Frank I Olotu's research while affiliated with Kilimanjaro Christian Medical Centre and other places

Background Femoral shaft fracture is among the most common causes of paediatric hospitalisation, mortality and morbidity worldwide. There is no clear option that is preferable to other treatment modalities, especially between 5 to 16 years and published studies are scarce on radiological outcomes in Sub-Saharan Africa.This study aimed to determine the pattern, treatment modalities and radiological outcome of the paediatric femoral fractures treated at KCMC. Methodology A cross-sectional study was conducted for all children with femoral shaft fractures treated at Kilimanjaro Christian Medical Centre from 1 st January 2018 to 31 st December 2022. The approval to conduct the research was obtained from Kilimanjaro College Research Ethics and Review Committee (CRERC) with ethical clearance Reg NO PG 88/2022. In our study we used secondary data and the permission to conduct the research was obtained from KCMC, hence no formal consent was required from patients/parents.The data was accessed from the files and Elecronic Health Management system (EHMS) from 01/04/2023 to 31/07/2023.The radiological outcome; shortening, angulations in six weeks and fracture union, 12 weeks post-management were reviewed with the involvement of a consultant radiologist and the orthopaedic surgeon to obtain the precise information and were recorded on the extraction sheet. Results This study included 230 study participants who met the inclusion criteria. The mean age of participants was 9.1 (5.1) years, 41.3%, was aged 6 – 12 years, 82.2% were males, 45.7% were involved in a MTC, and 83.5% had no health insurance. The commonest fracture type was 92.6% closed, 48.7% transverse, and 65.% right side. Non-operatively was used in 50.9% of which 76.8% were treated with late hip Spica. Of those treated operatively, 61.1% were plating. The majority had good radiological outcomes with acceptable solid union, angulation and shortening. Those patients who were not operated had 94% lower odds of satisfactory radiological outcomes than those who were operated ( AOR=0.06, 95% CI: 0.01 – 0.27 and p<0.001) whereas other factors were not statistically significant. Conclusion The majority of the study participants were male and were involved in MTC as the commonest mechanism of injury. Most had closed fractures that mainly presented on the right side and transverse fractures were the most common type. The hip Spica was common non-operatively option; however, plating was the most common operative option. Treatment modality substantially affected radiological outcomes and was statistically significant.

Introduction and importance: Sclerosing epitheloid fibrosarcoma is a rare variant of low grade sarcoma withspecific histologic and immunohistochemical features, and often associated with a poor prognosis.Clinical presentation: We report a case of a 35-year old male who presented with 2 year history of lower back pain,radiating to both lower limbs, weakness to both lower limbs and weight loss more than 5kgs in the past 6 months,no past history of trauma, drenching night sweats, no TB contact history, no incontinence and no any comor-bidities. He reported no history of alcohol intake or cigarette smoking, no history of exposure to radiations orsimilar presentation to his family and no features suggestive of metastasis.On examination – he had maximum midline tenderness L3-S1, no gibbous, upper limbs neurologically intact andpower 3/5 to both lower limbs, sensation intact.Computed tomography scan and magnetic resonance imaging revealed an ill-defined osteolytic mass spanning L3to L5, vertebral plana of L4 and involvement of the left paraspinal muscles. The tumor extended to the extraduralspace and was also abutting on the distal great vessels.Our intervention entailed laminectomy, tumor debulking and posterior instrumental fusion of the spine. His-topathology findings were in keeping with an invasive sclerosing epitheloid fibrosarcoma. He had adjuvantchemotherapy with good outcome.Discussion: This case was unique due to its lumbar column location, abutting the distal vessels and despite its lowgrade, it illustrates the malignant potential which responded well to adjuvant chemotherapy.Conclusion: Invasive SEF is an aggressive tumor that requires early diagnosis. Multi-modal treatment with sur-gical resection, adjuvant chemotherapy can improve patient survival and quality of life.

Background: Regional anesthesia techniques are increasingly used in high-income countries (HICs) for both surgical anesthesia and postoperative analgesia. However, regional anesthesia has not been utilized to the same degree in low- to middle-income countries (LMICs) due to a lack of resources and trained personnel. This study evaluates patient satisfaction with, and outcomes of, ultrasound-guided regional anesthesia for extremity surgery at Kilimanjaro Christian Medical Center (KCMC) in the Northeastern zone of Tanzania. Methods: Study patients were ≥18 years of age; American Society of Anesthesiologists (ASA) physical status I, II, or III; and underwent extremity surgery under peripheral nerve block with ultrasound guidance at KCMC. After placement, blocks were assessed for effectiveness intraoperatively, as demonstrated by the need for supplemental analgesic or sedative medication or conversion to a general anesthetic. Postoperatively, patients were assessed for satisfaction with their nerve block and pain at 12 and 24 hours. Adverse events related to regional anesthesia were assessed immediately, 45 minutes after block placement, and at 12 and 24 hours postoperatively. The primary outcome was patient satisfaction at 12 hours. Secondary outcomes were block success rate and analgesia at 12 and 24 hours postoperatively. Results: A convenience sample of 170 patients was included in the study, of whom 156 (95% confidence interval [CI], 87-95) were either satisfied or very satisfied with their block. Block placement was highly successful with only 8 of 170 participants (95% CI, 2.4-8.3), requiring conversion to a general anesthetic. Analgesia continued in the postoperative period, with 164 of 170 (95% CI, 93-98) patients and 145 of 170 (95% CI, 80-90) patients reporting acceptable analgesia at 12 and 24 hours, respectively. No major adverse events, such as local anesthetic toxicity, infection, bleeding, nerve injury, or pneumothorax, were observed. Conclusions: Our study found that ultrasound-guided regional anesthesia in a resource-constrained setting was effective for extremity surgery and resulted in high patient satisfaction. No complications occurred. The use of ultrasound-guided regional anesthesia shows promise for the safe and effective care of patients undergoing extremity surgery in LMICs.

Background Diaphyseal femur fractures contribute up to 40% of paediatric orthopaedic admissions with the World Health Organisation data showing youth are particularly vulnerable and road traffic injuries are the leading cause of death for children and young adults. Different mechanisms results to these injuries and they vary with age and geographical location of the patient. Understanding the incidence, mechanism and pattern of these injuries allows planning for preventive measures and treatment to meet modern day patient demands, generation of appropriate and timely protocols with minimum social and economic burden to the patient and family. Objectives and methods A hospital based cross sectional study was conducted using the orthopaedic department patient registry among children aged under 18 years admitted from 2014—2018. Our research question was to determine the epidemiology of diaphyseal femur fractures and coexisting associated injuries among admitted paediatric orthopaedic patients. Patient files were reviewed from the medical records department and a data collecting sheet was used to record demographics and injury data. Odds ratios with 95% confidence intervals for associated injuries in paediatric diaphyseal femur fractures were estimated using multivariable logistic regression model. Results We found the prevalence of diaphyseal femur fracture among paediatric orthopaedic admissions was 18% with the majority 111 (68.5%) being males. The leading injury mechanism was a fall (57.4%) followed by road traffic injuries (35.8%) out of which 48.3% resulted from pedestrian vs motorcycle accidents. Traumatic brain injury (TBI) was the most common associated injuries accounting for 69% of these injuries with the majority 79% occurring in patients aged 6 years and older. With age specific analysis, children in 6–12 years and 13–18 years age groups, had 8 and 11 times higher odds for associated injuries (OR 8.25, 95% CI, 1.04—65.31) p = 0.046 and (OR 10.54, 95% CI, 1.26—88.31) p = 0.031 respectively compared to those younger ≤ 2 years. Road traffic related injuries had 17 times higher odds of associated injuries when compared to fall (OR 16.73, 95% CI, 6.28—44.57) p < 0.001. 112 (69.1%) of femur fractures were treated by non-operative method out of this 90 (55.6%) by traction with delayed Spica application. The overall mean duration of hospital stay was 18.5 ± 11 days. Conclusion Pedestrian vs motorcycle injuries was the leading specific cause of paediatric diaphyseal femur fractures with TBI being the common associated injury. Non-operative management was the most utilized treatment plan and contributed to ten times higher odds for a longer duration of hospital stay. Initiatives to insure children safety on roads should be strengthened in order to reduce/eliminate this burden. Application and practice of current evidence based clinical guidelines and recommendations is paramount for timely and appropriate treatment of these injuries.

Background: Traumatic thoracic and lumbar spinal cord injury (TTLSCI) is one of the common musculoskeletal injuries which predisposes someone to a devastating disability, also associated with several life threatening complications and also pauses a huge financial burden to the society and the healthcare system. Early diagnosis, treatment and stabilization of the TTLSCI patients have led to reduction of complications, early discharges and early engagement into compatible and adaptive physical and occupational activities and also reduction of huge burden to the already crippled health care system of most developing world.

Background: Femoral shaft fractures contribute up to 40% of paediatric orthopaedic admissions with the World Health Organisation data showing youth are particularly vulnerable and road traffic injuries are the leading cause of death for children and young adults. The mechanism of injury varies with age and geographical location of the patient and involves a variety of mechanisms from falls to road traffic injuries. Understanding the incidence, mechanism and pattern of these injuries allows planning for preventive measures and treatment to meet modern day patient demands, generation of appropriate and timely protocols with minimum social and economic burden to the patient and family. Objectives and Methods: A hospital based cross sectional study was conducted using the orthopaedic department patient registry among children aged under 18 years admitted from 2014 - 2018. Our research question was to determine the epidemiology of femoral shaft fractures and coexisting associated injuries among admitted paediatric orthopaedic patients. Patient files were reviewed from the medical records department and a data collecting sheet was used to record demographics and injury data. Odds ratios with 95% confidence intervals for associated injuries in paediatric femoral shaft fractures were estimated using multivariable logistic regression model. Results: We found the prevalence of femoral shaft fracture among paediatric orthopaedic admissions was 18% with the majority 111 (68.5%) being males. The most common injury mechanism was a fall (57.4%) followed by road traffic injuries with 35.8% of which 48.3% resulted from pedestrian vs motorcycle accidents. Traumatic brain injury (TBI) was the most common associated injuries accounting for 69% of these injuries with the majority 79% occurring in patients aged 6 years and older. When comparing 6-12 years and 13-18 years age groups to those younger ≤ 2 years, they had 8 and 11 times higher odds for associated injuries (OR 8.25, 95% CI, 1.04 - 65.31) p=0.046 and (OR 10.54, 95% CI, 1.26 - 88.31) p=0.031 respectively with road traffic related injuries having 17 times higher odds of associated injuries when compared to fall (OR 16.73, 95% CI, 6.28 - 44.57) p<0.001. 112 (69.1%) were treated by non-operative method out of this 90 (55.6%) by traction with delayed Spica application. The overall mean duration of hospital stay was 18.5 ± 11 days, ranging from 3 – 68 days. Conclusion: Pedestrian vs motorcycle injuries was the leading specific cause of paediatric femoral shaft fractures with TBI being the common associated injury. Non-operative management was the most utilized treatment plan and contributed to ten times higher odds for a longer duration of hospital stay. Initiatives to insure children safety on roads should be strengthened in order to reduce/eliminate this burden. Application and practice of current evidence based clinical guidelines and recommendations is paramount for timely and appropriate treatment of these injuries.