Prevalence and Pattern of Open Fractures in Level-II Hospital, Central Africa

Introduction: Open fractures are known orthopaedic emergencies associated with healing problems and risk of infection. The open fractures are common cases because of motor vehicle and motorbike accidents, falls from height and sometimes gun-shot wounds. Significant morbidity and subsequent disability may happen, if not managed properly. Aim: To evaluate the pattern of open fractures associated with healing problems and achieving sound bone union, avoiding infection and regaining full functional recovery of the limb. Methods: This retrospective study included all the patients who were hospitalized with open fractures of lower limbs in a United Nations Level II Hospital of Bangladesh Medical Contingent at Kaga-Bandoro in Central African Republic from April 2015 to November 2018. Results: There were 57 patients with open fractures resulting 17.8% of total trauma patients. The mean age was 31.8±11.6 years. Most patients were in the 20-39 years age group. The male to female sex ratio was 4.2:1. Road traffic accident was the main cause of open fractures (59.6%). Fractures of tibia-fibula and femur contributed 49.1% and 15.7% respectively and 89.4% satisfactory results were achieved after treatment. Conclusion: The management of open fractures presents a challenge due to risk of infection, healing problems and subsequent morbidity. Adequate debridement and copious lavage remains one of the cornerstones of management of open fractures. The initial management of open fractures affects the ultimate outcome. JAFMC Bangladesh. Vol 15, No 1 (June) 2020: 50-53

The case of the disappearing bullet: An extraluminal compression of the biliary tree

Penetrating abdominal injuries, especially from gun shot wounds, are a common occurrence in South African hospitals, and a vast majority of these patient receive surgical intervention for suspected intra-abdominal injuries. Not all bullets are found and removed however, and we detail the case of a gentleman who presented to our institution with obstructive jaundice secondary to an extraluminal compression of his biliary tree by a retained migrated bullet, that spontaneously resolved, without any surgical intervention.

Civilian Gun Shot Wounds Associated With Spinal Injuries

Study Design: Retrospective Objective: To evaluate functional outcomes and characteristics associated with gunshot wound (GSW) to the spine. Methods: Patients with GSW to the spine managed at a Level 1 Trauma Center from January 2003 to December 2017 were enrolled. Patient demographics, diagnoses, level of injury, American Spinal Injury Association (ASIA) score, ambulatory status at follow-up, bowel and bladder function, clinical improvement, and mortality were evaluated. Clinical improvement was defined as a progression in ambulatory status category at latest follow up. Results: 51 patients with GSW of the spine were identified. 48 (94.1%) were male and 3 (5.9%) were female, with a mean age of 27 years-old (range 15-56). 38 (74.5%) were Caucasian, 7 (13.7%) were African American, 1 (2.0%) Asian-American, and 5 (9.8%) were Other/Unknown. 46 (90.2%) patients had GSW related spinal fractures and 44 (86.3%) had neurological deficits. Among patients with neurologic deficits, 5 (9.8%) had Cauda Equina Syndrome, 1 (2%) had Brown-Sequard Syndrome, and 38 (74.5%) spinal cord injuries: ASIA A 26 (68.4%); ASIA B 3 (7.9%); ASIA C 7 (18.4%); ASIA D 2 (5.3%). At mean follow-up time of 4.2 years (SD 3.9), 27 (52.9%) patients were wheelchair bound, 11 (21.6%) were ambulating with assistance, and 13 (25.5%) had normal ambulation. ASIA grade (A or B) was significantly, P < 0.00001, associated with being wheelchair bound and having neurogenic bowel or bladder at follow-up. Conclusions: Most spinal GSW patients (70.6%) did not have any clinical improvement in ambulatory status and most injuries were ASIA A.

Distance to trauma centres among gunshot wound victims: identifying trauma ‘deserts’ and ‘oases’ in Detroit

IntroductionAmong the factors related to survival among individuals with gun shot wounds (GSW) is distance to trauma care. Relatively little is known about neighbourhood-level patterns of GSW mortality and distance to hospitals with trauma centres. This study focuses on distance to the nearest trauma centre as a correlate of survival among GSW victims.MethodsFatal and non-fatal shooting incident data for 9,205 victimisation in Detroit, Michigan between 2011 and 2017 were collected. A Bayesian conditional autoregressive model was utilised to estimate block-group levels of GSW mortality. Clustering techniques were used to identify spatially proximate neighbourhoods with higher or lower than expected rates of GSW mortality.ResultsDistance to the nearest trauma centre was associated with a 22% increase in fatal outcomes, per-mile (OR 1.22, 95% CI, 1.06 to 1.40) after adjusting for block-group level covariates. A Getis-Ord Gi* analysis identified 91 block groups with lower than expected rates of GSW mortality and 12 block-groups with higher than expected rates.ConclusionDistance to the nearest trauma centre is associated with GSW victim survival. Clusters of block-groups with below-average GSW mortality were observed within close proximity of major trauma centres in Detroit. Improving speed and access to trauma care may play a role in reducing GSW mortality.

‘WOMEN, COME AND ROAST YOUR OWN RAM!’: RECOLLECTIONS ON MAU-MAU GENERAL CHUI WA MARARO (1927–1956)

Little has been written about General Chui (1927–1956), the unique and charismatic fighter during Kenya’s war of independence, yet he worked hand-in-hand with Field Marshall Dedan Kimathi Wachiuri, the overall commander of Kenya Land and Freedom Army (KLFA), also called Mau- Mau fighters. Kibara wa Mararo, later General Chui, who came from Meiria residence, Mugaya state, Kamuiru village of Mutira location, Ndia Division of the present day Kirinyaga County, Kenya, became a household name, and a hero to the then marginalised African populace, after the famous Mbaara ya Rui Ruiru (battle of river Ruiru). In this war of 1953, which took place on the border of Nyeri district (which was elevated to a County in 2010) and the old Embu district (which constitutes Kirinyaga and Embu counties), Kibara wa Mararo disguised himself as a regional inspector of the police. Clad in full colonial army uniform, he was able to trick some security officers and the loyalists who were derogatorily called Tukonia (empty sacks). This made them quickly rush to meet their boss. In a twinkle of an eye, the coded language (kebunoko) was sounded calling the Mau-Mau fighters who eventually turned their guns on the officers thereby wiping them clean in one blow. It is from there that the Mau-Mau high command declared him an army general. Since then, he became known as General Chui – ‘Chui’ meaning the sharp leopard. As Kenya marked its 50 years of independence (1963–2013), with pomp and colour, the sacrificial role of General Chui re-appears as one wonders: how was such a military genius finally ambushed at River Rwamuthambi’s Riakiania mushy cave and subsequently shot dead by the colonial forces? Did the surrendering Mau-Mau soldiers betray him, General Magazine and the other fighters who died of gun shot wounds at the Riakiania scene? Again, what were his political ideals? In its methodology, the article begins by retracing the nature of Mau-Mau movement citing the key issues that possibly caused it. It then moves on to chronicle General Chui wa Mararo as a case study. The materials in this presentation are largely gathered through interviews and archival sources.

London and the Great Windmill Street School

Charles Bell’s arrival in London in 1804 and interactions with various prominent surgeons are discussed. The existing medical educational system is described, including the various private schools. Bell established his own private school of anatomy and surgery in London and subsequently purchased the famous William Hunter School in Great Windmill Street. The fortunes of the school declined after he sold the school in 1826 and joined the faculty of the new University of London. Meanwhile, he was kept busy with the publication of his System of Operative Surgery, which in its second (1814) edition included his Dissertation on Gun-shot Wounds, and the preparation of his famous The Anatomy of Expression in Painting.