April 2024 VOLUME 62 Supplement 1

Abstract

Background Trauma is the leading cause of death in Ethiopia, with a rate of 26.7 deaths per 100,000 population. Emergency care systems have been shown to reduce trauma deaths, but the effectiveness of the emergency care system in Addis Ababa is not studied well. The aim of the study was to assess the effectiveness of the continuum of the trauma care system in selected emergency departments and trauma centers in Addis Ababa.

Methods A sequential explanatory mixed-methods approach was utilized, with in-depth interviews (N = 23) and focus group discussions (N = 17) with trauma team members, as well as a concurrently structured emergency care system assessment questionnaire (N = 333). The Chi-square test was used to show a significant association (P< 0.05) between the type and mechanism of trauma and patient condition categorization. The qualitative data were analyzed using Colaizzi's seven-step procedure.

Results The present study showed that Road Traffic Injury had been the most common cause of trauma (87.1%), with only 8.4% of trauma patients having received airway intervention during prehospital care. Out of 126 patients who had required emergency surgery, only 38.10% of injured patients received a prompt decision regarding the need for emergency surgery, and 78.7% couldn't have received rehabilitation service. The Chi-square test revealed a significant association (p < 0.05) between type and mechanism of trauma and patient condition categorization. Five themes had emerged from the qualitative analysis, and hospitals had faced difficulties in providing trauma care due to a lack of leadership, coordination, cooperation, referral links, knowledge gaps, poor organization, and insufficient medications and medical equipment.

Conclusion This study found that the trauma care system in the city is ineffective due to systemic gaps in emergency departments, policies, Resources, documentation, referrals, and communication. These gaps contribute to the high death and illness rates of trauma patients. To improve trauma care and reduce death and illness, the system needs to be improved and strategy has to be developed.

Around the world, almost 16000 people die from injuries every day. For every person who dies of injuries, several thousand injured persons survive, but many of them are left with permanent disabling squeal. Trauma places an enormous burden on countries with limited resources in which Ethiopia is included. From the musculoskeletal traumas, pelvic ring injury account for 3-8 % which is associated with a high mortality rate especially when it's complicated by hemorrhagic shock and other associated injuries. However, there is limited information concerning the outcome of non-operative management of pelvic ring fracture, and associated injuries in Ethiopia.

Objectives: The main objective of the study is to determine functional outcome following non-surgical management of Pelvic Ring Injury at TASH Orthopedic and trauma center

Methods:  The study design was Institution based retrospective cross sectional study of patient charts treated for pelvic ring injury at TASH from April 2019 to August  2021.( 50 patients have been treated non-surgically  for pelvic ring injury in the study period ).The data was collected from patients chart using structured data collection form. Majeed pelvic scoring was used to evaluate functional outcome by phone or email. Data entry and analysis was done using SPSS version 26.

Conclusion:  The overall majeed score for pelvic ring injury in this study was 82.92 ± 11.04 SD (95% CI, (80.13, 85.12)). At the end of the assessment, the majority of patients 26(52%) had excellent functional outcomes, followed by 19(38%) with good functional outcomes, 4(8%) scoring fair functional outcomes, and (2%) with poor functional outcomes.

Abstract

Background: Pediatric musculoskeletal problems are increasingly becoming a major public health problem worldwide. Developing countries are disproportionately affected by this issue. However, there is a scarcity of epidemiological data describing the magnitude of these issues in low resource settings. Understanding the pattern and burden of musculoskeletal problems helps in objectively understand the issue. This in turn will aid in the formulation of evidence driven policy and decision making. This study tries to summarize the pattern of all pediatric orthopedic conditions seen at Tikur Anbessa specialized hospital over the study period.

Objective: To describe the pattern of patient referral to the pediatric orthopedic clinic in Tikur Anbessa Specialized Hospital.

Methods: Hospital-based retrospective record review was conducted from January 2022 to January 2023, at Tikur Anbessa Specialized Hospital. Data were collected from medical records of all pediatric patients seen at the pediatric orthopedic clinic at Tikur Anbessa Specialized Hospital and diagnosed with orthopedic conditions were included in the study to determine the pattern of patient referral. Descriptive statistics were computed to describe the study population and variables.

Result: Of the pediatric patients who visited pediatric Orthopedics clinics 195 (32.3 %) were due to trauma, 139 (23.1 %) were due to a congenital disorder, 72 (11.9%) were due to developmental problems, 55 (9.1%) were due to neuromotor problems, 46 (7.6) were due to infection problems, 27 (4.5) were due to tumors, 24(4%) were due to metabolic (all constituting rickets) problem and 46 (7.6 %) constitute miscellaneous conditions.

Conclusion: The most common musculoskeletal diseases/conditions were trauma, followed by congenital disorders and developmental disorders/diseases.

Background: The occurrence of birth related fractures is linked to various factors, encompassing maternal aspects, fetal conditions, and the skills of the obstetrician. In this study, our aim was to evaluate the correlation between birth-related fractures and both high and low birth weights.

Methods: The study is a case-control study, spanning from August 2019 to August 2023 G.C. The sample size determination relies on birth weight as a variable, considering a type 1 error rate (alpha) of 0.05, a beta of 0.2, and a power of 80%, resulting in a total sample size of 36. After importing the data into a Microsoft Excel file, thorough cleaning procedures were applied. The refined dataset was entered into SPSS 26 for analysis. Statistical significance was assessed using a 95% confidence interval and a p-value threshold of < 0.05.

Result: The mean birth weight of neonates with birth related fractures was 3115 grams. Fifty-eight percent of the neonates had fracture of the humerus followed by femur (25%) and clavicle fractures (16.7%). The mean weight of neonates with clavicle fracture, humerus fracture and femur fracture was 3950, 3054 and 2700 grams respectively. Birth weight and breech presentation correlations were statistically significant for birth related fracture at a p- value of  <0.05.

Conclusion: The findings of this study indicated that both lower and higher birth weights, along with breech presentation, elevate the risk of birth-related fractures. In light of these results, we recommend optimizing the maneuvers of fetal body extraction through practical training.

Background: Idiopathic clubfoot is managed by the ponseti method worldwide; however, the recurrence of the deformity is a challenging problem and not studied in Ethiopia. This research aimed to determine predisposing factors for recurrence of idiopathic club foot after successful ponseti treatment.

Objective: Assessing predisposing factors for recurrence of idiopathic club foot after successful correction by the ponseti method.

Method: All children with corrected idiopathic club foot who start abduction brace and on were follow up from September 2021 to September 30 ,2023 after Ponesti method of treatment who fulfill the inclusion criteria included for study. From medical and club foot register and phone interview, data were exported to SPSS version 29 software. Descriptive statistics, bivariable analysis and multivariable analysis used for analysis.

Result: There were 104 patients (136 ft) underwent the ponseti method, with the follow–up period at on average 3.4 years .31 (29.8%)) patients with 39(28.7) feet out of 136 feet had recurrence. This study included 66 (63.5%) males and 38 females. Of them 32(31.7%) were right side clubfoot, 38(36.5%) were left side and 33(31.7%) were bilateral. Place of residence shows 62(59.6%) were from urban while 42(40.4%) were from rural. Chi-square tests found associations between recurrence and, awareness level of treatment (p=0.0001), education status (p=0.002), job of parent (p=0.003, satisfaction of parent with treatment (p=0.004), poor compliance (p<0.001), discomfort during wearing brace (p=0.01), pretreatment pirani scores (p<0.001) and longer follow up age (p=0.014). Poor compliance was significantly associated with discomfort wearing brace (p=0.000) and poor fit of brace to shoes (p=0.004). Logistic regression identified pretreatment pirani score (p=0.024), and poor brace compliance (p=0.022) have major predictive significance for recurrence and discomfort to brace and brace size has major predictive significance to poor compliance.

Conclusion. Low level of awareness to brace and educational level of mother, and more follow-up periods have more association. Pretreatment Pirani score, and poor brace compliance are independent significant predictors of recurrence.

Aims: Traditional bone-setting (TBS) is associated with many life- and limb-threatening complications. The aim of this study was to explore risk factors for complications among trauma patients who presented to our institution after traditional bone setting.

Methods: Prospective institutional-based study was conducted from July 2020 to June 2021.  All 230 patients who first visited TBS and presented to hospital were included. A structured, pre-tested questionnaire was used to collect data. The data were collected by trained health professional through face-to-face interviews which was uploaded to the website developed for this purpose and exported to SPSS version 24 for analysis. Descriptive statistics were used to summarize and present the data. Binary logistic regression analysis used to measure the association between independent and dependent variables. The presence of a statistically significant association was declared using a 95% confidence interval (CI) and a P-value less than 0.05.

Results: Over two-thirds, or 62.6%, of the patients had a complication during presentation to the hospital. In the multivariable logistic regression model, younger age (AOR = 2.43, 95% CI = 1.21, 4.92), longer time interval between initial injury and arrival at the hospital (AOR = 7.40, 95% CI = 3.86, 14.20), and the region where the patients live (AOR = 2.05, 95% CI = 1.06, 3.40) were significantly associated with complications.

Conclusions: The magnitude of complications among trauma patients who first visited TBS was unacceptably high. The risk factors for complications were younger age, delayed presentation to the hospital, and the region where the patients live.

Abstract

Introduction: Traditional bone setting (TBS) is extensively used throughout the world irrespective of the accessibility of modern medicine. It is a source for primary fracture care among Ethiopians although it has not been studied as much as it deserves especially from the perspective of the practitioners. The aim of this study was therefore to explore the perception of traditional bone setters and orthopedic surgeons towards TBS practice in Addis Ababa, Ethiopia.

Method: A qualitative descriptive study design was employed to conduct interviews. Audio recorded interview and field notes data was transcribed and then analyzed using thematic analysis.

Result: A total of 21 TBS practitioners and orthopedic surgeons participated in this study. The findings revealed four main themes that dealt with orthopedic surgeons’ perception towards TBS practice; reasons for community preference to use TBS services; materials used, client payments, home-based services, and sources of knowledge for TBS practice and views on possible collaboration between allopathic and traditional bone setting practice.

Conclusion: The TBS practice is commonly used and accepted by the Ethiopian community for different reasons despite the safety concerns raised. This calls for more collaboration among the TBS practitioners and the orthopedic surgeons as well as a policy intervention to ensure that society accesses safe and effective orthopedic primary healthcare services

Abstract

Background: Carpal tunnel syndrome (CTS) is a prevalent neuropathy caused by factors like thickened flexor tendon sheath, skeletal encroachment, edema, or soft tissue mass compressing the median nerve at the wrist. Manual weaving is a common method of producing traditional clothing in Ethiopia. The purpose of this study is to assess the prevalence and risk factors of carpal tunnel syndrome among manual weavers in Addis Ababa, Ethiopia.

Methods: A cross-sectional study was conducted. Data were collected via the open data kit (ODK) along with Kobo Toolbox server. Finally, data were analyzed using Statistical Package for Social Science (SPSS) version 25. Participants who were positive for both the Phalen’s and compression tests were considered positive for carpal tunnel syndrome. The strength of association was determined using an adjusted odds ratio (AOR) with a 95% confidence interval. In the multivariable binary logistic regression, statistical significance was declared at p<0.05.

Results: The prevalence of carpal tunnel syndrome among manual weavers in Addis Ababa was 14.7% (95% CI; 11.5-18.4). 15.2% (95% CI; 11.9-18.9) of the study participants were positive for Phalen’s test and 19.9 % (95% CI; 16.2-24.0) of the participants were positive for the compression test. Frequency of taking a break [AOR=2.64; 95% CI; 1.06, 6.58], co-morbidities [AOR=2.76;95% CI;1.02,7.51] and alcohol history [AOR=1.97;95% CI;1.09,3.57] had a statistically significant association. From the cases (n=62) most of them (90.3%) had complained of at least one sensory symptom.

Conclusion: Carpal tunnel syndrome is prevalent among manual weavers, and it is significantly associated with not taking frequent breaks during weaving, comorbidities, and alcohol consumption. Sensory symptoms (tingling, numbness, and nocturnal pain) were more common in manual weavers than motor weakness symptoms.

Introduction: preoperative templating has paramount importance for both THA and hemiarthroplasty. This study aims to assess the accuracy of predicting implant head size by digital templating with and without an external radiographic marker in hip hemiarthroplasty.

Methods: A retrospective cross-sectional study, two blinded observers used digital software (Radiant Dicom viewer) to template the femur head size of 35 individuals who had undergone hip hemiarthroplasty at TASH from in 1 year period using two different methods i.e. external radiographic marker and fixed magnification factor. The templated head size values are then compared to the head size of actual implants used intraoperatively to assess the accuracy of each method. Inter-observer variability was measured using Cohen’s kappa value.

Result: the accuracy of predicting implant head size in hip hemiarthroplasty using both methods is similar with a mean relative error of method 1 (2.8 & 3.1% for observer A & B respectively) and method 2 (3.3 & 3.4% for observer A & B respectively), p-value for both observer A & B is 0.46 & 0.59 with 95% CI). Interobserver agreement for both method 1 & 2 is excellent when a precision scale of 1 size is used with a kappa value of 0.84 and 0.93 respectively.

Conclusion: digital templating of hip hemiarthroplasties using a fixed magnification factor is as accurate as the radiographic marker method in predicting implant head size with excellent interobserver reliability.

Abstract

Background: The gold standard of care for a tibial shaft fracture is an intramedullary nail. When selecting the correct nail size, it is crucial to assess the length of the tibial bone before surgery. This study aimed to evaluate the feasibility of using the length of the olecranon to the fifth metacarpal head as an alternative method for determining the appropriate length of a tibial nail in situations where measurements using the contralateral tibia are not possible.

Method: A Cross-sectional study was conducted at Tikur Anbesa Specialized Hospital, involving 150 volunteers aged 18 or older attending the orthopedics outpatient department as patient attendants. Two observers conducted measurements using a tape meter. The length of the tibial nail was estimated by measuring the distance from the tibial tuberosity to the medial malleolus (TMD). Forearm measurement was obtained from the tip of the olecranon to the tip of the fifth metacarpal head, with the wrist in a neutral position and the hand clenched (OMD). Pearson's correlation test was used to assess the correlation between the two measurements. Hierarchical regression analysis was conducted to examine the impact of age, gender, and BMI on these measurements and their associations.

Result: A significant positive correlation between TMD and OMD was observed (Pearson correlation coefficient of (r) 0.927 (p < 0.001). The mean OMD measurement was 34.19 cm, while the TMD measurement was 34.1 cm. A hierarchical regression analysis revealed age, gender and BMI did not have statistically significant influence on these measurements and their correlation.

Conclusion: The study suggests that tibial nail length can be estimated using forearm measurement in situa- tions where contralateral tibia measurement is not possible.

Introduction Extra-medullary and intramedullary implants are options for treatment, although consensus is lacking concerning the outcomes. This study compared clinical and radiological results of unstable intertrochanteric fractures treated by either proximal femoral nail anti-rotation (PFNA) or dynamic condylar screw (DCS) system.

Methods This was an eighteen months retrospective comparative study (January 2022 to June 2023) where all the operated unstable intertrochanteric fractures from Tikur Anbessa Specialized Hospital (TASH) between January 2022 and June 2023 were reviewed. Data was analyzed with SPSS version 26 and results were summarized by text and table, with statistical significance set at p <0.05. Comparison of blood loss, duration of surgery, injury to the time of surgery, postoperative hospital stay, time of full weight bearing, radiologic union time, and quality of reduction, complications, and Harris hip score was between PFNA and DCS groups.

Results: A total of 51 patients were included in the study, 31 (60.8%) in PFNA and 20(39.2%) in DCS group. PFNA group had statically significant superior outcome difference for the amount of blood loss and Harris hip score with p-values of 0.017 and 0.001 respectively. While, age, sex, location, comorbidity, injury at the time of surgery, duration of hospital stay, duration of follow-up, radiologic union time, quality of reduction, and complications were not significantly different between the two groups.

Conclusion proximal femoral nail anti-rotation system has better functional outcomes and less intraoperative

blood loss than dynamic condylar screws in the treatment of unstable intertrochanteric fractures.

Background: Ankle fractures are the second most common lower limb fracture after hip fractures, accounting for 10% of all fractures. It is a common injury, with a global incidence of 187/100,000 inhabitants per year. It is the 5th most common fracture in patients who visited Tikur Anbessa Specialized Hospital. The purpose of this study was to evaluate functional and Health Related Quality of Life (HRQL) outcomes after surgically treated ankle fractures and to detect some of their predictors as well as complication rates.

Methods: This retrospective record review was conducted among ankle fracture patients treated with open reduction and internal fixation (ORIF) between January 2018 and January 2022, at Tikur Anbessa Specialized Hospital. Patients' responses were recorded with a structured questionnaire including the Olerud Molander Ankle Score (OMAS) via phone interviews. The collected data was entered, and analyzed using SPSS Version 26. The Chi-square test was conducted to assess the strength of association between the functional outcome of surgically treated ankle fractures and independent variables.

Results: Out of the 75 patients with ankle fractures treated with open reduction and internal fixation (ORIF), 61 patients met the inclusion criteria. Among these, males accounted for 55.7% (34), while females comprised 44.3% (27) of the total cases. The prevalence of comorbidities was 24.6% (15 out of 61), with diabetes being the most common, followed by hypertension and asthma The complication rate was 52.5 %, with residual ankle pain as most common type of complication. The mean value of OMAS and American Orthopedics Foot and Ankle Society-ankle hindfoot score (AOFAS) ware 70.43 and 72.96, respectively. A strong association was found between OMAS score and timing of surgery and age.

Conclusion: Despite surgical treatment being the primary approach for managing  unstable ankle fractures, patients often experience functional impairment. The complication rate following ankle fracture open reduction and internal fixation was found to be high. As an outcome of patients aged 60 and above treated operatively is significantly associated with lower OMAS and AOFAS scores.

Abstract

Background: Total hip arthroplasty (THA) is one of the most frequently performed procedures in orthopedic surgery where both the acetabular and femoral parts are replaced with a prosthesis. It is most often performed to relieve pain and restore function in patients with severe traumatic or non-traumatic hip pathologies.

  Objectives: The primary objective was to investigate the functional outcomes of total hip arthroplasty with a minimum follow-up of one year after the procedure.

 Methods: The modified Harris Hip Score (mHHS), Oxford Hip Score (OHS), EQ-5D and the Standard Version of the Short Form (SF) 36 outcome measures were used. Patients who underwent total hip arthroplasty from September 2017 to July 2023 were included. The functional outcomes of hip arthroplasty were expressed as frequency distribution, mean, and Median (IQR) depending on the nature of the variable. SPSS software version 27 was used for analysis. A p-value less than 0.05 was considered significant.

Results: This study included a total of 63 patients with an average follow-up of 45 months (3.75 years). There were more male patients (47, 74.6%). The mean age at the time of surgery was 48.6 years. The most common indication for THA was advanced osteoarthritis (40 patients, 63.5%). There was one case of dislocation and one revision due to infection.Mean scores of mHHS, OHS, and SF- 36 were 89.7, 43, and 88.9, respectively which indicates satisfactory joint functional outcome and a good quality of life.

Conclusion: Total hip arthroplasty is an effective treatment option for people with severe hip pain and disability at Tikur Anbessa Specialized Hospital with satisfactory outcomes. Proper documentation of outcome measures including preoperatively and on follow-up at 3 months, 6 months, 1 year, 2 years, 5 years, and 10 years is recommended to scale up and include the service to other hospitals to make it available for timely service.