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The diabetic foot is characterised by the triad of neuropathy, infection, and ischaemia, which may ultimately lead to limb amputation. It is important to understand the factors that place diabetic patients at increased risk of amputation in our society, hence the need for this study. The medical records of all patients admitted and treated for diabetic foot complications over a 3-year period (January 2007 to December 2009) were retrieved. Relevant information was obtained from the case notes. Thirty-six (36) patients entered the study, 25 males and 11 females (M:F ratio 2.3:1.0). Mean age was 54 years (range 24­74). Patients presented with foot gangrene (58%), ulceration (31%) and infection (11%) with trauma being the most common precipitating factor (53%). Nineteen patients (53%) had lower limb amputation, the commonest of which was below knee. Of the patients that had amputation, 18 (95%) had type 2 diabetics. Adequate diabetic foot disease preventive strategies need to be designed and implemented to reduce the incidence of lower limb amputations

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BACKGROUND: Pyogenic osteomyelitis is still frequently seen in the developing world and the treatment of chronic osteomyelitis presents a considerable challenge despite advances in microbiological techniques, antibiotics and surgical techniques. Acute haematogenous osteomyelitis is commoner in children. RESULTS: In the pre-antibiotic era, mortality rate was high and progression to chronic osteomyelitis was common. A near similar scenario still exists in many developing countries due to the combination of inappropriate and/or inadequate antibiotic therapy, delayed presentation and unorthodox interventions by traditional healers. DISCUSSION: Chronic osteomyelitis may result from poorly treated or untreated acute osteomyelitis, open fractures, surgery for an array of orthopaedic conditions and from contiguous spread from infected soft tissue as may occur in diabetic foot infections. A large array of treatment techniques hinged on sequestrectomy/ debridement, management of dead space, improvement of oxygenation and perfusion to ischaemic tissue exist. Despite these, total eradication of disease is difficult. CONCLUSION: This article summarizes the pathology and methods of management available for pyogenic osteomyelitis. In its acute and chronic forms, the disease is likely to remain prevalent in the developing world until issues of ignorance, poverty and prompt access to appropriate and efficacious medical care are addressed.

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Diabetic foot ulceration and gangrene is a major cause of morbidity andmortality. This study has examined potential preventive footcare practices in a cohort of diabetic patients presenting with foot gangrene. One hundred and two (102) diabetic emergencies presented during the study period. Diabetic foot gangrene accounted for 27 (26%) of these cases. There were 18 males and 9 females (M:F = 2:1), with a mean age of 52+13 years. The mean duration of ulceration was 4±3 weeks and mean ulcer­gangrene interval was 1.2±0.5 weeks. Only 9 patients (33%) had been exposed to any form of footcare education, 15 patients (55%) treated their ulcers by unorthodox means, and 63% of the patients practiced no significant footcare. More widespread education and awareness is needed to prevent the continuing and serious problem of diabetic foot gangrene and consequent lower limb amputation

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BACKGROUND: In North America and Europe, 80% of invasive skin cancers are basal cell carcinoma while 20% are squamous cell carcinoma (SCC). In contrast, African studies reveal a preponderance of SCC. Risk factors are grouped into solar and nonsolar. Oculocutaneous albinism (OCA) is a known risk factor for skin cancer in Africans. Their contributions vary with race and geographic region. This study sought to evaluate the pattern, risk factors, and outcome of management of this lesion in our setting. METHOD: All the patients with histologic diagnosis of SCC between January 2006 and December 2007 were prospectively studied as part of the wider study of skin cancers. RESULTS: The 19 patients (12 males and 7 females) whose ages ranged between 16 and 70 years (mean = 46.2 years) accounted for 51.4% of skin malignancies. Marjolin's ulcers were recorded in 12 patients (63.2%) while 7 patients (36.8%) were non-Marjolin's including 2 OCA patients. The limb was the commonest site involved (57.9%). The outcomes were poor in some cases because of late presentation after topical treatment. CONCLUSION: Chronic ulcers, inflammation, and albinism were identified predisposing factors. Public health education on prevention, early presentation, and surgical evaluation of chronic ulcers would improve outcome.

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BACKGROUND: Several studies have shown that in Africa squamous cell carcinoma (SCC) is commoner than other skin malignancies. The risk factors are grouped generally into solar and nonsolar factors and their contributions vary with race, geographical region and site of lesion. This study attempted to identify risk factors and outcome of management of this problem in our region of southern Nigeria. METHODS: All patients with histological diagnosis of SCC presenting to the University of Calabar Teaching Hospital during the period January 2005 to December 2006 were evaluated. RESULTS: In total, 10 patients (6 male, 4 female, mean age 39.3 years, range 16-62) were seen. There were six patients (60%) with Marjolin's ulcer (MU) of the leg, with a male:female ratio of 5:1 and a latency period of 14.7 years, with trauma as the leading cause of injury. The other four patients (40%) had non-MU SCC. Two of these four patients (one man, one woman) were albino, and had lesions that involved the head. The other two patients were both women, and had vulval lesions. All 10 patients had delayed hospital admission, after poor results with topical herbal treatment. After hospital treatment, the results were satisfactory in three patients (two with MU and the male albino patient). The other seven patients had generally poor results from treatment, which comprised various combinations of excision, adjuvant chemotherapy and radiation. CONCLUSION: Ignorance and sociocultural factors were underlying issues in delaying treatment. Education highlighting the risk associated with chronic wounds and albinism, and the need for prevention, prompt treatment and proper surgical management, would improve prognosis with a reduction in the healthcare cost of this problem.

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BACKGROUND: Lightning injuries are relatively uncommon and have been a subject of awe since primitive times. It most significantly affects the cardiorespiratory, nervous, and integumentary systems. Surprisingly, cutaneous burn injuries caused by lightning are usually superficial. OBJECTIVE: To present the cutaneous manifestations of lightning injuries and the sequelae of improper management. CASE REPORT: A 22-year-old woman presented with cutaneous manifestations of lightning-induced burns and bilateral upper limb gangrene after 2 months of improper treatment. She refused amputation after counseling and left the hospital. CONCLUSION: This is a rare case of burns with cutaneous manifestations peculiar to lightning injury. These features serve as evidence of lightning injury, when in doubt, especially in societies where superstition is rife. Education concerning the nature of lightning and proper management would improve outcome.

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BACKGROUND: Burn injuries are a common presentation in Nigerian hospitals and result from a variety of causes. Recently, many have resulted from Petroleum related fire incidents. High voltage electrical injuries are relatively rare; lightning strikes even rarer. In traditional societies where Traditional medicine practitioners are usually the first to be contacted and where late presentation to hospitals is the rule, complications such as the wet gangrene necessitating amputation are common. Even when patients present relatively early and are resuscitated and treated, complete prosthetic rehabilitation is difficult because of poverty and lack of social support systems. CASE REPORT: This review presents three cases of high voltage electrical burns resulting from typical 11KVA burns as well as lightning strike. It also highlights the role of prompt presentation in a health facility with appropriate resuscitation in determining good treatment outcomes.

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Objective: To present our experience with a transpubic approach to the management of one of the most challenging injuries of the lower urinary tract. Patients and Methods: Between January 2003 and December 2005; 7 patients presenting to our unit with complex urethral distraction defects due to type 2 or 3 posterior urethral disruption injuries complicating pelvic fracture were included in an ongoing evaluation of the transpubic approach to the repair of such defects. The patients had a mean age of 37.7 (range 22 - 56) years and were followed up for 1 - 4 years. Results: After the follow-up period 4 patients had a very successful outcome with trouble-free voiding. Three developed stric-tures; two of which were successfully managed with regular dilatation; while the third patient became catheter-dependent following dilatation and inadvertent creation of a false passage. This patient underwent a successful re-operation with full recovery. Conclusion: The transpubic approach to delayed repair of urethral distraction defects complicating pelvic fracture is feasible. It allows an effective dissection of the dense hematoma-fibrosis that commonly complicates these injuries at a later stage. The approach is particularly useful in complex long-standing defects where such dissection is made relatively easy by the ample working space provided. The successful outcome of treatment by this approach in 4 and ultimately 5 out of 7 patients offers a reasonable degree of salvage for patients with an otherwise poor prognosis. Further studies are warranted to confirm our positive results

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BACKGROUND: Lightning strikes are relatively uncommon. In our culture where superstitions are strong and natural events often linked to evil forces, the traditional bonesetter/healer is often consulted first. Patients then seek orthodox care when complications develop. Patients also have difficulty accepting ablative treatment when indicated. OBJECTIVE: To present an usual case of bilateral upper limb burns caused by lightning and complicated by refusal to receive orthodox treatment. CASE REPORT: A 22 year old woman was struck by lightning while asleep. Instead of going to hospital, she was taken to a traditional healer where she spent two months before presenting with gangrenous upper limbs to hospital. Patient refused amputation and abandoned hospital against medical advice. CONCLUSION: This case report of bilateral upper limb burns resulting from lightning is rare. Importantly, the case highlights the role of ignorance, superstition and the disastrous results of traditional medical practice in our healthcare delivery.

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Background: Patients with orthopaedic injuries patronize traditional bonesetters in our communities. This study was undertaken to find out and document the reasons and factors responsible for this patronage; who made the choice; the role of healthworkers; patients' perception of the practice and if their experience will encourage or discourage them from patronizing traditional bone setting in future. We also compared the cost between orthodox and traditional bone setting for close humeral and femoral fractures. Methods: A prospective study of patients in three traditional bone setting centres in Calabar . A pre-tested questionnaire requesting information on age; sex; educational level; type of injury; reasons for choice of traditional bone setting was administered. Other details included who decided on traditional treatment; perception of outcome; and the option of choice in the event of a future injury. Results: There were 98 patients with 106 injuries. The male: female ratio was 66:32 (2.1:1) and age range was 9 months to 60 years. There were 76 fractures in 68 patients; 28 dislocations and 2 brachial plexus injuries. Traditional bone setting was chosen in 50 patients (51.0) because traditional bonesetters were believed to be more skillful than orthodox orthopaedic practitioners; 32 patients (32.7) thought it was cheaper; 12 patients (12.2) believed orthodox orthopaedic practitioners have no empathy towards their patients and 4 patients (4.1) had no health facility in their locality. In 68 patients (69.4) the locus of decision was external; in 22 patients (22.4) internal and 8 patients (8.2) were encouraged by a healthworker. Complications including pain; mal/nonunion; joint stiffness and contractures occurred in 60 patients (61.2). Treatment outcome was adjudged satisfactory by 48 patients (49.0); fair by 40 patients (40.8) and unsatisfactory by 10 patients (10.2). Traditional bone setting for the management of humeral and femoral fractures was more expensive than orthodox management. Conclusion: Traditional bone setting is popular for varied reasons. The freedom to advertise may have helped to woo a public already biased towards traditional bone setting by cultural attachment. A paradigm shift is necessary to reverse the trend

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Background: Patients with orthopaedic injuries patronize traditional bonesetters in our communities. This study was undertaken to find out and document the reasons and factors responsible for this patronage; who made the choice; the role of healthworkers; patients' perception of the practice and if their experience will encourage or discourage them from patronizing traditional bone setting in future. We also compared the cost between orthodox and traditional bone setting for close humeral and femoral fractures.Methods: A prospective study of patients in three traditional bone setting centres in Calabar. A pre-tested questionnaire requesting information on age; sex; educational level; type of injury; reasons for choice of traditional bone setting was administered. Other details included who decided on traditional treatment; perception of outcome; and the option of choice in the event of a future injury. Results: There were 98 patients with 106 injuries. The male: female ratio was 66:32 (2.1:1) and age range was 9 months to 60 years. There were 76 fractures in 68 patients; 28 dislocations and 2 brachial plexus injuries. Traditional bone setting was chosen in 50 patients (51.0) because traditional bonesetters were believed to be more skillful than orthodox orthopaedic practitioners; 32 patients (32.7) thought it was cheaper; 12 patients (12.2) believed orthodox orthopaedic practitioners have no empathy towards their patients and 4 patients (4.1) had no health facility in their locality. In 68 patients (69.4) the locus of decision was external; in 22 patients (22.4) internal and 8 patients (8.2) were encouraged by a healthworker. Complications including pain; mal/nonunion; joint stiffness and contractures occurred in 60 patients (61.2). Treatment outcome was adjudged satisfactory by 48 patients (49.0); fair by 40 patients (40.8) and unsatisfactory by 10 patients (10.2). Traditional bone setting for the management of humeral and femoral fractures was more expensive than orthodox management. Conclusion: Traditional bone setting is popular for varied reasons. The freedom to advertise may have helped to woo a public already biased towards traditional bone setting by cultural attachment. A paradigm shift is necessary to reverse the trend

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Background: Limb injuries are common. The aims of this study were to evaluate the pattern of limb injuries seen at the University of Calabar Teaching Hospital (UCTH); Calabar and the role ofmotorcyclists in their causation. Methodology: Prospective study from 1st January; 2005. Seventy consecutive patients with limb injuries presenting at the accident and emergencyunit of UCTH were evaluated. Results: The seventy patients who entered the study presented between 1st January 2005 and 31st May 2005. They sustained eighty five (85) limb injuries.Ages ranged from 4.5years to 68years with mean of 30years. Male to female ratio was 2.7:1. Road Traffic Accident (RTA) was the commonest cause of injury accounting for 76.8of cases withmotorcycle accidents constituting 52.8of these. Fracture was the most common injury accounting for 54 cases (63.5). Fracture of the tibia and fibula (combined) was the most common fracture (37.0). Head injury was the most common associated injury (66.7). Conclusion: Motorcycle accidents are important causes of limb injuries. Appropriate measures to reduce incidence of road traffic accidents would significantly curtail the rate of occurrence of limb injuries

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