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Biomedical subjects

T O Alonge

Publications and source records attributed to T O Alonge.

At least 19 recordsLinked to original sources
PubMed2004

The surgical management of severely displaced supracondylar fracture of the humerus in childhood.

A total of 28 children with severely displaced supracondylar fractures of the humerus were operated between January 1997 and December 2001 using the posterior approach raising a tongue of triceps and stabilisation of the fractures with two crossed Kirschner wires. All the supracondylar humeral fractures were extension type. The mean age was 6.9 years with male/female ratio 1.5:1. Fall at home accounted for 85.7% of the cases while 67.9% presented with injury to the left elbow. In 92.9% of the children the triceps muscle power was grade 5, 71.4% could flex the elbow joint beyond 120 angle and only 10.7% had 15 degrees of extension lag at the elbow joint at six months. All had within normal carrying angle with 64.3% having carrying angle between 0 degrees - 10 degrees. The scar was cosmetically acceptable in 27 patients (96.4% ) at six-months.

Child↗
PubMed2004

Femoral head diameter in subcapital fracture of the femur in Ibadan, Nigeria.

Subcapital fracture of the femur is common in the elderly patients though the incidence is less in our environment than in the western world. Primary prosthetic replacement is the method of treatment in the majority of the patients. To facilitate this, a foreknowledge of the femoral head diameter is necessary. To determine the diameter of the femoral head and its magnification on radiograph among patients with hip fractures seen in South-West Nigeria, all patients with subcapital fracture of the neck of femur seen between March 1997 and February 2002 were included in the study. The femoral heads were measured on the radiographic film using a transparent ruler and after extraction of the femoral head during surgery using callipers. There were 25 patients in all, the mean age of patients was 73.2 years. Fall at home accounted for 70% of the cases. The femoral head diameter was between 42 mm and 50 mm in 92% of patients while magnification of femoral head diameter on radiograph was 10-14% in 92% of cases. The usaof 10-14% magnification of femoral head on radiograph would help the surgeon determine the size of prosthetic head before commencement of surgery.

Accidental Falls↗
PubMed2003

The Belfast technique for the treatment of chronic osteomyelitis in a tropical teaching hospital.

From September 1995 to August 2001, we treated 25 patients with chronic osteomyelitis of long bones by a two-stage technique. This consisted of the radical removal of all infected bone and soft tissue and immediate provision of soft-tissue cover. This was supplemented when necessary with delayed autogenous bone grafting. The average follow-up was 46 months (range: 19-80 months). One patient with haemoglobin sickle cell disease (HbSS) died after the second stage of surgery. There were four recurrences, one of which followed a myocutaneous flap that became necrotic. Ankylosis occurred in five patients.

Adolescent↗
PubMed2003

Infective lumbar discitis in a sickler--an occult 'typhoid' spine?

Pyogenic infection of the intervertebral disc (discitis) is a rare infection and the diagnosis often depends on a high index of suspicion. The cases of infective discitis described in the modern literature are similar to, if not identical with what was described as 'typhoid spine'. Salmonella infection of the musculoskeletal system on the other hand is more common in patients with sickle cell anaemia. This case report highlights the bizarre presentation of infective lumbar discitis in a sickler (HbSS) and calls attention to the need for a thorough evaluation of low back pain in these patients.

Adult↗
PubMed2003

Normal values of knee angle, intercondylar and intermalleolar distances in Nigerian children.

There is little data on the range of variation of knee angle, intermalleolar and intercondylar distances in African children. Such measurements are needed to assist determining whether a child legs are normal or not. Knee angle intermalleolar and intercondylar distances were measured in 2166 Nigerian children aged one year to 10 years to establish normal values for these measurements. In the study we discovered that knees were maximally bowed at ages 1-3 years and reduced to neutral of 0 degrees at age five (5 years) in girls and age seven (7) in boys. Both sexes had no bowing after age (7 years) in boys. Both sexes had no bowing after age of 7 years. The valgus angle was found to be constant at about 11 degrees between ages 1-10 years in both sexes. Mean intercondylar distance was 0.2 cm at 1 year of age and did not vary significantly at 10 years of age. The greatest intermalleolar distances of 2.5 cm and 2.2 cm were noted between the ages of 2 and 4 years. Normograms of these measurements are presented as diagnostic aids in clinical settings.

Anthropometry↗
PubMed2003

Hip fractures in a tropical teaching hospital.

The pattern of hip fractures, treatment, outcome of treatment, and complications of forty-four consecutive patients treated over a five-year period were retrospectively studied. This represents 3.5% of the hospitalised patients in orthopaedic services. The male:female ratio was 1:1.3. Seventy percent of the fractures occurred in those over 65 years of age. The fractures were the result of low energy trauma in 81.8% of patients. Intracapsular (cervical) fractures accounted for 79.5% of the total cases. Only two patients had associated injuries on admission. Austin Moore hemiarthroplasty was the choice of hip replacement for intracapsular fractures, while ORIF (Open reduction and internal fixation using fixed angle blade plate) was done for patients with (extracapsular) trochanteric fractures. Anaesthesia (general or regional) was uneventful. Non-fatal pulmonary embolism occurred in one patient post-hemiarthroplasty while in the hospital. This study shows that hip fractures are not uncommon in our environment although far less common than what obtains in the Caucasians.

Adolescent↗
PubMed2003

Management of open tibia fracture--Anderson and Hutchins technique re-visited.

Prior to September 1995, most open tibia fractures seen at the University College Hospital, Ibadan had hitherto been managed by the application of plaster-of-Paris after limited wound debridement. The outcome of this form of treatment was found, from the outpatient clinic follow-up records, to be associated with a high rate of complications including chronic osteomyelitis and joint stiffness. In most hospitals in the developed and developing countries, majority of these injuries are best managed by the use of various types of external fixators. However, these external fixator devices are by no means cheap and often times most patients in our environment are unable to afford them since the country operates a health care system where the patients are solely responsible for their health care needs. In this study, the Anderson and Hutchins technique (Steinmann's pins threaded through bone and incorporated in plaster-of-Paris) was used in the management of thirty-four open tibia fractures between September 1995 and August 1999. Seventy-nine percent of these were severe or Type III open fractures. The time to radiological union was 21 weeks and pin tract infection occurred in 15 percent of the patients, mainly in the proximal (tibia) pins. The use of a single stout proximal (tibia) transfixing Steinmann's pin was found to offer a stable fixation.

Adolescent↗
PubMed2002

Management of chronic osteomyelitis in a developing country using ceftriaxone-PMMA beads: an initial study.

Chronic osteomyelitis is a debilitating disease that is fairly common in developing countries. Various operative techniques have been adopted in the management of this disease but there have been few reports of their use in Africa. In this report, we present our experience of the use of a modified two-staged Belfast operation in patients with chronic osteomyelitis in Ibadan, Nigeria. An important modification of the procedure was the substitution of gentamicin beads (Septopal) with ceftriaxone-polymethylmethacrylate (PMMA) beads at the saucerised segment of bone at the first stage. Thirty-four patients with chronic osteomyelitis had the two-stage Belfast operation in 35 long bones; of these, 32 patients had ceftriaxone-PMMA antibiotic beads inserted at the saucerised segment of bone at the first stage, while the other two patients had gentamicin beads inserted. One of the two patients who had gentamicin beads had a residual collection of pus at second stage surgery but, following a repeat debridement, the cavity was rid of infection. There was recurrence of infection in three patients (8.6%) who had a suction drain inserted at the first stage and in six patients (17.1%) who had no suction drain at the first stage. The locally produced ceftriaxone-PMMA beads were found to be as efficient as the commercially available gentamicin beads in eluting antibiotics locally, thereby eliminating the residual infection in the bone cavities after the first stage. Another important outcome was a fourfold saving in cost in choosing to use ceftriaxone-PMMA beads rather than gentamicin beads.

Adolescent↗
PubMed2002

The choice of antibiotic in open fractures in a teaching hospital in a developing country.

Open fracture wounds may be contaminated, and the use of an appropriate antibiotic in the early stages of management reduces the risk of osteomyelitis developing. Environmental factors influence both the type of micro-organisms that are isolated from these wounds and the antibiotics that are chosen to manage the wounds. Before this study, the choice of antibiotic in the management of open fractures in our hospital was based on tradition and 'best guess' antibiotics. In a prospective study of 52 open fractures seen in the accident and emergency unit of University College Hospital, Ibadan, between January and June 2000, the positive bacterial culture yield was more than 70%. Staphylococcus aureus was the commonest microbial isolate, accounting for 37.5% of total isolates. The antibiotic sensitivity pattern revealed high efficacies for pefloxacin, ciprofloxacin and ceftriaxone against the isolated micro-organisms. In comparative costs, these antibiotics are cheaper than the combination of the 'best guess' antibiotics that were used previously. On the strength of this finding, we have suggested a change in the antibiotic policy of the hospital with regard to the antibiotic regimen to be used to complement the surgical management of open fractures.

Anti-Bacterial Agents↗
PubMed2002

Microbial isolates in chronic osteomyelitis--a guide to management.

Between August 1995 and December 1999, sixty patients with chronic osteomyelitis had the effluent from the discharging sinuses and bone biopsies cultured aerobically and anaerobically. 47 positive isolates were obtained and the organism commonly isolated both in the single- and two-organism isolates was Staphylococcus aureus. The sensitivity patterns of these isolates were carried out with the available antibiotic discs. 30 per cent of the organisms isolated were sensitive to ceftriaxone (Rocephine) and gentamycin.

Anti-Bacterial Agents↗
PubMed2002

Major limb amputation in Ibadan.

A prospective study of patients who had major limb amputation at the University College Hospital Ibadan over a 5-year period is presented. One hundred and one major limb amputations were performed within this period (71 Males, 30 Females, M:F = 2.3:1). Trauma accounted for 48% of the cases followed by diabetes in 26%, soft tissue infection in 13% and tumours also in 13%. The major post-op complication was wound infection. In accordance with the findings in other centers, a higher proportion of the amputations (69%) were carried out in the lower limbs. Patient's refusal to accept amputation resulted in a delay in amputation in 49 patients. This delay (before surgery) ranged from 1 day to 150 days, with a mean of 15.49 (SD 9.V). From this study, we found that a reduction in vehicular accidents and increasing emphasis on efficient foot care (and glycaemic control) in the diabetic may significantly reduce the rate of amputations in our environment.

Adult↗
PubMed2001

Further characterization of storage-related alterations in immunoreactivity of archival tissue sections and its implications for collaborative multicenter immunohistochemical studies.

Storage of unstained paraffin slides may lead to the deterioration of specimens and failure to detect cellular proteins immunohistochemically. Although the implication of age-induced alterations on multicenter immunohistochemical studies would be considerable, they have not been investigated previously. The current study was undertaken to examine the effect of this factor further and to explore new ways of overcoming the resultant shortcomings. The authors now report on the immunodetection of a host of antigens in similarly preserved unstained serial paraffin slides obtained from three centers using a panel of eight antibodies. Staining of recently prepared sections from the authors' centers resulted in similar strong patterns in seven of eight antibodies, with one antibody demonstrating variable immunoreactivity. However, storage of unstained paraffin sections at room temperature resulted in a variable but progressive decrease in expression of several tissue antigens. Although the loss in antigenicity was proportional to the length of storage, the effect was reversible if super antibody concentrations were used. The authors conclude that recently prepared paraffin sections from centers with similar fixation protocols have similar immunoreactivity and are suitable for use in comparative multicenter studies. However, in view of the delays that may attend tissue transportation during these projects, the authors suggest that test systems should be checked for age-induced antigen degradation by incubating sections with higher antibody concentrations.

Antibodies↗
PubMed2000

An investigation of the frequency of co-existence of osteophytes and circumscribed full thickness articular surface defects in the knee joint.

Osteophytes are osteochondral repair tissues formed usually at the margins of synovial joints in response to a more central full thickness articular cartilage defect. These defects can be managed using the autologous chondrocytes implantation technique or with composite osteochondral grafting. Materials for osteochondral grafting of circumscribed full thickness articular surface defects may be obtained from osteophytes. In this study, the frequency of co-existence of these two intra-articular lesions was studied prospectively in patients undergoing therapeutic arthroscopy for painful knee conditions. Thirty-three of 88 knees (37.5%) had full thickness articular surface defects and 23 of these (69.7%) had associated osteophytes formation.

Adolescent↗
PubMed2000

A review of 100 cases of supracondylar fractures in children seen in Ibadan.

Supracondylar fracture of the humerus in children is one of the commonest fractures in children of school age all over the world. The experience of the mode of presentation, mechanism of injury and the different modalities of treatment in the University College Hospital, Ibadan is presented. The results suggest that severely displaced supracondylar fractures in this environment are better managed with open reduction and internal fixation.

Age Distribution↗
PubMedDate not supplied

Haematoma block in reduction of distal radial fractures.

A total of 35 patients who presented in the Accident and Emergency Department of University College Hospital with displaced distal radial fracture between January 2000 and March 2001 had reduction of the fracture under haematoma block using 10ml of 2% lignocaine. There was significant reduction of the pain following infiltration of the fracture site with lignocaine and significant pain reduction during manipulation compared to pain score at presentation. All the patients had satisfactory reduction of the fracture. The fracture was mobilised in Plaster of Paris 6 weeks in patients with Collens' fracture and 3 weeks in patients with distal radial epiphyseal injury. All patients had good range of movement at 8 weeks after removal of Plaster of Paris and patients expressed satisfaction with this method. We recommend the use of Haematoma block for patients of 15 years and above with displaced distal radial fracture in the Accident and Emergency Department.

Accidental Falls↗
PubMedDate not supplied

Traumatic dislocation of the hip joint--pattern and management in a tropical African population.

Traumatic dislocation of the hip is an orthopaedic emergency for which early reduction is indicated. This article describe our experience of the pattern and choice of management of traumatic dislocation of the hip joint in a tropical African population. Majority of the dislocation (87%) were Thompson and Epstein's grades I and II which were easily managed by closed reduction following the administration of titrated intravenous analgesic and intravenous diazepam. This treatment option is cheap and readily administrable to avoid undue delays in the management of this orthopaedic emergency. All the close reduction were carried out in the accident and emergency room except for one patient with bilateral posterior hip dislocation who had his reduction on the ward. Early diagnosis and treatment of traumatic hip dislocation are essential to reduce the morbidities that are commonly associated with delay in reduction.

Adolescent↗
PubMedDate not supplied

Primary malignant bone tumour in a tropical African University teaching hospital.

Bone tumours are relatively rare tumours as compared with all other tumours. The relative frequency has not been well documented in this environment. The aim of the study was to define the frequency of primary malignant bone tumours in an African University teaching hospital in Ibadan. The medical records of 114 patients with malignant bone tumours recorded in the Cancer Registry of the University College Hospital, Ibadan, Nigeria between January 1977 and December 2000 were reviewed retrospectively. Primary malignant bone tumours represented 0.53% of all the 21390 cancers seen in the teaching hospital in the period studied, with a male female ratio of 1.4:1. About 45% oftumours occurred among patients < 20 years of age. Osteogenic sarcoma was the most common primary malignant bone tumour while the mandible was the most commonly affected bone. In contrast to previous studies, Burkitt's lymphoma affected the mandible more commonly than the maxilla. The relative frequency of primary malignant bone tumours is low in our environment as observed in other developing countries.

Adolescent↗