Sickle cell disease (SCD) is an inherited disorder of abnormal haemoglobin commonly encountered in the West African sub-region. It has varied osteoarticular and non-osseous complications that mimic some surgical conditions. The most common orthopaedic complications include avascular necrosis, osteomyelitis, septic arthritis, etc. A cautious and painstaking evaluation is required in handling these patients. Acute care and anaesthetic precautions are vital in ensuring an uneventful postoperative period.

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.

Pin-track infection (PTI) is a common complication of external fixation. Antimicrobial dressings of the pin-site interface should reduce the severity and incidence of PTI. This study is aimed at determining the efficacy of 1 % silver sulphadiazine dressings in preventing PTI in external fixation. We compared the incidence of PTI between group A (dry sterile gauze dressing) and group B (1 % silver sulphadiazine impregnated gauze dressing). PTI was diagnosed when there was: (1) redness around any pin-site, (2) tenderness near a pin-site and (3) serous or purulent discharge from the pin-skin interface. With infection, swab was obtained for microscopy, culture and sensitivity. Pin-track infections were diagnosed in 22.5 and 4.1 % of patients in groups A and B, respectively. This difference was statistically significant. The commonest organism isolated from swabs was Staphyloccus aureus. In patients with external fixation, 1 % silver sulphadiazine lowered PTI. This further underlines the need for antimicrobial dressings of pin-sites. We recommend the use of 1 % silver sulphadiazine impregnated ribbon gauze for pin-site dressings.Level of evidence II.

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Background: There are many reports from different parts of the world addressing different aspects of surgical mortality. However, none has been done in this centre as it relates to orthopaedics and trauma admissions. Such data are invaluable to health planning and epidemiological monitoring. Objective: To retrospectively review all mortalities arising from orthopaedics and trauma admission as they present to Irrua specialist Teaching Hospital (ISTH) Irrua from Jan 2005-Dec 2014. Method: Medical records of case mortalities among orthopaedic and trauma admissions over ten years (Jan 2005-Dec 2014) were retrospectively reviewed. Results: Over this period, 2129 admissions and 45 deaths were recorded, with an overall crude mortality rate of 2.11%. No death was recorded among the paediatric age group. Thirty-four patients (75.56%) died from trauma (fracture) related diagnosis, majority of which were from head injury followed by infection 5 (11.11%), tumours 4, (8.89%) and disc herniation 2 (4.44%). Males were more affected 77.78% and median age at death was 44 years. Medical co-morbidities were found in 37.77% of the deceased patients. Conclusion: Patients with trauma related cases particularly head injuries, topped the list of mortalities. Young and middle aged adult males were most affected. Need for manpower development, investment in diagnostic and therapeutic facilities and preventive measures is emphasised.

We conclude that it is justifiable to use a fixed femoral valgus cutting angle in the patients undergoing total knee replacement.

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Gap bone defect is a major challenge. Its treatment has evolved over the years from amputation to limb reconstruction through vascularised graft, distraction osteogenesis and use of customised implants. Availability and affordability of these innovative techniques have always been an additional challenge in the developing resource poor countries. We report the use of Tibialization of Ipsilateral fibula first suggested by Hahns in 1884 to bridge a gap of 12 cm in an 8 year old male, with segmental tibia loss from chronic osteomyelitis. We did an end to end transposition of the ipsilateral fibular into the tibia gap defect in a one stage procedure. This was after eradication of the infective process of osteomyelitis. He commenced partial weight bearing ambulation in cast at 3 months and out of cast ambulation at 18 months post surgery. The transposed fibula was 75% tibialized at 18 months post surgery. Conclusion: Fibular is a useful armamentarium in filling segmental bone defect.