The indications for major limb amputations: 8 years retrospective study in a private orthopaedic and trauma centre in the south-east Nigeria

Agu, Thaddeus Chika; Ojiaku, Mathew Emeka

doi:10.1016/j.jcot.2016.03.006

Cited by 19 publications

(13 citation statements)

References 15 publications

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“…Diabetes care in LMICs especially those in sub-Saharan Africa (SSA) is beset with inherent organisational deficits including fragmentation of care, inadequate allocation of resources and unwavering attention to achieving glycemic targets [14, 15]. These factors have contributed to an increasing burden of complications prominent among them foot disorders [16, 17]. Although a high burden of non-traumatic LLA has recently been reported in Ghana [18], the role of diabetes on this burden is yet to be clarified.…”

Section: Introductionmentioning

confidence: 99%

Incidence and determinants of diabetes-related lower limb amputations in Ghana, 2010–2015- a retrospective cohort study

et al. 2019

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Background Diabetes-related lower limb amputations (LLA) are associated with significant morbidity and mortality. Although the incidence has decreased over the past two decades in most High-Income Countries, the situation in Low-Middle Income Countries (LMIC), especially those in sub-Saharan Africa (SSA) is not clear. We have determined the incidence and determinants of diabetes-related LLA in Ghana. Methods This was a tertiary-care-based retrospective cohort study involving patients enrolled in the diabetes clinic of Komfo Anokye Teaching Hospital, Ghana from 1st January 2010 to 31st December 2015 after a median follow-up of 4.2 years. Demographic characteristics and clinical variables at baseline were recorded. The primary outcome was new diabetes-related LLA in each year under study. Cox proportional hazard regression models were used to describe the associations of diabetes-related LLA. Results The mean age at enrolment for the cohort was 55.9 ± 14.6 years, with a female preponderance (62.1%). The average incidence rate of diabetes-related LLA was 2.4 (95% CI:1.84–5.61) per 1000 follow-up years: increasing from 0.6% (95% CI:0.21–2.21) per 1000 follow up years in 2010 to 10.9% (95% CI:6.22–12.44) per 1000 follow-up years in 2015. Diabetes-related LLA was associated with increased age at enrollment (for every 10 year increase in age: HR: 1.11, CI: 1.06–1.22, p < 0.001), male gender (HR: 3.50, CI:2.88–5.23, p < 0.01), type 2 diabetes (HR 3.21, CI: 2.58–10.6, p < 0.001), high Body Mass Index (HR: 3.2, CI: 2.51–7.25 p < 0.001), poor glycemic control (for a percent increase in HbA1c, HR:1.11, CI:1.05–1.25, p = 0.03), hypertension (HR:1.14, CI:1.12–3.21 p < 0.001), peripheral sensory neuropathy (HR:6.56 CI:6.21–8.52 p < 0.001) and peripheral vascular disease (HR: 7.73 CI: 4.39–9.53, p < 0.001). Conclusion The study confirms a high incidence of diabetes related-LLA in Ghana. Interventions aimed at addressing systemic and patient-level barriers to good vascular risk factor control and proper foot care for diabetics should be introduced in LMICs to stem the tide of the increasing incidence of LLA.

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Section: Introductionmentioning

confidence: 99%

Incidence and determinants of diabetes-related lower limb amputations in Ghana, 2010–2015- a retrospective cohort study

et al. 2019

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“…Two hospital-based studies in Nigeria have demonstrated that diabetic foot disease accounted for the majority of non-traumatic amputations performed, ranging from 22.3% to 29.3% 5,6. The combination of neuropathy, ischaemia and direct adverse effects of DM on hosts defense mechanisms make patients with diabetes particularly vulnerable to foot infections and gangrene; often resulting in limb loss 7.…”

Section: Introductionmentioning

confidence: 99%

Pattern and microbiological characteristics of diabetic foot ulcers in a Nigerian tertiary hospital

et al. 2019

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Purpose To determine the pattern and bacteriological characteristics of diabetic foot ulcers in patients attending a tertiary health care facility. Method 160 Patients with Diabetes Mellitus foot syndrome were recruited, out of which 52 had diabetic foot ulcers. Relevant clinical, biochemical, and microbiological evaluations were carried out on the subjects. Data analysis was done using SPSS version 20. p value was set at <0.05. Results 52 (32.5%) out of 160 subjects with Diabetes Mellitus Foot Syndrome (DMFS) had diabetic foot ulcers. Poor glycaemic control (mean HbA1c = 9.2 (2.7) %), and abuse of antibiotics (76.9%) characterized the subjects. Foot ulcers mainly involved the right lower limb and followed spontaneous blister formation (50%). Microbiological culture pattern was polymicrobial (71.2%); predominantly anaerobic organisms (53.3%). Gram positive and negative aerobic isolates yielded high sensitivity to common quinolones (76% – 87.8%). The gram positive and negative anaerobic isolates were highly sensitive to Clindamycin and Metronidazole respectively (80.2% – 97.8%). High sensitivity (>80%) yield for gram negative anaerobes was recorded for Imipinem and Ampicillin/Sulbactam. Conclusion Diabetic foot ulcers (DFU) contribute about one-third of DMFS. The bacteriological isolates from these ulcers are mainly polymicrobial with high sensitivity to common antibiotics. The need for appropriate use of antibiotics should be advocated among the patients.

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“…The limit of our study is its retrospective character and the small sample size despite a long study period. This number reflects the rarity of this indication in our current trauma and its low frequency in the literature gives this series of [11].…”

Section: Discussionmentioning

confidence: 67%

Hip Disarticulation for Severely Injured Lowerlimbs about 11 Cases and Literature Review

Samba¹,

Eric²,

Adibo³

et al. 2018

OJO

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Introduction: Hip disarticulation (HD) consists of a removal of the entire lower limb at the height of the hip-femoral joint. It is an extremely mutilating intervention with a major functional and psychological impact. We report 11 cases of hip disarticulation following severe trauma of the lower limb. The aim of the study is to analyze the frequency, the clinical aspect and present their management results and the patients' becoming. Patients and methods: A 13-year retrospective study was conducted in our traumatology department.

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The indications for major limb amputations: 8 years retrospective study in a private orthopaedic and trauma centre in the south-east Nigeria

Cited by 19 publications

References 15 publications

Incidence and determinants of diabetes-related lower limb amputations in Ghana, 2010–2015- a retrospective cohort study

Incidence and determinants of diabetes-related lower limb amputations in Ghana, 2010–2015- a retrospective cohort study

Pattern and microbiological characteristics of diabetic foot ulcers in a Nigerian tertiary hospital

Hip Disarticulation for Severely Injured Lowerlimbs about 11 Cases and Literature Review

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