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Trauma care in Africa: The way forward
Charles Mock, Robert Quansah, Olive Kobusingye, Jacques Goosen
January-June 2014, 3(1):3-10
  11 9,607 981
Pediatric burn care in sub-Saharan Africa
Rene Albertyn, Alp Numanoglu, Heinz Rode
July-December 2014, 3(2):61-67
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.
  7 10,558 4,595
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
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.
  5 8,460 649
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
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.
  3 6,238 476
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
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.
  3 9,133 1,210
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
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.
  3 5,463 1,846
An unusual impalement injury involving both extremities
TP Elamurugan, GS Sreenath, S Jagdish
July-December 2014, 3(2):91-93
Impalement injury occurs due to penetration by sharp objects during road traffic accident, fall or workplace mishaps. They usually involve the trunk, cranium, or isolated extremities. Involvement of upper and lower extremity in the same injury is rare. We report the case of a 48-year-old man who sustained a fall from 25 feet under the influence of alcohol onto a wooden fencing pole. The pole went penetrating posteriorly through the right axilla and anteriorly through the right thigh without involving the trunk.
  2 3,925 331
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
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 5,856 491
Analysis of complication of mandibular fracture
Akhiwu Benjamin, Kolo Emmanuel Sara, Amole Ibiyinka Olushola
January-June 2014, 3(1):24-29
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.
  2 6,944 668
Bilateral blindness from ocular injury: A 15 year review
Adepoju Feyi Grace, KF Monsudi, BJ Adekoya
January-June 2014, 3(1):35-38
Background: Ocular injury remains a significant cause of monocular visual impairment and blindness worldwide; impact on bilateral blindness needs further elucidation. Aims: The aim of this study is to review cases of bilateral blindness from ocular injury: The etiology, risk factors, psychosocial effect as well as suggest preventive measures. Materials and Methods: A 15 year retrospective review of bilateral blindness from ocular injury at the eye clinic of the University of Ilorin Teaching Hospital (UITH) From January 1997 through December 2012 was carried out. Results: Sixteen cases of traumatic bilateral blindness were recorded, compared to 2155 total number of bilateral blindness recorded during the study period, giving a proportion of 0.8%. This consisting of 12 males and 6 females. The modal age group was 17-33 years. Blindness resulting from chemical assault was (37.5%), gunshot injury (12.5%), and assault for presumed ritual purposes made up 25%. The major risk factors identified are male sex, younger age group, students, and artisan. Psychosocial burden in the immediate period of loss of vision include anxiety, fear of loss of occupation or basic skills, denial and hope for visual restoration, aggression, poor appetite, and excessive crying. Three patients developed depression and required medical management. Conclusion: Bilateral blindness in our environment is mainly assault-related from chemicals, gunshot, and rituals. Public enlightenment on far reaching consequences of sudden traumatic blindness, health education on preventive measures, legislation and adequate punitive measures are important tools required to reduce this menace. Adequate psychotherapy by behavioral scientist, rehabilitation, and societal reintegration is mandatory to effectively treat cases.
  2 3,837 364
Mother to child impact: An unusual cause of blunt chest trauma
Kelechi E Okonta, Emmanuel O Ocheli, Peter D Okoh, Uriah S Etawo
January-June 2014, 3(1):49-51
The presence of airbags in the internal front row of cars is the main reason for not allowing children occupy the front seat while in a car. Its deployment in low-speed collision may cause injury to the front occupant especially children because of the difference in sizes. An 18-month-old girl presented in the emergency with progressive dyspnea 6 h following a road traffic accident. She was carried on the laps of her unbelted mother in the front row of a car which had low-speed collision with a stationary car parked off the road. The mother was propelled forward; hitting her head on the dash board with laceration on the forehead with the child sustaining a crush injury which was deployed by the mother instead of the airbag. This resulted in bilateral hemothoraces and lung contusion. Even when the airbag was not deployed in low-speed collusion state, the compressive effect of the passenger holding a child protectively might cause severe crushing injury like blunt chest trauma.
  1 4,418 326
A rare form of domestic accidents: Penetrating abdominal injuries with evisceration of abdominal viscus
Nurudeen Toyin Abdulraheem, Roland I Osuoji, Oluwaseun R Akanbi, Lukman Olajide Abdur-Rahman, Abdulrasheed Adegoke Nasir
January-June 2015, 4(1):30-33
Penetrating abdominal injury resulting from home accidents is rare. Only one such case was found in the English literature after online searching on PubMed. We report two cases of penetrating abdominal injury. The first was a 2-year-old girl who was brought into the emergency room (ER) with evisceration of most of the stomach through the left hypochondrium. She had fallen on a broken soft drink bottle; she was holding, after missing her steps. On examination, she had a penetrating injury in the left hypochondrium and a 1.5 cm perforation on the proximal aspect of the anterior wall of the stomach. She was explored within 3 h of presentation, during which the gastric perforation was closed eviscerated bowel returned into the peritoneum and primary wound closure achieved. The patient did well postoperatively. The second was a 9-month-old boy who was brought to the ER by parents on account of gut evisceration following injury from a soft drink bottle at home. He sustained injury from exploded soft drink bottle while crawling. Examination revealed a penetrating injury in the left upper quadrant with evisceration of small intestinal loops. He also had exploratory laparotomy within 4 h of presentation, during which intact abdominal viscera was found. Bowel loops were returned and primary abdominal closure done. Postoperatively, the patient did well. These cases are eye openers to an unusual form of domestic injury, exemplifying the potential hazards of soft drink bottles in the home. Awareness about this is pertinent.
  1 5,121 346
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
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.
  1 6,308 4,508
Epidemiology of traumatic dental injuries in Tunisia: A prospective study
Ines Kallel, Imen Kallel, Nabiha Douki
July-December 2015, 4(2):51-56
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.
  1 5,477 636
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
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."
  1 5,488 1,023
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
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.
  1 6,679 552
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
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 4,487 3,356
Community-based study of road traffic accident among Almajirai in Zaria
Jerry Godfrey Makama, Tukur Dahiru, Alaji A Aliyu
July-December 2016, 5(2):48-53
Background: Trauma is a leading cause of morbidity and mortality among people of age <45 years. Almajiri is a boy of age 5–15 years that has left his parents to a distanced place in search of Islamic knowledge. They are often left on their own to cater for themselves, roaming on roads and streets from one place to another searching for alms and food. Therefore, we aim to assess the characteristics of road traffic injury among the Almajirai in Zaria. Materials and Methods: This was a cross-sectional, descriptive study, conducted in Zaria metropolis from June to December 2012. A multistage sampling technique was used to sample clusters of Almajirai. A structured interviewer-administered questionnaire was used to obtain the data. The information obtained from the respondents included the biodata, basic understanding of the use of roads, application of traffic rules and regulations, involvement in road traffic crash (RTC), the frequency and severity of RTC, where the Almajiri was managed and the outcome of each episode. The analysis was done using SPSS version 20 for the purpose of generating frequency tables, pie and bar charts including mean and Chi-square where applicable. Results: A total of 417 Almajirai participated in the study. Of this number, three hundred and sixteen (75.8%) admitted being involved in at least one form of RTC while 101 (24.2%) were not. Most accidents (23.5%) occurred in their neighborhoods and during rush hours (25%). Only 1%–2% had basic knowledge of road signs and proper use of busy roads. The majority (41.5%) were involved as pedestrian with injury, commonly, affecting the lower extremity. Conclusion: RTC was a significant cause of injury among the Almajirai in Zaria. The most common injury was trauma to the lower extremity. Special attention needs to be paid to this group of children in our society by all road users.
  1 4,480 327
The etiology and patterns of maxillofacial trauma in Jazan Province, Saudi Arabia
Sultan Mohammed Namis, Ghassan M Al-Iryani, Ali Mohammed Makarami, Fareedi Mukram Ali, Eissa Hakami, Mahmoud Y Almasrahi
July-December 2017, 6(2):32-36
Objective: The aim of the present study was to evaluate the etiological factors and patterns of oral and maxillofacial fractures in patients treated at Jazan Province. Methods: A retrospective institute-based study of oral and maxillofacial trauma patients was carried out from November 2016 to April 2017. The records of 133 patients between the ages of 0–75 years were included. The data were categorized by demographic details, mode of injury, etiology, and anatomical fracture site. Chi-square test was applied for statistical analysis according to age group, nationality, and gender at P < 0.05. Results: Radiographs revealed that mandible fractures (50.7%) were more commonly found followed by zygomaticomaxillary complex fractures as 18.2%. Less number of cases showed nasoorbitoethmoidal and maxillary fractures as 5.3% and 4.6%, respectively. Further males were predominantly more affected with maxillofacial injuries than females, and the highest rate of injuries was in seen the age group of 20–29 years as 51 (38.6%). Records also mentioned that road traffic accidents (RTAs) were the most significant source behind the facial injuries (65.9%). Conclusion: Mandibular fractures were dominant over other types of maxillofacial fractures, and RTA was the key factor in the etiology of oral and maxillofacial facial injuries. Hence, road safety rules should be strictly implemented.
  1 12,094 12
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
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.
  1 6,123 2,285
Pattern of gun pellet ocular injuries in Kashmir, India
Imtiyaz A Lone, Wasim Rashid, Nusrat Shaheen, Sheikh Sajjad
July-December 2014, 3(2):76-80
Objective: The objective was to study the type and severity of ocular injuries in gun pellet victims. Materials and Methods: The study is a retrospective case series conducted in the Department of Ophthalmology, SKIMS Medical College, Bemina, Srinagar. The study included gun pellet victims admitted in our department between January 2010 and September 2013. Results: The study included 20 patients with 19 males and 1 female. Mean age of the subjects was 21.45 years. Ocular injury was unilateral in 17 cases and bilateral in 3 cases. The most common type of injuries encountered were hyphema in 82.60% of eyes, followed by corneo-scleral tear in 78.26% and vitreous hemorrhage in 47.82% of eyes. Of the 23 eyes, 18 eyes (78.26%) had an open globe injury, while only 3 eyes (13.04%) had closed globe injury at presentation in our hospital. The most commonly performed surgery was corneo-scleral repair in 18 eyes. Final corrected visual acuity (VA) remained unchanged in 34.78% and improved in 65.22% of eyes. About 47.83% of eyes had final VA < 6/60. Conclusion: Gun pellet related ocular injuries are becoming increasingly common in Kashmir Valley. In severely injured eyes, the visual prognosis remained poor despite adequate treatment. Measures toward reducing violence in our society so as to reduce avoidable visual impairment are strongly advocated.
  1 4,463 513
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
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.
  1 6,351 616
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
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.
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* Source: CrossRef