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The aim of this paper was to study the indications and patterns of limb amputations in the University of Calabar Teaching Hospital, a retrospective study of 142 limb amputations performed in patients admitted to the University of Calabar Teaching Hospital, South-South, Nigeria. Data was obtained from theater records and the medical record department of the hospital after due ethical approval. The data spanned a period of 10 years (from January 2004 to December 2014). A total of 142 patients were seen. The age ranged from 8 to 87 years with a mean age of 46 years ± SD 17.9 years and a male to female ratio of 2.3:1. Adults accounted for 95.8% while 4.2% were children. Emergency procedures accounted for 47.9% of the amputations. Diabetic foot gangrene was the major cause of lower limb amputation 91 (64.1%), trauma accounted for 27 (19%) of these, 15.5% were due to road traffic accidents, and 3.5% were cases of gunshot injuries. Tumors and limb ischemia accounted for 9.2 and 2.8%, respectively. Electrical injury, industrial accidents, and ischemic limbs from tight tourniquet splints by traditional bonesetters were the common causes of upper limb amputations. Most of the amputations were on the lower limb (83.7%) with the left lower limb accounting for 47.8% and the right lower limb accounting for 35.9% .Upper limb amputations accounted for 15.4% with right and left upper limbs being 8.4 and 7.0%, respectively .Only one patient had bilateral lower limb amputation(0.7%). For the levels of amputation, the majority were below knee 54 (38%) followed by above elbow 38 (26.8%) amputations (Figure 1); others were ray amputation of the foot and hand as 28 (19.7%) and 8 (5.6%), respectively. The least was below elbow amputation 6 (4.2%). The study showed that 96% of the causes were potentially preventable, and that establishment of a prosthetic-orthotic center is needed in this part of the country.

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To document the outcome of treatment in the first six months for open tibial shaft fractures managed with external fixators in resource-poor economy and the pattern of presentation of open tibial shaft fractures, a 12-month prospective observational study was conducted from January 2010 to December 2010. All the patients were recruited from the accident and emergency department of the University of Calabar Teaching Hospital. The demographic data of each patient, the type of injury, the mechanism of injury, and the outcomes were assessed. Moreover, 42 patients with open tibial shaft fracture were recruited for this study with forty (95.2%) patients successfully followed up for six months while two patients (4.8%) were lost to follow-up. Their ages ranged from 18 to 65 years with a mean age ± standard deviation of 33.5 ± 12.8 years. Majority of the patients (77.5%) were aged 20-50 years. There was a male to female ratio of 3:1. A total of 7 (17.5%) fractures healed after 20 weeks, Type IIIB fractures were 3 (7.5%), Type IIIA fractures were 4 (10%), but all Type II fractures had united between 12 and 15 weeks. The middle third fractures 9 (22.5%) had the highest number of fracture union within 16-20 weeks. The major cause of the injuries was from motorcycle accidents, which were 30 (75%), and others were from cars 7 (17.5%) and buses 3 (7.5%). This was largely due to the utilization of motorcycles as the major means of commercial transportation in the city until it was banned recently. However, they are still in use in the suburbs. The higher the Gustillo and Anderson grading of the open fracture of tibia, the more severe the wound and bone infection that occurred, and a significant interval between the injury time, wound debridement, and the time the external fixator was applied showed poor outcome for those who presented late (after two weeks of injury).