East African Orthopaedic Journal

The prevalence, patterns and factors associated with work related musculoskeletal symptoms among surgical residents in Kenyatta National Hospital, Nairobi, Kenya

K.M. Macharia, F.C. Sitati — Fri, 19 Apr 2024 00:00:00 +0000

Background: In the medical sector, surgeons work in an environment that is not ergonomically ideal, and many suffer work-related musculoskeletal symptoms that may result in reduced quality of life, disability, and diminished career longevity. While data exists on musculoskeletal symptoms in practising surgeons, this is not the case for trainee surgeons.

Objective: To determine the prevalence, patterns and factors associated with work-related musculoskeletal symptoms among surgical residents working in Kenyatta National Hospital, Nairobi, Kenya.

Methods: A cross-sectional survey was done to determine the prevalence, patterns and factors associated with work-related musculoskeletal symptoms among surgical residents working in Kenyatta National Hospital. An electronic questionnaire based on the Nordic Musculoskeletal Questionnaire (NMQ) was sent to all participants via electronic messaging.

Results: Two hundred and seventeen responses were received. The overall prevalence of workrelated musculoskeletal symptoms was 93%. The most commonly affected anatomic region was the lower back (68%) followed by the neck (47%). Residents from the thematic units of urology, paediatric surgery and general surgery had a 100% prevalence rate of work-related musculoskeletal symptoms. Residents from plastic surgery and ophthalmology units had the lowest prevalence rates (83% and 84% respectively). Neck symptoms were associated with using loupes (OR, 2.9, p=0.02) and microscopes (OR, 2.2, p=0.05). Female gender was associated with wrist/hand symptoms (OR, 3.84, p=0.01). Increasing age was associated with symptoms in the neck (OR, 1.22 p=0.002) and lower back (OR, 1.15 p=0.03). No association was found between overall prevalence and thematic unit (p=0.13), year of study (p=0.903) or hours in theatre (p=0.97).

Conclusion and recommendations: Surgical residents experience a significantly high prevalence of work-related musculoskeletal symptoms. Urology, paediatric surgery and general surgery residents had the highest overall prevalence of work-related musculoskeletal symptoms.

Canal fitting and treatment outcomes of patients treated with sign fin nail at a Tertiary Hospital in Tanzania

J.E. Olomi, M. Muhamedhussein, B.T. Haonga — Fri, 19 Apr 2024 00:00:00 +0000

Background: The Surgical Implant Generation Network (SIGN) Fin nail is a relatively newer design of intramedullary nails that eliminates the requirement for distal locking. While various factors influencing treatment outcomes with different nail designs have been extensively studied, limited research has focused on the specific implications of using the SIGN Fin nail.

Objective: This study aimed to assess the relationship between Fin nail canal fitting and treatment outcomes in femur fractures treated with the SIGN Fin nail at Muhimbili Orthopaedics Institute.

Methods: A cross-sectional study was conducted at a tertiary hospital in Tanzania. Patients who underwent femoral fracture fixation with SIGN Fin nails between January 2016 and December 2021 were recruited from the SIGN surgical database. Radiographic measurements were performed using radiant software, fracture union at one year was assessed using the mRUST score, and weight-bearing status at 6 weeks was obtained from patient records.

Results: The mean canal diameter was 11.30±1.75 mm, and 82.2% had a canal fill of 80% or more. The reoperation rate was 5.9% (7/118). Although not statistically significant, patients with canal fill less than 80% had a higher rate of reoperation (p = 0.074). The union rate was 84.1% in this study, with a mean mRUST score of 9.4, and those patients with a canal fill of less than 80% were more likely to have nonunion at 1 year (p = 0.028). Pain on weight bearing at 6 weeks was reported by 42.9% (24/118) of participants, and this was significantly associated with canal fitting (p < 0.001).

Conclusion: The study found the degree of canal fitting of the Fin nail to be an important factor affecting the outcomes of femoral fractures treated with SIGN Fin nails. A higher degree of canal fill was associated with better pain outcomes and lower nonunion rates.

Current perspectives of south african orthopaedic surgeons to the direct anterior approach in total hip arthroplasty

J.R.T. Pietrzak, D.B. Geldenhuys, N. Sikhauli, J.N. Cakic, L. Mokete — Fri, 19 Apr 2024 00:00:00 +0000

Background: Despite the global increase in popularity for the use of the Direct Anterior Approach (DAA) for Total Hip Arthroplasty (THA), the current beliefs and reasons for its use and disuse amongst South African orthopaedic surgeons is not well understood.

Objective: To determine the perspectives regarding DAA compared to other surgical approaches to THA.

Methods: We conducted an anonymous online survey sent to all current members of the South African Orthopedic Association (SAOA).

Results: The response rate was 24.25% (n=194). There were 76 (39.18%) respondents that have performed DAA (DAA Performers) and 118 (60.82%) that have never performed DAA (DAA nonperformers). A proportion of 50% and 11.84% of DAA performers were between 30 to 45 years and older than 60 years of age, respectively (p<0.000). The DAA is the preferred approach to THA for 36.84% (n=28) of DAA performers, whilst 63.16% (n=48) prefer an alternative approach. Both DAA performers who prefer DAA and those who prefer alternative approaches consider DAA more satisfactory for length of hospital stay (p<0.000) and short-term functional outcomes (p=0.002) compared to other surgical approaches. For DAA non-performers, the primary reasons for not performing DAA THA were inexperience in surgical technique (72.09%), increased operative time (12.79%), unsatisfactory outcomes (27.91%) and learning curve (67.44%). There were 5 (18.52%) and 30 (70.33%) surgeons who have been in clinical practice for more than 10 years that do and do not intend to use DAA in the future, respectively (p<0.000).

Conclusion: The trends of the adoption of the DAA by South African orthopaedic surgeons show increasing popularity, similar to patterns seen in the United Kingdom and the United States of America. Younger surgeons are more likely to perform the DAA THA whilst more experienced surgeons are less likely to deviate from their current standard of practice.

Clinical and microbiological profiling of infections in open tibia fractures at Muhimbili Orthopaedic Institute

W. Mgisha, M. Majigo, A. Mwinga, E. Henry, T. Ambrose, B.T. Haonga — Fri, 19 Apr 2024 00:00:00 +0000

Background: Fracture-Related Infection (FRI) is a challenging complication after surgical fracture treatment. Consequences include reoperations, increased medical costs, loss of function and even amputation.

Objectives: This study aimed to analyze the rate, predictors of infection, clinical-radiological presentation and microbial profiles of open tibia FRI.

Methods: Between January 2022 and June 2022, a descriptive cross-sectional observational study was conducted at Muhimbili Orthopaedic Institute (MOI) involving patients aged 18 years and above with surgically managed open tibial shaft fractures in the preceding 12 months. Microbiological culture of three intraoperative tissue and bone specimens were taken by sterile techniques using separate and sterile instruments.

Results: There were 190 patients between 18-72 years with a mean age of 35.6 ±10 years. After surgical debridement, all 190 (100%) were managed with either an external fixator or an intramedullary nail. It was found, 49 (25.8%) patients had FRI. A smoking history was identified as a predictor of infection (AOR= 2.21 95% CI 0.84-5.59, P value 0.108). Delayed union was a complication found in 70.3% of patients with infection attending 12th week follow-up and beyond. Almost all (96.5%) intraoperative tissue samples were culture positive, yielding most isolates as polymicrobial (57.9%) and the predominant pathogen identified being Gram-negative bacteria in delayed and late infections.

Conclusion: About one-quarter of open tibial shaft fractures are at risk of FRI. The risk is higher among smokers. Intraoperative tissue sampling provides significant cultural yield with predominant gramnegative infection in delayed and late presentation.

Diagnostic correlation between plain radiographic and histopathology reports among patients with long bones tumours treated at a Tertiary Hospital in Tanzania

A. H. Said, V.M. Lupondo, A.B. Hussein, M. Muhamedhussein, J.E. Olomi — Fri, 19 Apr 2024 00:00:00 +0000

Background: Bone tumours are significant global health concern, with a rising number of new cases being diagnosed each year. The incidence of bone tumours has shown a significant increase in recent years, as evidenced by a 50% rise in new cases in 2020 alone. Early and accurate diagnosis is crucial for effective treatment and improved patient outcomes. The diagnosis of primary bone tumours is based on clinical, radiological and histopathological findings.

Objective: This study aimed to determine the diagnostic correlation between plain radiographic and histopathological reports in diagnosing long bone tumours.

Methods: A cross-sectional study was conducted between 2018 and 2021. Participants who underwent a histological examination for long bone tumours and met the inclusion criteria were enrolled. Relevant information was obtained from patient records then sensitivity, specificity, and accuracy of the plain radiograph were calculated with histopathology serving as the gold standard.

Results: The study included 83 participants, the majority were aged 30 years old or younger. Forty six percent of the cases were malignant tumours while benign were 54%. Osteosarcoma was found to be the most common tumour type both by radiological and histological diagnosis and femur was the most commonly affected bone. Plain radiograph was found to have a sensitivity of 92.1%, specificity of 73.3% and accuracy of 82%.

Conclusion: This study found a strong diagnostic correlation between plain radiographic and histopathology reports in patients with long bone tumours. This suggests that plain radiography can serve as a useful screening tool for long bone tumours in resource-limited settings, allowing for early and accurate preliminary diagnoses.

Physician, heal thyself

J.M. Muthuuri — Fri, 19 Apr 2024 00:00:00 +0000

No Abstract