Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 28  |  Issue : 1  |  Page : 7-10

Pattern of congenital musculoskeletal anomalies in a suburban Nigerian tertiary hospital


1 Department of Orthopaedics and Trauma, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
2 Department of Orthopaedics and Trauma, Delta State University, Oghara, Delta State, Nigeria
3 Department of Surgery, Faculty of Clinical Sciences, Ambrose Alli University, Ekpoma, Edo State, Nigeria

Date of Submission28-May-2018
Date of Decision21-Feb-2019
Date of Acceptance29-Apr-2019
Date of Web Publication20-Jan-2020

Correspondence Address:
Dr. Edwin Omon Edomwonyi
Department of Orthopaedics and Trauma, Irrua Specialist Teaching Hospital, Irrua, Edo State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njss.njss_5_18

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  Abstract 


Introduction: Available data in congenital musculoskeletal anomalies (MSAs) in Africa are sparse; hence, we decided to evaluate the pattern of congenital MSA as seen in Irrua Specialist Teaching Hospital (ISTH), Irrua, Edo state of Nigeria. Materials and Methods: The clinical records of patients who presented to ISTH with congenital MSA over 10 years (January 2005–December 2014) were extracted and reviewed. Demographic data, diagnosis, description of abnormalities, associated congenital deformities, side of the body involved, and bilaterality were noted. Results: Seventy-five patients met the criteria. Fifty patients were male and 25 were female. Male: female ratio was 2:1. Congenital talipes equinovarus (CTEV) deformity was the most common MSA in 46 (61.33%) patients. Others were syndactyly in 20 (26.7%) patients and congenital constriction band syndrome in 4 (5.3%) patients. Among patients with clubfoot were a predominance of bilaterality involved with 44.7% in the idiopathic group and 62.5% of those in the nonidiopathic group. The idiopathic variety constituted 82.5% of clubfoot deformity. Spina bifida cystica was the most common associated deformity among patients with nonidiopathic clubfoot. Conclusion: CTEV was the most common congenital MSA seen in ISTH, Irrua, with a high incidence of bilaterality. Spina bifida cystica was the most associated anomaly in the nonidiopathic clubfoot in this center.

Keywords: Congenital, hospital, musculoskeletal anomalies, Nigerian, tertiary


How to cite this article:
Edomwonyi EO, Enemudo R, Morgan E, Omokehinde TJ. Pattern of congenital musculoskeletal anomalies in a suburban Nigerian tertiary hospital. Niger J Surg Sci 2018;28:7-10

How to cite this URL:
Edomwonyi EO, Enemudo R, Morgan E, Omokehinde TJ. Pattern of congenital musculoskeletal anomalies in a suburban Nigerian tertiary hospital. Niger J Surg Sci [serial online] 2018 [cited 2020 Aug 14];28:7-10. Available from: http://www.njssjournal.org/text.asp?2018/28/1/7/276112




  Introduction Top


According to the World Health Organization (WHO) document of 1972, congenital malformation should be confined to structural defect at birth.[1] A more recent WHO fact sheet of October 2012 defined it as structural and functional anomalies including metabolic disorders, present at birth even when diagnosed later in life.[2] They result in physical or mental disability and sometimes may even be fatal. They are one of the major causes of stillbirths, neonatal deaths, disabilities, and childhood health problems worldwide.[3]

Children with major congenital malformations represent 4% of live births with a higher rate in males than females (4.6% vs. 3.1%) (4.4% vs. 3.8%).[4]

Musculoskeletal, cardiovascular, central nervous system, and digestive systems are among various organs and systems, in which congenital abnormalities occur. Various studies have shown one or the other as the most frequently affected.

The incidence of congenital musculoskeletal anomalies (MSAs) in Nigerian children is 0.16%–0.55%.[5] According to a study done by the WHO, musculoskeletal defects are second most common birth defect after central nervous system anomalies with a prevalence of 51.12/1000 population.[6]

The pattern and prevalence of congenital anomalies may vary over time or with geographical location, reflecting a complex interaction of known and unknown genetic and environmental factors including sociocultural, racial, and ethnic variables.[7] With improved control of infections and nutritional deficiency diseases, congenital anomalies have become important causes of perinatal mortality in developing countries.[8]

Musculoskeletal defects seen in childhood occur when a part of or the entire limb fails to form normally during pregnancy.

Disruptive events such as amniotic band or vascular disruptions appear to be the most common cause of congenital MSA.[9],[10] Approximately 66% of major congenital anomalies have no recognized etiology, most of them have a multifactorial inheritance.[11],[12] Etiology of congenital anomalies can be divided into genetic (multifactorial: 20%–30%); single gene: 25% or chromosomal: 6%; environmental factors and teratogenic agents; maternal conditions (alcoholism, smoking, endocrinopathy, and nutritional deficiency); infections (rubella), mechanical problems; chemical agents; drugs such as thalidomide; radiation; hyperthermia; and unknown.[13]

Congenital MSAs are classified into three broad groups. Congenital defects of the upper limbs such as amelia, phocomelia, absence of forearm and hand, hand and fingers, club hand, radial club hand, absence of radius or ulnar, longitudinal reduction defect of ulnar, split hand. Congenital defects of the lower limb, e.g., amelia, phocomelia, absence of leg and foot, absence of foot and toes, aplasia or hypolpasia of toes with foot intact, absence or hypoplasia of foot with remainder of foot intact, longitudinal defect of the femur (proximal focal femoral deformity), tibia, or fibula, aplasia or hypoplasia of the tibia or fibula, split foot, talipesequinovarus, calcaneovalgus, and calcaneovarusdeformities Unclassified exomphalos/omphalocoele, gastroschisis.

Infants and children with a congenital musculoskeletal defect need specialized pediatric orthopedic care facility which can provide comprehensive care, right from diagnostic evaluation and surgery to prosthetic rehabilitation. It also calls for close coordination among obstetric, pediatric, and orthopedic departments from early recognition and comprehensive care of musculoskeletal defects under one roof.

There are few available reports on the pattern of congenital anomalies in Sub-Saharan Africa and none from Irrua Specialist Teaching Hospital (ISTH), Irrua, to the best of author's knowledge. Keeping all these facts in mind, an effort was made to bridge this gap by reviewing the pattern of congenital MSA as seen in our clinical practice in ISTH, Irrua, Edo State of Nigeria, which provides obstetric, pediatric, and orthopedic services.

The data and results from this study can help the government in policy-making, planning, and allocation of resources and funds for the development and the need for an appropriate pediatric orthopedic care facility at designated tertiary referral centers.


  Materials and Methods Top


This is a hospital-based, retrospective, descriptive study.

The clinical records of patients who presented at ISTH, Irrua, Edo State of Nigeria, with congenital MSA over 10 years (January 2005–December 2014) were reviewed.

All babies delivered in the hospital; referred to the orthopedic clinics from other hospitals; and admitted to the orthopedic, pediatric, and postnatal wards were included in the study. Those with incomplete records were excluded from the study. The records were flagged in the medical record department. Paediatric and orthopaedic clinics, Labor ward, paediatric orthopaedic wards were also involved. Data regarding sociodemographic data; diagnoses; description of abnormalities; and the presence of associated congenital deformities, side of the body involved, bilaterality, and modality of treatment applied were extracted. They were analyzed in simple frequencies and tables. The data were manually obtained and filled using a structured pro forma. Approval of the ethics committee was sought and obtained from the relevant authorities.


  Results Top


Over the period, 75 patients with clinical records of congenital musculoskeletal abnormalities were seen. One hundred and nine cases were flagged. Ninety-four case notes were retrieved, of which 19 had incomplete records. Fifty were male and 25 were female with a M:F ratio of 2:1.

Congenital talipes equinovarus (CTEV) deformity was the most common MSA seen in 46 (61.3%) patients in ISTH, followed by syndactyly in 20 (26.7%) patients.

Other congenital anomalies encountered include congenital band syndrome in 4 (5.3%) patients and flexion contractures of the fingers in 1 (1.3%) patient [Table 1].
Table 1: Spectrum of congenital musculoskeletal anomaly

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Thirty-eight (82.6%) patients had idiopathic CTEV which affected 55 feet, of them 17 (44.7%) had bilateral involvement; right side was involved in 12 (31.6%) patients and the left in 9 (23.7%) patients.

Eight (17.4%) patients had the nonidiopathic variety. Five (62.5%) patients had bilateral involvement, 1 (12.8%) patient had involvement of the right side, and other 2 (25.6%) patients were unstated [Table 2].
Table 2: Associated deformities seen in patients in non-idiopathic club foot

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Patients with clubfoot had serial manipulation and castings, elongation of Achilles tendon, and soft-tissue releases whereas others had triple arthrodesis. Separation with Z-plasty with or without skin grafting was performed on patients with syndactyly.

Patients with spina bifida were referred for neurosurgical intervention.

Congenital knee dislocation and calcaneovalgus deformity as well as deformities in patients with arthrogryposis multiplex congenita were also treated by manipulation and casting. The different varieties of deformities had their prescribed treatment applied. No mortality was reported.


  Discussion Top


Clubfoot was reported as the most common congenital musculoskeletal anomaly, consistent with the findings of other researchers.[5],[14] In contrast with other reports,[5],[15] polydactyly was not recorded in our report; instead, it was syndactyly which closely followed clubfoot. However, this is a hospital-based study. Rostamizodeh et al.[16] reported from North West Iran that congenital dislocation of the hip (CDH) was the most frequently encountered congenital musculoskeletal anomaly.

The clinical importance of club foot and the social and economic burden, calls for educational programs on congenital limb malformations for pregnant women, health care providers on ways of identifying cases and referrals made appropriately. Workforce should be developed to administer the appropriate treatment to minimize or correct the disability that may arise from neglected, inadequate, or wrong treatment of this highly treatable condition. Ponseti's method has proven efficacy in the treatment of clubfoot.[17],[18]

The musculoskeletal conditions identified were fairly widespread. This calls for enhancement in the training of pediatric orthopedists, to handle the myriads of problems arising therefrom, so as to reduce the disabilities resulting from this and improve the quality of lives of affected patients.

Orimolade et al.[19] reported 44.7% prevalence of spina bifida cystica in nonidiopathic clubfoot. We recorded 27.3%. This disparity may be due to the absence of neurosurgeons and neurosurgical facilities in our center during the period. This limits the number of neurosurgical referrals of patients with neural tube defects to our center.

A preponderance of male patients with congenital MSA with an overall M:F ratio of 2:1 was reported. This is consistent with the result of survey by other researchers.[5],[19] However, a few congenital anomalies such as CDH have been reported to have female preponderance.[20],[21],[22]

No mortality was recorded in our study. This is a common finding as other authors [19] have noted the same. Mortality seems to be lower for congenital anomalies affecting musculoskeletal system compared to major congenital anomalies of cardiovascular, gastrointestinal, or the central nervous system. Follow-up rate was low among our patients.

Being a hospital-based study was a limitation in this study. A tertiary care hospital does not have a specific catchment area. This may not be a true reflection of what obtains in the society.


  Conclusion Top


CTEV was the most common congenital MSA seen in ISTH Irrua, Edo state, with male preponderance. There was a relatively high rate of bilaterality. Spina bifida cystica was the most commonly associated anomaly in the nonidiopathic clubfoot variety.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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