Vol 58, No Supplement 03 (2020): ORTHOPEDICS IN ETHIOPIA

Introduction

Bone mineral density is  the amount of inorganic  mineral in bone tissue. Its’ measurement is an important screening investigation done to diagnose patients with osteoporosis. Osteoporosis is a metabolic disorder characterized by low Bone mineral density resulting in increased incidence of fragility fractures.

Objectives

This study is an attempt to establish a normative Bone mineral density data for the Ethiopian population

Methods

This is a uni-center-based retrospective study. We reviewed the Bone mineral density of 345 Ethiopian individuals measured with a Dual-energy X-ray absorptiometry.

 Results

The peak bone density in males was reached at the age of 20-29 years. The age-related decline in bone mineral density was about 0.62%per year at the lumbar spine and 1.01% per year at the femur neck from the age 30 to 70 years. The peak bone density in females was reached at the age of 20-39 years, the age r-related decrease in bone density was about 0.465% at the lumbar region and 1.41% at the femur neck region .

Conclusion

Although this study has outstanding draw backs we found that the Bone mineral density values of Ethiopian individual was higher than those established for Caucasian individuals. Its significance is in highlighting the importance of establishing a normative data so as to accurately diagnose, treat and follow osteoporosis.

Key words: Bone mineral density, osteoporosis, Ethiopian, DEXA scan, BMI

Methods: A five-year retrospective study was conducted. Data analysed with SPSS version 24 and result summarized by texts, tables, and figures. The association between initial Pirani score and number of casts was assessed using the Pearson correlation coefficient with the level of significance set at P<0.05.

Results: A total of 526 patients with mean age at presentation of 15.3 weeks were included. Male account for 387 (73.6%).  More than two-third (70.7%) were born in the health facilities. Nearly half of them (47%) had bilateral involvement followed by right side (27.5%). In average, 5.94 corrective casts were needed to correct the deformity. According to Pearson correlation coefficient, a positive correlation was observed among number of casts to correct the deformity with initial pirani score and age at presentation (r=0.225, p<0.001; r=0.178, p<0.001). Among 587 feet for which tenotomy performed, only 186 tenotomy (31.7%) was done appropriately according to the criteria (HFCS >1 and MFCS = 0).

Conclusions: Ponseti method of club foot treatment is effective in treating idiopathic club foot in our setup. Close monitoring of tenotomy decision based on pirani scoring should be made by consultant orthopedic surgeon in order to prevent unnecessary tenotomy.

Key words:  Idiopathic Clubfoot, Ponseti treatment, Number of casting, Pirani scoring system

Background: Ring tourniquet syndrome is not uncommon and patients will present with pain, swelling, ischemia, and finger wounds related to previous ring removal attempts. It may be due to application of undersized ring or related to swelling around a previously well-fitted ring.

Objective: This study aimed to describe epidemiologic features, predisposing conditions, and treatment outcomes of strangulated fingers.

Methodology: In this prospective observational study, we enrolled consecutive patients who presented to any of the three selected emergency departments at Tikur Anbessa Specialized Hospital, Alert trauma center and Hawassa University Comprehensive Specialized Hospital with ring tourniquet syndrome between January 01, 2017 and December 31, 2019. Data collected after getting ethical clearance.

Result: Among 33 patients enrolled, 52 % were female and the mean age was 24 (1.5 - 56) years. Eleven (33%) presented after wearing undersized ring, 7(21%) had trauma to the ipsilateral hand, wrist and/or forearm, and 7(21%) were psychiatric. The mean duration of ring incarceration was 3 days (4 hours – 3 weeks). Thirty-one patients (93%) reported previous attempt of removal of the constricting agent. Twenty-two patients (69%) required destruction of the constricting object and 5 patients (15%) need ray’s amputation of the finger. There were no reported major complications.

Conclusion: Ring tourniquet syndrome is not uncommon in our setting, and since most of the incarcerated rings required ring-destructive technique, the health personnel need to be had at least ring or k-wire cutter.

Key words: strangulated finger, ring incarceration, Tourniquet Syndrome, ring devices,

Introduction

The burden of cancer is on the rise, according to WHO’s report the number of new cases is said to increase by about 70% over the next two decades. It is the second leading cause of death worldwide, and 2/3^rd of these deaths are in low- and middle-income countries like Ethiopia. Musculoskeletal tumors refer to abnormal growths involving bone and the surrounding soft tissues. In Ethiopia, like that of rest of sub-Saharan nations estimates for the incidence of musculoskeletal tumors is increasing;

Methods

The source of information is the Orthopedic Center at Tikur Anbessa Specialized Hospital which is the Country’s largest and major diagnostic and treatment center for musculoskeletal tumors. The patients demographics and selected variables are recorded from their medical records onto Ms.Excel and then analyzed using IBM SPSS(V.24). The database spans from 1989 G.C upto 2009 G.C

Result

There is a trend of rising case numbers, from less than ten cases in 1989 to more than a 100 cases per year in 2007 and 2008 each. Overall, the leading musculoskeletal tumors are soft tissue sarcomas at 66.3% followed by Osteosarcoma 18.5% which is the leading primary bone tumor in the study duration.

Conclusion

There is a need for establishing or strengthening population?based Musculoskeletal tumor registry in the whole of Ethiopia to implement executive and evidence?based national and regional cancer control programs. 

Background: Femoral shaft fractures represent the most common pediatric orthopedic injury that requires admission to the hospital. The epidemiology of femur shaft fractures is well described in literature from developed countries. However, abundant studies are not available on pediatric femur shaft fractures in resource-limited areas like the sub-Saharan Africa.

Objective: To determine pattern of pediatric femur shaft fractures at Addis Ababa Burn Emergency and Trauma Hospital.

Methods: Institution-based retrospective cross-sectional study was used. All cards of pediatric patients with femur shaft fractures, who were treated between September, 2015 and August, 2018 were reviewed.  Cards with incomplete data were excluded. Data abstraction format was applied to collect data. The data was then entered and analyzed using SPSS version 20.0.

Result: Ninety one patients who had femur shaft fractures were reviewed in the study. Males were 67(73.6%). The most commonly affected age group was 6-12 years in 40(44%); the mean age being 8.8 years. Majority of the fracture were due to fall (41.8%). Most fractures occurred in June to August (36.3%). Left side was involved in 45(49.5%) cases. Eighteen patients (19.8%) had associated injury; head injury being the commonest, 7(38.9%). Closed fracture was the commonest type 84(92.3%). Traction followed by spica was the commonest treatment modality (28.6%). The mean length of hospitalization was 15.3 days.

Conclusion: The most affected age group was 6-12 years. Fall accidents predominated as the etiology. Most of the fractures were closed type. Conservative management was mostly used.

Key Words: Pediatric, femur shaft, fracture, pattern

Introduction:

Whole Person Disability (WPD) evaluation is a difficult task done finally after treatment of an injured person. To avoid subjectivity, to exercise transparency and to calculate quickly, computer software applications are of potential use. Rating calculations shall be well reproducible and reliable.

Objective:

This study aims at comparing Permanent Physical Disability Rating using the software developed and doing it manually to award percentage WPD to applicants with Musculoskeletal (MSK) injury.

Methods:

Prospective study of all MSK injured applicants of permanent whole person disability evaluation was performed in Black-Lion Hospital (TASH) from Sept 2017-Sept 2019. Evaluation of Permanent Physical disability from injury was done after the time of Maximum Medical Improvement (MMI). A questionnaire, request letters, board letters, software database, and the Hospital’s charts were used to gather information. Analyses and statistical testes were done.

Results: Only a fifth of the applicants were female. Majority of applicants came from Addis Ababa (219, 54.75%). Peak age group affected was 20-29 years (151, 37.75%). Road Traffic Crushes (256, 64%) & falls (57, 14.25%) caused most of the injuries. Mostly, law enforcement personnel requested the evaluation (155, 38.75%). Most, (260, 65%) were TASH patients and 102 (25.5%) of applications came from Private Hospitals in the Capital.  Lower limb was the most injured region (258, 49.2%). Occurrences of multi-injury and poly-trauma respectively were (85, 20.8%) & 20(5%). There was only fair agreement (71%) between the two rating methods with Cohen’s Kappa K=0.217.

Conclusions:  Software based computerized WPD rating is better than manual method.   

Background: Clinical experience shows majority of patients with open long bone fracture present late in Ethiopia, and is associated with poor outcome.

Objective: The aim of this study is to assess prevalence of delay in hospital presentation among patients with open long bone fractures.

Methods: This is a prospective observational sub-study of the ongoing Open Fracture Irrigation Study (OFIS), which is a randomized control trial (RCT) being conducted at Tikur Anbessa and Hawassa University Hospitals. The data is extracted from OFIS data registry into Microsoft excel, which was then exported to SPSS version 25 for analysis.

Result: A total of 301 open long bone lower extremity fractures were included. Men accounted for about 85% with mean age of 32 years. The most common mechanism of injury was road traffic incidents in 171patients (57%) followed by gunshot in 50 (16.6%). Majority (71%) were Gustilo-Anderson grade III. About 85% of open fractures did not present to hospital within the Lancet Commission on Global Surgery recommended 2 hours’ time frame. Similarly, once the patient presented into the hospital, more than 65% were not operated within 24 hours of their presentation.

Conclusion: Theis study shows that there is a significant delay among open long bone fracture in our set up in both time from trauma to hospital presentation and arrival to operation. We recommend further study to identify factors responsible for open long bone fracture delayed presentation.

Key word: open fracture, delayed presentation, Tikur Anbessa Specialized Hospital, Hawassa University Comprehensive Specialized Hospital

Introduction-Negative pressure wound therapy is a way of treating wounds using a vacuum-assisted system that is applied over the wound bed and helps expedite wound healing process.

Objective-To assess the contents of Vaccum Assisted Therapy(VAT) outcome reporting initiative in Tikur Anbessa Specialized Hospital, initiate a Wound care database and standardize patient follow-ups

Method-Patients who have been admitted to Orthopedics ward for various musculoskeletal pathologies and treated with wound VAC have been included in this study, descriptive analysis of these case series was performed with data obtained from Nursing follow-up forms and serial pictures.

Result-Out of the 28 patients, 18 were men, and 10 were women.71% of patients were between the age of 15-49,4 patients between the age of 50-65 ,  2 pediatric patients under 15 years and 2 patients above the age of 65. 52 % of the patients had dressing changes up to 5 times and 48% required between 5-10 times. The most common cause of injury is road traffic injuries, 16 patients. The second most common cause is bullet injury, followed by falling down accidents in 4 patients. The average percentage of reduction in size was 49%, with a maximum of 94% on one patient, and a minimum of 0 % on 5 patients. Wounds were covered with primary closure in 11, secondary intention in 10, and skin graft was done for 7 patients.

Conclusion-Reporting of patient progress needs to be more detailed, inclusive, and creating a nationwide database is the first step forward.

Introduction: The impact of COVID-19 has influenced every society in the globe since it was declared as public health emergency of international concern. The recommendation to prevent the transmission includes proper hand hygiene, proper physical distancing and face mask utilization in public places.

Objective: To assess the practice of face mask utilization and proper physical distancing in patients and attendants visiting Tikur Anbessa Specialized Hospital Out-patient waiting areas.

Methods: Institution-based cross-sectional survey was conducted. All patients and attendants visiting the out-patient waiting areas of Tikur Anbessa Specialized Hospital were the source population. Anonymous non-participatory observation data collection using a pretested checklist was used. Excel and SPSS softwares were used for data management and analysis. Descriptive analysis was used to present data.

Result: A total of 3816 individuals were observed in the study. Among them 53.2% were female. Proper face mask utilization was practiced almost universally, 93.4%. Proper physical distancing was practiced in 48.3% of them. The presence of individual enforcement, the daily patient load and the capacity of the waiting areas were influencing the practice of proper physical distancing. 

Conclusion: Proper mask utilization among individuals visiting out-patient waiting areas of Tikur Anbessa Specialized Hospital is close to universal relative to physical distancing. Overcrowding and lack of sustainable enforcement of good practices lead to low practice of proper physical distancing.

Key words: COVID-19, mask utilization, physical distancing, Tikur Anbessa Specialized Hospital