Overall mortality was 11.0%. Spearman's correlation showed a relationship between the ISS and the duration of hospital stay (r = 0.261, P < 0.001). Likelihood Chi-square tests also showed association between ISS and mortality χ2 = 193.8, P < 0.001. Conclusion: Road traffic accidents remain the leading cause of trauma in our country, especially among young adults. Preventive measures should be improved to reduce this scourge. Universal health insurance coverage should be embarked on to reduce the incidence of "discharge against medical advice."
  2,263 716 -
Epidemiology of traumatic dental injuries in Tunisia: A prospective study
Ines Kallel, Imen Kallel, Nabiha Douki
July-December 2015, 4(2):51-56
DOI:10.4103/1597-1112.179218  
Purpose: The aim of this study was to investigate the epidemiological characteristics of traumatic dental injury (TDI) in Tunisian patients. Patients and Methods: All the trauma patients who had attended the Department of Dental Medicine, Hospital, Sahloul, Sousse city, during 4 years (2009-2013), were included in this study. Age, sex, etiology, and, time between the TDI and dental cares were recorded. The type of trauma was identified according to Andreasen's classification. Data were evaluated using the Chi-square, ANOVA, and Student's t-test. Results: TDIs were higher among the age group of 11-20 years (35%), with more males being affected (sex ratio: 2.2:1). Falls was the most common etiological factor causing TDI (33%). The most frequent type of trauma is enamel-dentin fracture without pulp exposure (38%). Only 9% of patients sought dental care within 24 h of the injury.   A significant difference of the sex repartition between different trauma etiologies (P = 0.013) was found. Age group repartition and etiology of trauma was significantly associated (P = 0.007) (the most common etiology of TDIs in 11-20 years age group is fall). Conclusion: In this study, fall is the most common etiology of TDI and that the majority of patients sought dental treatment after more than 24 h of the injury.   Therefore, significant strategies of trauma prevention and immediate treatment of injuries such as awareness campaigns in primary schools, colleges for emergency attitudes to adopt in case of dental trauma including total dislocation are needed to change epidemiologic data to the better.
  2,377 294 -
Changing pattern in the treatment of mandibular fractures in North-Western Nigeria
Adebayo Aremu Ibikunle, Abdurrazaq Olanrewaju Taiwo, Ramat Oyebunmi Braimah, Olalekan Micah Gbotolorun
July-December 2016, 5(2):36-42
DOI:10.4103/ajt.ajt_15_16  
Background: Maxillofacial fractures constitute a significant proportion of fractures seen at tertiary hospitals. Management of maxillofacial fractures is challenging and often associated with reduced quality of life among patients if not properly managed. This study was designed to analyze the trend in management of maxillofacial fractures at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Northwest Nigeria between 2011 and 2016. Materials and Methods: Data on the sociodemographic characteristics, etiology, type of fracture, and treatment done were retrieved. Data analysis was done with SPSS and comparisons were made using Chi-square and t-test. Statistical significance was set at P < 0.05. Results: A total of 341 fracture sites were observed in 201 patients, the majority were males giving a male to female ratio of 6.2:1. The overall modal age group at presentation was the 21–30 year age group accounting for 78 (36.3%) of all cases seen. Road traffic accident (RTA) was the principal etiological factor accounting for 137 (63.7%) of the fracture cases seen. The mandibular body and dentoalveolar sites were the most frequently occurring fracture sites on the mandible accounting for 69 (20.2%) and 42 (12.3%) of all fractures. A comparison of the etiological factors among groups of patients based on the year of presentation and gender was statistically significant (P = 0.02). A comparison of the mode of treatment (open reduction and internal fixation [ORIF] or closed reduction) among patients based on the year of treatment was statistically significant (P < 0.001). Conclusion: RTA remains the foremost cause of maxillofacial fractures in our environment. Despite a variety of challenges, ORIF is gradually being embraced as a viable mode of treatment in our center.
  1,869 788 1
Blunt abdominal trauma in child: Epidemiological, diagnostic, and therapeutic analysis of 55 cases
Oumar Ndour, Souleymane Camara, Vianel Tendart, Aimee Lakh Faye Fall, Fatou Gassama, Pape Alassane Mbaye, Ndeye Aby Ndoye, Cheikh Diouf, Mbaye Fall, Gabriel Ngom
January-June 2017, 6(1):11-18
DOI:10.4103/ajt.ajt_12_17  
Objective: The objective of this study was to report the epidemiological, diagnostic, therapeutic, and evolutionary aspects of blunt abdominal trauma in children. Patients and Methods: We carried out a descriptive retrospective study which collected between 55 children of victims of abdominal bruises and the children's surgery department of the Aristide Le Dantec hospital in Dakar between January 1, 2009, and December 31, 2015. The parameters studied were as follows: age, sex, circumstances and mechanisms, hemodynamic status, abdominal table, imaging, associated lesions, and treatment. Results: The mean age was 7.2 years. Boys were more affected with a sex ratio of 3.58. Road accidents were the most frequent cause of accidents with 50.9%. Thirty-six lesions of solid and hollow organs were recorded. The liver was the most affected organ (23.63% of patients), followed by spleen (9.1%) and kidney (7.3%). Multiple trauma was observed in 30.9% of patients with extra-abdominal lesions involving the thorax (64.7%), the skull (35.3%), and the pelvis (35.3%). Forty-seven patients (85.45%) received conservative treatment with a success rate of 93.62%; 11 patients (20%) underwent surgery. The overall morbidity rate was 14.54%, and mortality was 1.81%. Conclusion: Abdominal bruising in children is more common than wounds in the abdomen. Road accidents are the main etiology. Conservative treatment is in vogue in the service and gives very good results.
  2,379 262 -
CASE REPORTS
Unilateral visual loss following assisted forceps vaginal delivery in a Nigerian neonate
Oluyemi Fasina, Mary Ogbenyi Ugalahi, Bolutife A Olusanya
July-December 2015, 4(2):63-65
DOI:10.4103/1597-1112.179222  
Ocular injuries from assisted vaginal delivery have been reported in literature. Although retinal hemorrhages occur more frequently, severe sight-threatening injuries may also occur. We report a newborn baby with multiple ocular injuries and visual loss occurring after assisted forceps vaginal delivery.
  2,493 132 -
ORIGINAL ARTICLES
Burns of the face in epilepsy: Risk factors and an opportunity for prevention
Abdulrasheed Ibrahim, Malachy Eneye Asuku
July-December 2014, 3(2):87-90
DOI:10.4103/1597-1112.154931  
Burns are devastating injuries that may occur during altered levels of consciousness in an epileptic seizure. There is a paucity of literature on the profile of epileptic patients with severe burns of the face. This article reports the avoidable risk factors in burn injuries of the face in patients with epilepsy. A review of the medical records for all burn admissions in patients with epilepsy was undertaken from January 2010 to December 2013. Demographic and clinical data of the patients were collected and analyzed. Grading of facial appearance was based on the classification of facial soft-tissue deformities in post-burn patients by Zan et al. All the patients were female and the mean age was 27 years. Age range was 18 - 35 years. Carbamazepine was the commonest antiepileptic drug utilized. Three patients reported the use of herbal medications in addition to antiepileptic drugs while one patient admitted to the use of only herbal medications. Three of these patients presented with full thickness burns of the face and had Type IV post burn facial deformity. There are trends that accord to female gender, low socioeconomic status and poor adherence to antiepileptic drugs in this study. The use of the electronic media (television and radio) is suggested as an effective strategy to increase awareness.
  2,394 170 -
CASE REPORTS
Maxillary central incisor impaction due to childhood trauma and orthodontic intervention
Ganesh Chinthan, Kiran Nagarahalli
July-December 2015, 4(2):57-59
DOI:10.4103/1597-1112.179220  
The maxillary central incisors play an important role in smile esthetics. The absence of a central incisor can affect esthetics, phonetics, and function. Permanent maxillary central incisor impaction can occur due to supernumerary teeth, cyst, abnormal tooth bud position, trauma to the deciduous incisor in childhood, etc. The purpose of this article is to discuss maxillary central incisor impaction due to childhood trauma and orthodontic intervention in its management, with an example of a case treated by two-stage surgical exposure and orthodontic traction.
  2,294 241 -
ORIGINAL ARTICLES
Motorcycle accident mortality in Lagos, Nigeria: Impact of a traffic law
Festus Edobor Emiogun, Francis Adedayo Faduyile, Sunday Sokunle Soyemi, Olugbenga Olaide Oyewole
July-December 2016, 5(2):43-47
DOI:10.4103/ajt.ajt_12_16  
Introduction: The use of the motorcycles for commercial purposes has been associated with a high rate of road traffic injuries and mortality in Nigeria. This study is to examine the effects of newly introduced traffic laws on the mortality rate as well as pattern of injury following the enforcement of the laws. Methodology: This is a 4-year retrospective autopsy study of motorcycle accident deaths in Lagos State University Teaching Hospital, Ikeja. The study period was divided into two parts; 2 years before the law, August 2010–July 2012 and 2 years after the law, August 2012–July 2014. The anatomical location of the injuries as well as the cause of death of the patients was extracted from the register and the data were analyzed using SPSS version 20. Test for statistical significance was set as P < 0.05. Results: There were 128 motorcycle death autopsies recorded during the period of study with 96 cases (75%) before the law and 32 cases (25%) after the law. The frequency of head injury was 39.8% before the law and 43.6% after the law. The proportion of road traffic accident deaths due to motorcycle crashes was from 23.4% before the law to 11.2% after the law. Conclusion: Head injury is the most frequent anatomical region of injury in both periods. There is a 3-fold decrease in the proportion of death from motorcycle crashes following the enforcement of the traffic law.
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Motorcycle spokes entrapment foot injuries: Prevalence, and pattern of presentation in a private orthopedic and trauma center, Southeast Nigeria – A 10-year retrospective analysis
Thaddeus Chika Agu
January-June 2017, 6(1):6-10
DOI:10.4103/ajt.ajt_8_17  
Background: Pupils commuting on the backseats of motorcycles to and from schools is commonplace in cities where motorcycles are used for intracity transportation. Often times, the feet of these children get entrapped between the spokes as the motorcycles are in motion and this could cause severe injuries. This is a major health concern in Nigeria because of the increasing use of motorcycle as a transport system. Study Design and Setting: This is a 10-year retrospective analysis of all the motorcycle spokes injured patients admitted in a private orthopedic and trauma center in the southeast region of Nigeria between January 2007 and December 2016. Results: A total of 690 patients seen during the period under review were victims of motorcycle accidents. Seventy-one patients (10.3%) had spokes entrapment foot injuries. They were mostly between the ages of 5–<10 years, n = 50 (70.4%) with the mean of 6.2 years, standard deviation = 1.093. Majority of the injuries were Grade III and the worrisome patterns were degloved heels n = 26 (15.4%) and Achilles tendon tear n = 20 (11.8%). The most significant complication was marginal necrosis of the heel pad n = 8 (30.8%). The patients except one had full recovery and without morbidity. Discussion: Motorcycle spokes entrapment foot injuries occur commonly in children passengers with variation in pattern and severity. Early presentation and prompt treatment made the outcome of these injuries favorable. Conclusion: The dangling feet of a child passenger sitting on a motorcycle could get entrapped in the spoke wheel causing injuries. Strong and enforceable legislation on the use of commercial motorcycles and public enlightenment on these injury patterns are advocated.
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CASE REPORTS
Iatrogenic displacement of impacted mandibular third molar into the submandibular space complicated by submasseteric abscess
Michael Olayinka Adeyemi, Olutayo James, Akinola Olakusehin Lawal, Sunday Olurotimi Fadeyibi
January-June 2016, 5(1):19-22
DOI:10.4103/1597-1112.192845  
The accidental tooth displacement into adjacent anatomical spaces is rare but potentially serious complication of impacted third molar extraction. A few cases of accidental displacement of third molars into anatomical spaces, such as the infratemporal fossa, the pterygomandibular space, the maxillary sinus, or the lateral pharyngeal space, during surgical interventions have been reported. In this paper, a case of a mandibular third molar accidentally displaced into the submandibular space in a 24-year-old male patient is presented. Delayed presentation resulted in infection and trismus which were controlled by antibiotic therapy and the displaced tooth recovered under general anesthesia.
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ORIGINAL ARTICLES
Epidemiology and management of life-threatening hemorrhage secondary to maxillofacial injuries: Analysis of 14 cases in a Nigerian tertiary care center
Otasowie D Osunde, Godwin O Bassey
January-June 2016, 5(1):5-9
DOI:10.4103/1597-1112.195447  
Background: Life-threatening hemorrhage from the maxillofacial region is a rare occurrence. In this study, the management of maxillofacial patients with life-threatening acute blood loss in a Nigerian tertiary health care facility is presented. Materials and Methods: Data on the management of all consecutive patients who presented to the Accident and Emergency department of our institution with life-threatening hemorrhage arising from trauma to the oral and maxillofacial region were prospectively collected over a 4-year period. The information obtained included demographics, etiology, vital signs at presentation, interval between injury and presentation, nature and mechanism of injury, sources of bleeding, treatment done, postoperative follow-ups, and outcome. The data were analyzed using the Statistical Package for Social Sciences (SPSS version 13, SPSS Inc, Chicago, Illinois, USA). Statistical significance was set at a P < 0.05. Results: Fourteen patients (males = 12; female = 2) with age ranging from 17 to 65 years, mean 29.8 ± 12.82 years were managed within the study period. Majority of the victims were students (n = 7; 50%), and assault (n = 6; 42.9%) and road traffic accidents (n = 5; 38.5%) were the dominant modes of injury. The source of intraoral bleeding was from fractured mandible (n = 2) and lacerated tongue. The time interval between injury and time of presentation at treatment center ranged from 50 min to 1380 min (about 23 h), with a mean time interval of 275.1 ± 446.02 min. Ligation of the bleeder vessels combined with suturing of lacerations (n = 10; 71.4%) was the most common methods of arrest of hemorrhage in affected patients. Three of the patients required transfusion of whole blood plus intravenous infusion of crystalloids. The other eleven cases received only crystalloids. Conclusion: Early presentation achieved by prompt referral to a health facility with the requisite workforce and facility will bring about good treatment outcome and avoid preventable deaths.
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