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   2016| January-June  | Volume 5 | Issue 1  
    Online since December 8, 2016

 
 
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ORIGINAL ARTICLES
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.
  6,111 524 1
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."
  4,976 988 1
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.
  5,497 434 3
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.
  4,632 354 -
CASE REPORTS
Bilateral brachial plexus palsy with unilateral phrenic nerve paresis: An uncommon birth injury
Shyam Sundar Mina, Deepika Mina
January-June 2016, 5(1):16-18
DOI:10.4103/1597-1112.192849  
Events during delivery of an infant can result in substantial harm to the infant or mother. Common birth injuries consist of traumatic brain injury, seizures, and mental retardation. Brachial plexus palsy, although rare, may result in substantial and chronic impairment. Phrenic nerve palsy is a peripheral nerve disorder caused by excessive cervical extension due to birth trauma. In this report, we describe the case of a newborn with bilateral brachial plexus palsy along with unilateral phrenic nerve paresis.
  4,399 299 -
Diaphragmatic rupture presenting with strangulated hernia: Report of two cases
Isaac Assam Udo, Kingsley U Umeh
January-June 2016, 5(1):23-26
DOI:10.4103/1597-1112.192846  
Traumatic rupture of the diaphragm can complicate blunt abdominal trauma. It is rare in our practice, and its diagnosis may be delayed if the index of suspicion is low among emergency room physicians. Imaging studies can easily confirm the diagnosis of diaphragmatic rupture. Herniation of organs and viscera through the diaphragmatic defect occurs commonly, and same may obstruct or strangulate and worsen the outcome. We present two adults with complaints of severe acute abdominal pain and a history of high-speed vehicular trauma whose definitive diagnoses were delayed. The presence of air-fluid levels in the left hemithorax on a chest radiogram and a history of blunt abdominal injury made us arrive at the diagnosis of intestinal obstruction secondary to traumatic diaphragmatic hernia.
  4,182 277 -
Unusual case of maxillofacial injury secondary to camel aggression and attack during phlebotomy: Report of two cases
Abdurrazaq Olanrewaju Taiwo, Nabilla Awwal, Ramat Oyebunmi Braimah, Adebayo Aremu Ibikunle
January-June 2016, 5(1):27-29
DOI:10.4103/1597-1112.192848  
The camel is a very docile animal used extensively in the Northern region of Nigeria for farming, transport, and others. It is rarely implicated in the literature as an etiological factor for facial fracture. Hence, the aim of this report is to highlight the unusual presentation of mandibular, zygomatic, and orbital blowout fractures caused by camel aggression and discuss the various challenges involved in its management. The camel though docile should be carefully handled, especially during phlebotomy and rutting period to avoid any mishap.
  3,967 291 -