Acetabular and femoral reconstruction in total hip replacement for adult hip dysplasia: A technical guide for surgeons in our environment Olukemi Lawani, Michael Okunola, Imoniche Adeoye-Sunday, Charles Ayekoloye Nigerian Journal of Orthopaedics and Trauma 2019 18(1):1-3 Hip dysplasia is abnormal development of the hip joint resulting in joint incongruity and characterised by a shallow acetabulum, inadequate femoral head coverage and femoral and acetabular version abnormalities. Childhood hip dysplasia is uncommon in this environment because of child swaddling practices. Adolescent onset forms are however not uncommon and present in adulthood more frequently than is recognized for total hip arthroplasty. Clinical and radiologic evaluation is key for diagnosis and surgical planning. The pathologic abnormalities on both sides of the hip joint present formidable challenges to total hip arthroplasty which remains the mainstay of treatment for end-stage arthritis secondary to adult hip dysplasia. Posterior approach is preferred in our unit as it provides excellent acetabular exposure and enables assessment of sciatic nerve integrity when addressing leg-length discrepancy common in this condition. Leg lengthening more than 3–4 cm should, however, be avoided with arthroplasty for this condition. We outline technical tips for successful total hip arthroplasty for this condition. This study aims to describe total hip arthroplasty in the setting of adult hip dysplasia. The objectives are to describe the pathologic changes in adult hip dysplasia, the evaluation of these patients and surgical technique.

Surgical emergency deaths in a teaching hospital in lagos, Nigeria OI Akinmokun, MO Afolayan, OA Ojo Nigerian Journal of Orthopaedics and Trauma 2019 18(1):4-8 Introduction: Surgical emergency is a medical condition for which immediate or urgent surgical intervention is required. This includes acute trauma and other life- or limb-threatening conditions that may cause a loss of life or permanent deformity if surgical interventions are not applied immediately. The accident and emergency (A and E) room is the first point of call for patients with such surgical emergencies. This study is an audit of surgical emergency deaths in the A and E of the Lagos University Teaching Hospital (LUTH). Methodology: This was a retrospective study. It involved analysis of the records of patients who were attended to at the A and E room of LUTH, Idi-Araba, Lagos state. The period of study was 12 months. Data obtained were analysed using Microsoft Excel 2010 (Microsoft Corporation, Redmond, Washington, USA). Results: The crude mortality rate was 8.3%. The overall male:female ratio was 2:1. The average age at death for both sexes was 46.5 ± 17.5 years. The age ranged from 6 to 87 years. Trauma was the cause of death in 99 cases (52.4%), with a male:female ratio of 5.2:1. Traumatic brain injury was the largest contributor of death overall, with a male:female ratio of 6.6:1. The average age of females who died following trauma was 6 years younger than that of the males. More patients involved in trauma died within 24 h of presentation. The overall average age at death for trauma-related deaths was 38.9 ± 17.2 years. However, the overall average age at death for malignancy-related causes was 53.9 ± 13.5 years. The male:female ratio for malignancy as a cause of death was 1:2.3. More deaths occurred within ages 20 and 39 years, accounting for almost half (46.8%) of the total deaths. Breast carcinoma was the major (45.3%) cause of death among the malignancy-related causes of death, with all but one case occurring in women. Conclusion: Mortality at the surgical department of A and E is still high compared to centres of other Western countries. The general populace needs orientation to reduce risk factors for trauma, especially brain injury. The government also needs to improve facilities available at the trauma centre.

Reduced bone mineral density in nigerian women: A Prevalence Study Ngozi Rosemary Njeze, Olanike Agwu-Umahi, Salome Nwaelom Ezeofor, Sussan Arinze-Onyia, Nneze C Njeze, Damaris Ulugo Akpagbula, Kenechi Madu Nigerian Journal of Orthopaedics and Trauma 2019 18(1):9-12 Background: Reduced bone density if left untreated is a known precursor of osteoporosis, a silent disease with increased morbidity. In the developing country, fragility bone fractures occur in the general population, and health-seeking behaviour is low. An incredibly high level of ignorance is observed. Methodology: A descriptive cross-sectional study was carried out to determine the bone mineral density (BMD) among patients who visited a specialist clinic for screening for osteopenia using the unigamma dual energy X-ray absorptiometry (DXA) machine. 54 participants were selected for this study having met the inclusion criteria. Data were analysed using SPSS version 22 with P = 0.05. Results: BMD of 54 women whose ages ranged 42–86 were analysed. Twenty-eight (51.9%) were obese while 7 (13.0%) had normal weight. 50 (92.6%) had low BMD. BMD of the right and left femora correlated more with age (P = 0.015 and 0.008, respectively). Mild and severe osteopenia were found mostly in the left femoral neck and left femoral ward, respectively, while moderate osteopenia was more common in the right greater trochanter. In this population, diagnosis of loss of bone mass by DXA examination is best on the left femur. Conclusion: Reduced BMD was present in most participants. It is advised that Nigerian women have their baseline bone density test to avoid unnecessary preventable fractures later in life. More awareness programmes is advised in the future.

Coping mechanisms as predictor of stress in patients with chronic low back pain: A Nigerian Study Joseph Asuquo, Innocent Abang, Chukwuemeka Anisi, Adetunji Toluse, Emmanuel Essien, Bassey Edet, Pius Agweye Nigerian Journal of Orthopaedics and Trauma 2019 18(1):13-17 Introduction: Chronic low back pain (LBP) is one of the most common musculoskeletal conditions worldwide. It can be quite severe, affecting physical, social, occupational and even psychological well-being. This study describes the coping mechanisms commonly employed in patients with chronic LBP and its relationship to perceived stress. Methods: In this descriptive hospital-based study, Brief Cope Scale and the Perceived Stress Scale (PSS) were administered to 100 patients with chronic LBP. Variables analysed were sociodemographic characteristics, dimensions of the Brief Cope Scale and the PSS. Logistic regression was used to determine predictors of perceived stress. Data were analysed using IBM SPSS version 20, and the threshold for statistical significance was set at 0.05. Results: Sample was comprised of 59 females and 41 males with an age range of 18–72 years (x̄= 42.7 ± 16.2). The most common spinal pathologies were lumbar spondylosis (n = 39), canal stenosis (n = 18) and facet joint arthritis (n = 16). The average perceived stress score for the entire sample was 28 (standard deviation [SD] = 6.94), and the coping mechanisms most employed were religion (x̄ = 6.9, SD = 1.77), planning (x̄ = 6.4, SD = 1.34) and emotional support (x̄= 6.0, SD = 1.54). After logistic regression, instrumental support, self-blame, active coping, religion, positive reframing and venting emerged as predictors of perceived stress. Conclusion: Coping styles are an important determinant of perceived stress in patients with chronic LBP. Due consideration should be given to the stress experienced by patients with chronic LBP, and their clinical care should include stress management to improve outcome.

Outcomes of surgical management of severe lumbar spinal canal stenosis Oluwole O Ige, Opeyemi A Lawal, Temiloluwa O Olufemi, Ishaq B Ojodu, Bright A Igbinoba, SO Alao Nigerian Journal of Orthopaedics and Trauma 2019 18(1):18-22 Background: Lumbar Spinal Canal Stenosis (LSCS), requiring surgical intervention is a common presentation in Orthopaedic practice in Nigeria. Although it is well established that surgery is very effective in relieving the symptoms of this condition, there is a paucity of reports of surgical treatment outcomes of LSCS in Nigeria. Objective: The study aims to report the early outcomes of surgical treatment of LSCS in the study centre. Methods: Prospective Observational Pretest and Post-test Study at a single centre, the University of Medical Sciences Teaching Hospital, located in Ondo State in Southwest Nigeria, West Africa. The study was done between January 2015 and June 2017. Preoperative and postoperative data collected from 32 patients with a diagnosis of LSCS who had Decompressive Laminectomy with or without instrumented fusion were analyzed for relief of symptoms: pain, functional wellbeing and general health status using Visual Analogue Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI) and Short Form 36 (SF 36). Results: Excellent to good pain relief was reported by 31 (96.9%) and 30 (93.8%) of the patients for leg and back pain respectively at 6 months, 1 (3.1%) reported a fair outcome for leg pain while 2 (6.2%) reported fair outcome for back pain. No patient had a poor pain relief outcome. Functional outcome and general health status were also excellent/good for 28 (87.5%) and 29 (90.6%) respectively. There was no mortality or major cardiorespiratory event recorded. However, there was a minor complication rate of 68.8% (22 patients). These include dural tears 16 (50%), deep vein thrombosis 1 (3.1%), postoperative neurological weakness 2 (6.2%), wound infection 20 (62%), wound dehiscence 10 (31%), reoperation 6 (18.6%). The outcome at 24 weeks was unaffected by these minor complications. Conclusion: Although associated with early perioperative minor complications, Spine surgery is an effective and safe therapeutic option for the relief of LSCS symptoms with short term good clinical outcomes.

NOA Scientific Conference/AGM EKO 2018 Nigerian Journal of Orthopaedics and Trauma 2019 18(1):23-33