Management of Traumatic Joint Dislocations in Irrua

Abstract

Aim: To elucidate the pattern of presentation and management of traumatic major joint dislocations as seen in Irrua Specialist Teaching Hospital. Method: A five-year retrospective review of 44 cases in 43 patients. Data were retrieved from the Medical Records Department of the hospital. Results: Forty-four cases of traumatic dislocations were reviewed in 43 patients. Male to female ratio was 7.6:1. Median age was 33 years. The majority of patients were in the 3 rd decade of life. Patients below 40 years accounted for 62.79% of cases. Twenty-four (55.81%) patients had hip dislocation. Knee dislocations were the least, accounting for 2.32% of cases. All cases except three resulted from road traffic accidents (RTAs). None had neurologic deficits. Nineteen (44.23%) patients had isolated injuries. 76.7% cases presented in less than 6 hours. All shoulder dislocations were anterior while all elbow dislocations were posterior. All except 3 cases were managed by closed manipulation under general anaesthesia. Two patients died from associated head injury. Fourteen patients discharged against medical advice while recuperating in the ward. Follow-up was however difficult as a significant number did not turn up. Conclusion: Hip dislocation is the commonest variety of traumatic dislocation in our setting. A majority of cases were amenable to closed manipulation and immobilization. Road traffic accidents accounted for the majority.

An Update on Traumatic Joint Dislocations in Nigeria

“…The young adults are the most affected. Mean age ranging from 30 -34 years has been reported by various authors [7] [8] [10] [16] in Nigeria. These represents the most active, productive and mobile group.…”

“…Collapsed mud house has been reported as a cause of joint dislocationin Nigeria accounting for 2% [7]. Athletic injuries, assault, gun-shot, domestic violence are other uncommon causes in Nigeria.…”

“…A fall on the outstretched hand with the outstretched hand with the elbow in extension disrupts the capsule and ligaments can result in posterior or posterior-lateral dislocation of the elbow joint. Older literatures on the incidence of traumatic joint dislocation in Nigeria, arising from falls were sparse, but currently less than 5% has been reported [7]. Report [11] from India indicated 26% which include falls from trees, high terrain or from roof of wooden houses in hilly areas while climbing wooden stairs.…”

“…In first decade of the 21 st century, reports [8] [16] [17] indicated a range of male to female ratio of 1.8:1 to as high as 4:1 from the Western and Eastern parts of Nigeria respectively. Current reports [7] [10] from Southern Nigeria showed a range of ratio of 7:1 to 7.6:1 in the last (second) decade of this century. This shows a consistency as well as an increase in the number of males affected.…”

“…Road traffic accident is currently the commonest cause of traumatic joint dislocations in Nigeria, with figures as high as 62% -95% being recorded [7]- [10] Similarly high figures have been reported in India [11] as well as Saudi Arabia [12]. The hip joint is an inherently stable joint, requiring high velocity forces or energy to dislocate it; Posterior hip dislocation usually occur in a road accident when someone seated in a truck or car is thrown forward, striking the knee against the dashboard.…”