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Intramedullary interlocking nailing for diaphyseal fractures is a standard treatment option in affluent societies. These procedures are often performed under image intensifier guidance. The cost of these gadgets precludes their common use in resource poor regions. External jig-aided intramedullary interlocking nailing is relatively cheap and offers the chance for performing these procedures in resource poor regions. The aim of this study was to document the advantages, challenges and outcome of this form of treatment in a resource poor setting. The Surgical Implant Generation Network (SIGN) implants and instrumentation were used for this study. Thirty-seven limbs in 35 patients were included. There were 30 males and five females giving a ratio of 6:1. The mean age was 35 ± 11.9 years with a range of 15-61 years. The femur and tibia were the bones studied with a total of 23 and 14 fractures, respectively (ratio 1.6:1). There were 14 comminuted fractures, two segmented fractures, six mal-unions, eight non-unions and seven simple fractures. Road traffic accidents were the most common cause of injuries with motorcycle accidents accounting for 19 (57.4%) cases. The mean follow-up period was 22 ± 5.32 months, mean time to union was 16.9 ± 5.4 weeks and the major complication was osteomyelitis (10.8%). We conclude that this is a viable treatment option for musculoskeletal injuries in resource poor regions. Education to encourage early acceptance of surgical intervention and reduced patronage of traditional bone setting for injudicious interventions can reduce the infective complication rates.

Objectives: To evaluate the pattern of fractures in children in the south eastern region of Nigeria, seeking to highlight the planning and designs of buildings, roads and playgrounds to prevent paediatric fractures., Design: Retrospective review of paediatric patients with fractures who presented at the only tertiary referral centre in the region., Setting: A university teaching hospital situated in the south eastern corner of Nigeria., Subjects: 102 paediatric patients treated for fractures between January 1993 and December 1995., Main Outcome Measures: Causes of fractures and their anatomical distribution., Results: 71 boys and 31 girls were treated for fractures. The commonest cause of fractures was road traffic accidents accounting for 50% of the patients, followed by falls and collapsing mud walls. Most of the fractures seen (58 patients) were of the green stick type. The femur was the commonly fractured bone (25 patients) followed by the radius (22 patients) and humerus (20 patients). Road traffic accident victims presented earlier at the hospital than victims of other causes. Also lower limb fracture patients presented earlier than patients with upper limb fractures., Conclusion: Paediatric fractures are amenable to conventional conservative therapy and open reduction became necessary in long neglected cases with associated malunion. Since the causes of fractures are largely preventable, public enlightenment campaigns, provision of pedestrian pathways, care on the part of school authorities and proper structural construction of the traditional houses may help reduce the number of cases of fracture in our environment.

A prospective study of 20 patients with traumatic amputations of the fingers and a thumb was carried out during a six week period at Mpilo Central Hospital, Bulawayo. Most of the adult injuries (17 patients) resulted from industrial accidents (76.5 pc) while two out the three children sustained their injury from domestic accidents. Inadequate safety precaution, ignorance and human error contributed significantly to the injuries. Safety education and preventive measures both at home and in industry should be inoculated into the daily life of individuals.

We studied 13 spinal injury patients who had hyperpyrexia during an 18 month period (September 1984-March 1986) to discover if differences existed in the core temperature of patients with tetraplegia and those with paraplegia, and the contribution of these differences to the final outcome. Children were excluded from this study as well as patients with any sign of infection on first admission, patients with multiple injuries, and those referred from peripheral hospitals more than one week after injury. Patients with tetraplegia (C3-C7) had persistently high and uncontrollable core temperatures (average 39.5 degrees C) while those with paraplegia (T4-L5) showed lower core temperatures which were still high (average 38.1 degrees C). The difference in the average high core temperature (1.4 degrees C) is statistically significant. The lowest average core temperatures were about the same in tetraplegics and paraplegics (just over 35 degrees C). Four patients died: 3 tetraplegics and one paraplegic. Antipyretic analgesics were ineffective in reducing the high core temperatures.

This paper discusses the surgical and medical problems affecting off-shore oil drilling workers in the south-eastern Atlantic coastline of the Nigerian territorial waters; about 50-60 kilometers from land. There were a total of 1300 attendances at the off-shore clinic within 12 months, ie 3.6 daily for a workforce of 110, were successfully managed by 2 well-trained industrial staff nurses who were supervised by an experienced base doctor on-shore. Although, most of the patients were treated for minor medical and surgical conditions such as headaches, malaria, cuts and bruises, a few acute emergencies arose which had to be taken on-shore by helicopters, for subsequent management. Four accidental deaths occurred during the period, one of them was clearly preventable but there were no major disasters. This demonstrated the effectiveness and significant role which well-trained nurses can play in industrial health.

A three-year-old boy, who was previously healthy, had a severe attack of measles which resulted in left corneal ulceration with blindness and axillary nerve palsy on the same side with subglenoid subluxation of the humerus. The recovery of the function of the nerve after one year of intensive physiotherapy was negligible. This is an unusual complication of measle as peripheral nerve involvement is rare.

A case of bony metastasis from carcinoma of the body of uterus is presented, hitherto unreported. Diagnosis was difficult in this very unusual presentation, but the importance of post-menopausal bleeding must be emphasized.

Thirty patients presenting with the heel pain syndrome, commonly referred to as "plantar fasciitis", were studied prospectively over a two year period. The pain was associated with a calcaneal spur in 21 patients (70%). In a control series of 25 patients without heel symptoms, calcaneal spurs were present in only 4 out of 50 heels (8%). This difference is highly significant (p 0.001). Seven patients (22%) in the plantar fasciitis group complained of ipsilateral sciatica.

Acute haematogenous osteomyelitis is a major disease in this area, affecting 10% of the children seen in orthopaedic clinics. Few patients report early enough to benefit from antibiotic treatment, so the majority are seen quite late, usually in the chronic stage with discharging sinuses or chronic ulcers. In adults, chronic osteomyelitis results from inadequately treated open fractures. Injudicious sequestrectomy or very severe disease may lead to loss of length of the bone. A 5-year-old boy and a 30-year-old man suffered loss of length of tibia (averaging 8 cm). In an experimental work, a non-vascularised ipsilateral fibular graft was used to bridge the gaps in both tibiae, fixation was achieved with a tubular plate in one instance and an intramedullary rush nail in the other case. Both patients bore weight at 4 and 6 months, respectively. Amputation should therefore be avoided.

Two cases of non-union of fractures of the carpal scaphoid in children are described. They were successfully treated by screw fixation without bone grafting.