From February 2001 to May 2001, 792 latex gloves used in 100 operations from three orthopaedic sub-specialties (paediatrics, hand and spine) were tested for puncture by a water infusion test. Sixty-nine gloves from 45 operations were punctured, giving an overall glove perforation rate of 8.7% (69/792) and an operative perforation rate of 45% (45/100). The hand operations had the lowest operative perforation rate (19.4%) while the spine operations had the highest (63.6%). The glove perforation rate increased in bony procedures (60% versus 22.5%), in procedures with major instrumentation (66% versus 18%) and in more lengthy procedures. The thumbs and the left index finger had more punctures than other parts. In addition, the glove perforation rate for single gloving was 9.6% (53/552) while that for the inner glove of double gloving was 0.8% (1/120). Based on these findings, we would like to recommend double gloving and regular glove changing in these high-risk surgeries.

BACKGROUND: Traditional bone setters (TBS) have existed for decades in Nigeria and other countries. Their treatment methods often lead to several complications, the most dangerous being extremity gangrene which usually leads to proximal amputation. OBJECTIVE: To apprise the Orthodox Practitioners of complications of musculoskeletal injuries treated by the bone setters, the factors that encourage patronage of TBS services and the outcome of the treatment of these complications by the orthodox practitioners. METHODS: This was a one-year prospective study involving one hundred and twenty-one consecutive patients presenting with complications related to treatment of their musculoskeletal injuries by bone setters. The following data were obtained using observer-administered questionnaires viz; demography, details of initial injury, reasons for patronage of TBS, nature of treatment, estimated cost of treatment and disability of patients at presentation. The outcome of orthodox treatment of these complications was assessed at six months using the following parameters -wound healing, bone union and use of prosthesis by the patients. RESULTS: One hundred and twenty-one patients with 155 musculoskeletal injuries and 168 complications of treatment by the TBS were seen; 75 (57%) were male and 52(43%) were female. The ages of the patients ranged from 6 weeks -72 years (mean 29.49 years). The common complications of TBS treatment were malunion and non-union which each accounted for 27 (16.1%) cases. The major reasons for TBS patronage was the perceived low cost of treatment in 47(27.9%) and pressure from family and friends in 36 (25%) patients. The cost of treatment of the TBS ranged from USD 18-380, whereas, at the Orthopaedic Hospital, it ranged from USD 34-98. At six months after orthodox surgery, 10(91%) of the patients who had amputation were yet to start using prosthesis, 3(23%) who had internal fixation failed to unite. CONCLUSION: The commonest reason for patronage was the believed cheapness of the TBS services. However, this study showed that orthodox treatment is actually cheaper in most cases. Despite all the complications associated with their treatment, majority of the people still have a strong belief in their capability. A suggested solution will be the incorporation of the TBS into the healthcare system so that they could be better trained and controlled. RÉSUMÉ CONTEXTE: Les os setters (TBS) existent depuis des décennies au Nigeria et dans d'autres pays. Leurs méthodes de traitement conduisent souvent à plusieurs complications, le plus dangereux étant extrémité gangrène qui conduit généralement à l'amputation proximale. OBJECTIF: Afin de sensibiliser les praticiens de l'Eglise orthodoxe de complications des blessures musculo-squelettiques traités par l'os setters, les facteurs qui encouragent les services de patronage de TBS et des résultats du traitement de ces complications par les orthodoxes pratiquants. MÉTHODES: Il s'agissait d'une année une étude prospective impliquant cent vingt et un patien...

We studied prospectively 87 patients who underwent extremity amputation in the National Orthopaedic Hospital in Lagos in 1995-1996. Trauma from road traffic accident was the most common indication (34/87) with peripheral vascular disease being the least encountered (2/87). Traditional bonesetters' gangrene accounted for 9/87 cases in circumstances that were largely avoidable. Our study revealed that amputation is still being performed as a life-saving procedure, as 44/87 patients presented with gangrene of a limb. The nonavailability of special investigations such as Doppler ultrasound, arteriography, and CT scan was responsible for a delay in definitive treatment in 28 cases. Poor prosthetic services and the absence of a well-coordinated amputee clinic were responsible for some of the unsatisfactory results. We believe that the availability of specialized diagnostic tools and facilities for microvascular surgery, together with a multidisciplinary approach to the management of the amputee, would considerably change the current gloomy picture of amputation in developing countries such as Nigeria. Résumé Nous avons étudié prospéctivement 87 malades qui ont subi une amputation de l'extrémité d'un membre dans l'Hôpital Orthopédique National de Lagos en 1995/96. Les traumatismes résultant d'accident de la route, était l'indication la plus commune (34/87) tandis que les maladies vasculaires périphériques étaient la plus rare (2/87). La gangrène causée par la fixation traditionnelle des fractures a expliqué 9/87 cas dans circonstances qui étaient en grande partie évitables. Notre étude a révélé que l'amputation était encore exécutée comme une procédure de sauvetage chez 44 /87 malades présentant une extrémité gangrèneuse. La non-disponibilité d'outils d'investigation spécialisés comme le doppler, l'artériographie et le scanner était responsable d'un retard dans le traitement définitif dans 28 cas. L'insuffisance des possibilités d'appareillage et l'absence d'une clinique de l'amputé bien coordonnée sont des éléments nuisibles mis en évidence par cette étude. Nous croyons que la possession d'outils diagnostiques spécialisés et des installations. Pour chirurgie microvasculaire, dans le cadre d'une approche multidisciplinaire de la gestion de l'amputé changerait considérablement l'image sombre de l'amputation dans un pays en voie de développement comme le Nigeria.

Study design: Pressure ulceration and other complications constitute an encumbrance in the management of spinal cord injury in many services with limited resources in developing countries. These services undertake patients' care without adequate prehospital care, limited modern infrastructure and limited number of trained staff. Objectives: To evaluate the associated risk factors for pressure ulceration in traumatic spinal cord injured managed in a resource constrained spinal injury unit in Lagos, Nigeria. A regional acute trauma and rehabilitation centre serving a population of 420 million. Methods: This is a prospective study in patients presenting with traumatic spinal cord injury between 1 October 2004 and 30 November 2006. The data collected include demographic characteristics, interval before admission in the unit, type of spinal cord injury and serum albumin. The incidence of pressure ulcers and the isolated organisms was recorded for patients who developed pressure ulcers on admission and during the period of stay in the unit. The length of hospital stay was also recorded for all the patients. Results: The overall incidence of pressure ulceration on admission was 57.1%. There was an average lengthening of hospital stay of 33.1 days in the group of patients with pressure ulceration compared to patients without pressure ulcers. The nutritional status on admission, interval before admission and the type of neurological injury were significant factors for the incidence of pressure ulcers. Conclusion: The incidence of pressure ulceration was high, delay in admission and poor nutritional status may be significant factors in the incidence of pressure ulceration in spinal cord injury.