Interlocking nails are commonly performed using an image intensifier. These are expensive and are not readily available in most resource-poor countries of the world. The aim of this study was to achieve interlocking nailing without the use of an image intensifier. This is a prospective descriptive analysis of 40 consecutive cases seen with shaft fractures of the humerus, femur, and tibia. Fracture fixation was done using Surgical Implant Generation Network (SIGN) nails. Forty limbs in 34 patients were studied. There were 12 females and 22 males, giving a ratio of 1:2. The mean age (years) was 35.75± 13.16 and the range was 17-70 years. The studied bones were: humerus 10%, femur 65%, and tibia 25%. The fracture lines were: transverse 40%, oblique 15%, and communited 45%. Fracture grades were: closed 90%, grade I, 5%, grade II, 2.5%, and grade IIIA, 2.5%. Surgical approaches were: antegrade 62.5% and retrograde 37.5%. Indications for fixation were: recent fracture 92.5%, non-union 5%, and malunion 3%. Methods of reductions were: open 85% and closed 15%. The mean follow-up period (years) was 1.50±0.78. The union time averaged 3 months. Complication was mainly screw loosening due to severe osteoporoses in one case. It is, therefore, concluded that, with the aid of external jigs and slot finders, interlocking can be achieved without an image intensifier.Résumé Les clous verrouillés sont d'utilisation commode mais demande une imagerie dans leur utilisation. Cette imagerie est chère et ne peut être réalisée de façon valable dans les pays pauvres. Le but de cette étude est de montrer que le verrouillage des clous peut se faire sans l'utilisation d'une imagerie. Il s'agit d'une étude prospective de 40 cas de fracture de la diaphyse humérale, fémorale ou tibiale, la fixation de ces fractures étant réalisée par un clou de type SIGN. 40 membres chez 34 patients ont été étudiés, 12 femmes, 22 hommes (ratio de 12). L'âge moyen a été de 35,75±13,16 s'échelonnant de 17 à 70 ans. Les fractures affectaient l'humérus dans 10% des cas, le fémur dans 65% des cas et le tibia dans 25% des cas. La fracture était transverse dans 40% des cas, oblique dans 15% et communitive dans 45% des cas. Il s'agissait d'une fracture fermée dans 9 cas sur 10. Lorsqu'elle était ouverte, de grade I dans 5%, de grade II dans 2,5% et de grade IIIA dans 2,5%. L'approche chirurgicale a été antérieure dans 62,5% des cas et postérieure dans 37,5% des cas. Il s'agissait d'enclouage pour fixer une fracture fraîche dans 92,5% des cas, après pseudarthrose dans 5% des cas et cal vicieux dans 3% des cas. La réduction a été réalisée par voie sanglante dans 85% des cas, à foyer fermé dans 5% des cas. Le suivi moyen a été de 1,50±0,78, la consolidation a été obtenue en moyenne en 3 mois. Une seule complication avec mobilisation d'une vis après une ostéoporose sévère a été observée dans un seul cas. Nous pouvons conclure qu'il est possible, grâce à la méthode que nous décrivons de verrouiller un clou sans imagerie.

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During an 18-month period we studied prospectively 63 consecutive patients (42 males, 21 females) with an open fracture of the lower limb. Their mean age was 32 years (range: 4-78 years) and 58 patients with 59 fractures were available until the conclusion of the study. Forty-seven had tibial fractures, 12 had femoral fractures and the majority of the patients were either students or traders. According to Gustilo and Anderson's grading, 21 fractures were of type II and 16 of type IIIA. On arrival all the wounds were irrigated and debrided and the patients also received tetanus prophylaxis and intravenous antibiotics. Of the 47 tibial fractures 39 were managed with an above-knee plaster of Paris cast which was windowed so as to allow wound care. Of the 12 femoral fractures ten were treated with skeletal traction on a Bohler frame. The time taken for soft tissue healing was not significantly different between the tibial and femoral fractures. There were, however, significant differences with respect to (1) the time interval between injury and debridement, (2) the incidence of wound infection, (3) the occurrence of osteomyelitis, (4) fracture union time, and (5) time spent in hospital. The most common complications were wound infections (27 cases) and delayed union (26 cases). The time interval between injury and wound debridement was a major prognostic factor.

Objectives:The aim of this study is to evaluate the success rate and complications of mandibular reconstruction with nonvascularized bone graft in Ile-Ife, Nigeria.Patients and Methods:A total of 25 patients who underwent reconstruction of mandibular discontinuity defects between January 2003 and February 2012, at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife constituted the study sample. Relevant information was retrieved from the patients’ records. This information include patients’ demographics (age and sex) as well as the type of mandibular defect, cause of the defect, type of mandibular resection done, source of the bone graft used, and the method of graft immobilization. Morbidity associated with the graft procedures were assessed by retrieving information on graft failures, length of hospital stay following surgery, rehabilitation device used and associated graft donor and recipient site complications.Result:There were 12 males and 13 females with a male:female ratio was 1:1.1. The age of the patients ranged from 13 to 73 years with a mean age for males 32.7 ± standard deviation (SD) 12.9 and for females 35.0 ± SD 17.1. Jaw defect was caused by resection for tumours and other jaw pathologies in 92% of cases. Complete symphyseal involvement defect was the most common defect recorded 11 (44%). Reconstruction with nonvascularized rib graft accounted for 68% of cases while iliac crest graft was used in 32% of the patients. Successful take of the grafts was recorded in 22 patients while three cases failed. Wound dehiscence (two patients) and postoperative wound infection (eight patients) were the most common complications recorded.Conclusion:The use of nonvascularized graft is still relevant in the reconstruction of large mandibular defects caused by surgical ablation of benign conditions in Nigerians. Precise surgical planning and execution, extended antibiotic therapy, and meticulous postoperative care contributed to the good outcome.

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