A B Omololu

University College Hospital Ibadan, Ibadan, Oyo, Nigeria

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Publications (19)7.53 Total impact

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    ABSTRACT: This study was done to find out factors that contribute to development of Non-union of long bone fractures in this environment and the outcome of operative intervention. This is a prospective hospital based study. All patients with Non-union of long bone fracture that presented in the hospital since January 1997 were recruited into the study. The data included causative factors, treatment given before presenting in the hospital, type of surgical procedure and result of treatment. The study was completed in December, 2005. 78 patients presented with 87 Non-union of long bones. A male, female ratio of 1.6:1 was encountered while 69.2 per cent of the patients were below the age 55years. Road Traffic Accident accounted for 68 fractures (78.2 per cent) while duration of injury before presentation varies from 6 months to 22 months. Atrophic non-union occurred in 60 cases (69.0 per cent) and hypertrophic non-union in 21 cases. Non-union of the femur occurred in 33 cases (37.9 per cent) humerus in 24 cases (27.6 per cent), tibia in 16 cases (18.4 per cent), radius and ulna in 14 cases (16.1 per cent). The initial treatments of the fresh fracture in the 78 patients with nonunion were by the traditional bonesetters in 51 patients (65.4 per cent) while the remaining fractures were treated by plaster of paris in hospital. Open reduction and internal fixation using plate and screws with bone grafting was the most common procedure for treating the non-union in most cases. Union was achieved in the entire patients following surgical intervention. Important factor that appears to contribute to non-union of long bone in this environment is soft tissue interposition between the fracture ends of the bone, which is found in all fractures with more than one diameter displacement. Another factor is interference with periosteal blood supply from disruption of soft tissue envelope as a result of high energy injuries which is also responsible for the displacements that were observed in these fractures. The treatment by traditional bone setters which entails daily massage of the fracture creating a macro movement at the fracture site is also an important contributing factor.
    The Nigerian postgraduate medical journal 03/2011; 18(1):56-60.
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    ABSTRACT: Orthopaedic implant surgery is often regarded as risky in developing countries due to likely hardware infection and the perception that the technical know-how are unavailable. The outcome of operative fixation of fractures at our centre was evaluated to determine whether this should be an option in our environment or not. All open reduction and internal fixation of fractures done at our hospital between September 1995 and December 2008 were reviewed. Details of the fractures, indications for surgery, fixation technique and outcome measures were recorded. A total of 524 fractures in 456 patients out of 1003 long bone fractures operatively stabilised during the period. About 15% were open fractures while a quarter of fractures involved the femoral shaft. Mean age of patients was 34.0 years. Traffic injuries accounted for 64% of cases. Average follow up period was 11.1 months. Plate osteosynthesis was employed in 330 cases (63.0%). Associated injuries and infective wound complications prolonged hospital stay. Complication rate was 21.0%, joint stiffness in 7.8% and chronic osteomyelitis in 3.8%. Open fractures and multiple long bone fracture stabilisation were associated with increased risks of chronic osteomyelitis. Although plate osteosynthesis remains the mainstay of long bone fracture stabilisation at our centre due to the lack of instrumentation for closed nailing, our results are comparable to those from other parts of the world. Open reduction and internal fixation is a recommendable option in treatment of fractures and nonunions in the 3rd world if standard precautions are observed.
    Injury Prevention - INJ PREV. 01/2010; 16(1).
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    ABSTRACT: Bone tumours are relatively rare compared to tumours of other sites. The frequency of primary malignant bone tumours is low in our environment, as was observed in an earlier study. The aim of this study is to update the information available on the pattern of primary malignant bone tumours at the University College Hospital (UCH), Ibadan, Nigeria. The medical records of 49 patients with malignant bone tumours documented in the Cancer Registry of UCH, Ibadan between January 2001 and September 2007 were reviewed retrospectively. The results were then added to those of the previous study published in 2002. This brought the number of cases of primary malignant bone tumours to 163 from January 1977 to September 2007. Primary malignant bone tumours represented 0.53% of the 30462 cases of cancer seen in the hospital in the period studied. The male female ratio was 1.5:1. About 44% of the tumours occurred among patients less than 20 years of age. Osteogenic sarcoma was the commonest malignant bone tumour. Important changes recorded in the seven years since the last review from this centre include; a rise in the prevalence rate of primary malignant bone tumours (49 new cases in the last seven years as compared to 114 cases over 23 years), the male-female ratio of Osteogenic sarcoma showed a decline (1.5:1 as compared to 1.6:1), and there was an increase in the prevalence of primary malignant bone tumours in the 0-9 years and > 60 years age groups. The significance of these findings will need to be determined by further studies.
    African journal of medicine and medical sciences 03/2009; 38(1):77-81.
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    ABSTRACT: Traditional bonesetters (TBS) have been in Nigeria for centuries. Up to 85% of patients with fractures present first to the traditional bonesetters before coming to the hospital and therefore this mode of care delivery cannot be overlooked in Nigeria. We attempted to document the current practice of TBS in Ibadan and their methods of fracture treatment with a view to training and improving the services offered by them. We carried out a literature search to review all previous studies on traditional bonesetters' practice and visited a few of them to document their current practice. The only change in the management of fractures by the TBS over the past 28 years was the use of spiritual methods of healing to treat open comminuted fractures; a technique for which no scientific basis was readily discernible. There is a need to educate and train the TBS in effective management of both open and closed fractures. Such training should be provided by orthodox orthopedic surgeons with a view to minimizing mismanagement of fractures. To this end, we propose a training algorithm.
    Clinical Orthopaedics and Related Research 08/2008; 466(10):2392-8. · 2.79 Impact Factor
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    ABSTRACT: Background: Studies in our environment show that fractures of the tibia occur mainly following road traffic crashes. The increasing volume of motor vehicular traffic and the emergence of commercial motorcycling (popularly called ‘okada’) suggest a change in the pattern of road traffic injuries and subsequent fractures.Study design: A retrospective review of records of patients with tibial fractures seen at the Accident and Emergency (A/E) Department of the University College Hospital (UCH), Ibadan between January and December 2002 was carried out. The aim was to re-evaluate the aetiology, severity and mechanisms of injuries responsible for tibia fractures.Results: A total of 70 tibial fractures in 68 patients with a mean age of 35.5±18.8 years (peak 31-40 years) were reviewed. The causes of injury were motor vehicular crashes (35%), pedestrian injuries (29%), falls (16%) and motorcycle crashes (10%). The tibial shaft was the commonest site of fracture (66% of cases). Delay before presentation averaged 10.7 hours. Forty eight percent of the fractures were open, 61% of these being of the severe, high energy type. Most (87%) were managed nonoperatively. Mean time to union was 18.1 weeks and the complications included wound infection (2), delayed union (2), malunion (2), non-union (1), and chronic osteomyelitis (1).Conclusion: There is a change in the causation of tibial fractures most being due to motor vehicular and pedestrian injuries. An issue for concern is the increasing incidence of open fractures which are often of the more severe varieties in this study. Efforts should be geared towards curtailing the menace of road crashes as well as the provision of standard but affordable health care for victims of road traffic crashes.
    Journal of Orthopaedics. 01/2008;
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    ABSTRACT: Background: Osteoarthritis is the commonest disorder of the synovial joints. It is potentially a very disabling chronic disease often associated with pain and joint stiffness among other symptoms. Pain is the main reason for the patient seeking medical attention, therefore most forms of therapy are aimed at achieving adequate pain relief. The use of oral medications can be problematic with issues such as poor patient compliance and various adverse drug reactions have been credited to these drugs including the coxib group. In the orthopaedic community in West Africa, there is now a move towards the use of intra-articular injections (particularly hyaluronic acid as sodium hyaluronate) as the primary treatment option in knee osteoarthritis. Aim: To evaluate the short-term pain relief in patients with knee osteoarthritis following the injection of 1% hyaluronic acid. Study Design and location: Prospective study carried out at the University College Hospital, Ibadan, South-Western Nigeria, West Africa. Method: 20 consecutive patients with clinical and radiological diagnosis of knee osteoarthritis seen at the Orthopaedic outpatients clinic at the University College Hospital, Ibadan, were entered into the study and were scheduled to receive a total of three injections into the affected knee on a weekly basis. The pain intensity was evaluated using the Visual Analogue Scale (VAS) prior to each injection. 11 knees in 8 patients completed this study with the prescribed number of intra-articular injections. An intention to treat analysis was used. Results: There was significant reduction in knee pain following each injection (particularly between week 1 and week 3 injections) and this was sustained over a short period of 12 weeks follow-up. Conclusion: In patients with knee OA who are also poor responders or intolerant to non-steroidal anti-inflammatory drugs, intra-articular Synject (1% hyaluronic acid) offers an alternative but effective therapy for the relief of pain.
    Journal of Orthopaedics. 01/2008;
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    ABSTRACT: A total of 28 children with severely displaced supracondylar fractures of the humerus were operated between January 1997 and December 2001 using the posterior approach raising a tongue of triceps and stabilisation of the fractures with two crossed Kirschner wires. All the supracondylar humeral fractures were extension type. The mean age was 6.9 years with male/female ratio 1.5:1. Fall at home accounted for 85.7% of the cases while 67.9% presented with injury to the left elbow. In 92.9% of the children the triceps muscle power was grade 5, 71.4% could flex the elbow joint beyond 120 angle and only 10.7% had 15 degrees of extension lag at the elbow joint at six months. All had within normal carrying angle with 64.3% having carrying angle between 0 degrees - 10 degrees. The scar was cosmetically acceptable in 27 patients (96.4% ) at six-months.
    The Nigerian postgraduate medical journal 01/2005; 11(4):258-61.
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    ABSTRACT: Subcapital fracture of the femur is common in the elderly patients though the incidence is less in our environment than in the western world. Primary prosthetic replacement is the method of treatment in the majority of the patients. To facilitate this, a foreknowledge of the femoral head diameter is necessary. To determine the diameter of the femoral head and its magnification on radiograph among patients with hip fractures seen in South-West Nigeria, all patients with subcapital fracture of the neck of femur seen between March 1997 and February 2002 were included in the study. The femoral heads were measured on the radiographic film using a transparent ruler and after extraction of the femoral head during surgery using callipers. There were 25 patients in all, the mean age of patients was 73.2 years. Fall at home accounted for 70% of the cases. The femoral head diameter was between 42 mm and 50 mm in 92% of patients while magnification of femoral head diameter on radiograph was 10-14% in 92% of cases. The usaof 10-14% magnification of femoral head on radiograph would help the surgeon determine the size of prosthetic head before commencement of surgery.
    African journal of medicine and medical sciences 10/2004; 33(3):235-8.
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    ABSTRACT: To highlight the dangers inherent in the practice of traditional bone setting in south western Nigeria as evidenced by the preventable complications that accompany treatment of fractures, joint dislocations and limb deformities by traditional bonesetters (TBS). Twenty-five consecutive patients with fractures, dislocations and limb deformities who had been previously managed by TBS and who subsequently presented to the University College Hospital, Ibadan (on account of complications from treatment at the TBS) between 15 October 1999 and 31st March 2000 were evaluated. Fourteen patients had fracture non-union or malunion necessitating open reduction and internal fixation. Two patients with wet gangrene of the extremities had amputations. Traditional bone setting is an ancient trade practiced in Nigeria and most developing countries without government regulations and they lack guidance. The complications that accompany these practices are unacceptable and it is imperative that there should be legislation to curb their activities and save the unsuspecting public from further harm or even death.
    West African journal of medicine 05/2004; 23(1):81-4.
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    ABSTRACT: A total of 35 patients who presented in the Accident and Emergency Department of University College Hospital with displaced distal radial fracture between January 2000 and March 2001 had reduction of the fracture under haematoma block using 10ml of 2% lignocaine. There was significant reduction of the pain following infiltration of the fracture site with lignocaine and significant pain reduction during manipulation compared to pain score at presentation. All the patients had satisfactory reduction of the fracture. The fracture was mobilised in Plaster of Paris 6 weeks in patients with Collens' fracture and 3 weeks in patients with distal radial epiphyseal injury. All patients had good range of movement at 8 weeks after removal of Plaster of Paris and patients expressed satisfaction with this method. We recommend the use of Haematoma block for patients of 15 years and above with displaced distal radial fracture in the Accident and Emergency Department.
    West African journal of medicine 03/2004; 21(4):282-5.
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    ABSTRACT: Bone tumours are relatively rare tumours as compared with all other tumours. The relative frequency has not been well documented in this environment. The aim of the study was to define the frequency of primary malignant bone tumours in an African University teaching hospital in Ibadan. The medical records of 114 patients with malignant bone tumours recorded in the Cancer Registry of the University College Hospital, Ibadan, Nigeria between January 1977 and December 2000 were reviewed retrospectively. Primary malignant bone tumours represented 0.53% of all the 21390 cancers seen in the teaching hospital in the period studied, with a male female ratio of 1.4:1. About 45% oftumours occurred among patients < 20 years of age. Osteogenic sarcoma was the most common primary malignant bone tumour while the mandible was the most commonly affected bone. In contrast to previous studies, Burkitt's lymphoma affected the mandible more commonly than the maxilla. The relative frequency of primary malignant bone tumours is low in our environment as observed in other developing countries.
    West African journal of medicine 01/2004; 21(4):291-3.
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    ABSTRACT: A total of 20 children presenting in Accident and Emergency (A&E) Department of University College Hospital, Ibadan, Nigeria with femoral shaft fracture treated with straight leg fixed traction in a domiciliary setting is presented. The male:female ratio is 3.2 with fall accounting for 65% of the cases. There was satisfactory correction of overriding and angular deformity following the application of the fixed traction in all the patients. There was good Callus formation at six weeks with no vascular, neurological or soft tissue complication.
    West African journal of medicine 01/2004; 22(1):67-71.
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    ABSTRACT: Pyogenic infection of the intervertebral disc (discitis) is a rare infection and the diagnosis often depends on a high index of suspicion. The cases of infective discitis described in the modern literature are similar to, if not identical with what was described as 'typhoid spine'. Salmonella infection of the musculoskeletal system on the other hand is more common in patients with sickle cell anaemia. This case report highlights the bizarre presentation of infective lumbar discitis in a sickler (HbSS) and calls attention to the need for a thorough evaluation of low back pain in these patients.
    West African journal of medicine 10/2003; 22(3):267-8.
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    T O Alonge, S O Ogunlade, A B Omololu
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    ABSTRACT: From September 1995 to August 2001, we treated 25 patients with chronic osteomyelitis of long bones by a two-stage technique. This consisted of the radical removal of all infected bone and soft tissue and immediate provision of soft-tissue cover. This was supplemented when necessary with delayed autogenous bone grafting. The average follow-up was 46 months (range: 19-80 months). One patient with haemoglobin sickle cell disease (HbSS) died after the second stage of surgery. There were four recurrences, one of which followed a myocutaneous flap that became necrotic. Ankylosis occurred in five patients.
    International Orthopaedics 02/2003; 27(2):125-8. · 2.32 Impact Factor
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    ABSTRACT: Chronic osteomyelitis is a debilitating disease that is fairly common in developing countries. Various operative techniques have been adopted in the management of this disease but there have been few reports of their use in Africa. In this report, we present our experience of the use of a modified two-staged Belfast operation in patients with chronic osteomyelitis in Ibadan, Nigeria. An important modification of the procedure was the substitution of gentamicin beads (Septopal) with ceftriaxone-polymethylmethacrylate (PMMA) beads at the saucerised segment of bone at the first stage. Thirty-four patients with chronic osteomyelitis had the two-stage Belfast operation in 35 long bones; of these, 32 patients had ceftriaxone-PMMA antibiotic beads inserted at the saucerised segment of bone at the first stage, while the other two patients had gentamicin beads inserted. One of the two patients who had gentamicin beads had a residual collection of pus at second stage surgery but, following a repeat debridement, the cavity was rid of infection. There was recurrence of infection in three patients (8.6%) who had a suction drain inserted at the first stage and in six patients (17.1%) who had no suction drain at the first stage. The locally produced ceftriaxone-PMMA beads were found to be as efficient as the commercially available gentamicin beads in eluting antibiotics locally, thereby eliminating the residual infection in the bone cavities after the first stage. Another important outcome was a fourfold saving in cost in choosing to use ceftriaxone-PMMA beads rather than gentamicin beads.
    International Journal of Clinical Practice 05/2002; 56(3):181-3. · 2.43 Impact Factor
  • A B Omololu, T O Alonge, S A Salawu
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    ABSTRACT: Public symphysis diastasis is an uncommon condition which is caused mostly by severe trauma like road traffic accidents and fall from heights. We present cases of pubic symphysis diastasis following spontaneous vaginal delivery. This is to reiterate the fact that this type of public symphysis diastasis is different from other types of traumatic pubic symphysis diastasis and can be managed successfully with absolute bed rest.
    African journal of medicine and medical sciences 01/2001; 30(1-2):133-5.
  • T O Alonge, A B Omololu, S O Ogunlade
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    ABSTRACT: The management of bone loss following tumour resection poses a problem particularly in the upper limb where limb preservation is paramount. For bone loss less than 6cm, nonvascularized fibular graft has been advocated whereas in bone defects larger than this, vascularized fibular graft is the preferred option. In this case study, we have used a nonvascularized fibular on-lay graft (supplemented with cancellous bone graft) in the management of a distal radial bone loss of ten centimeters following resection of a giant cell tumour with remarkable success.
    West African journal of medicine 01/2001; 20(3):270-1.
  • A B Omololu, T O Alonge, A Adebisi
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    ABSTRACT: Supracondylar fracture of the humerus in children is one of the commonest fractures in children of school age all over the world. The experience of the mode of presentation, mechanism of injury and the different modalities of treatment in the University College Hospital, Ibadan is presented. The results suggest that severely displaced supracondylar fractures in this environment are better managed with open reduction and internal fixation.
    African journal of medicine and medical sciences 07/2000; 29(2):167-9.
  • A B Omololu, T O Alonge, A Ayantunde
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    ABSTRACT: Primary hyperparathyroidism is a recognized though relatively rare cause of multiple limbs fractures. We report a case in a young Nigerian adult. It is emphasize that primary hyperparathyroidism may be asymptomatic and therefore under-recognized in this environment because it is very uncommon.
    African journal of medicine and medical sciences 07/2000; 29(2):181-3.