Orthopaedic aspects of sickle-cell disease at Kenyatta National hospital

Abstract

A retrospective study of 100 patients with orthopaedic aspects of sickle-cell disease was carried out. Males and females were almost equally affected in a ratio of 1.3: 1.2. A half of the patients (50%) were below 5 years of age and the least number was after 20 years of age. Most patients originated from Nyanza province (76%) followed by Western province (19%) with a few from Rift Valley and Coast provinces (1% and 2% respectively). Most patients presented generally with pain (87%) and swelling (82%) while nearly a half had fever (49%) and limping or loss of function of the affected limb (41%). Swelling, tenderness and warmth were the predominant local signs in percentages of 83, 68 and 31 respectively. The mean haemoglobin level was 7.8 gldl in the 86 patients who had results in the file. The majority of patients were HbSF (55%) and followed by sickle-cell anaemia (HbSS - 35%). Blood culture and pus swab specimens taken from patients with osteomyelitis and septic arthritis had no growth demonstrated in 31 patients (57.4%) while isolation was done in the remainder of patients. Bacterial isolates revealed Salmonella typhimurium to be the predominant organism (8patients (14.8%) and 4 patients (30.8%)) in osteomyelitis and septic arthritis respectively. Radiologically the limbs (appendicular skeleton) was dorminantly affected (99.5%). 119 lesions were diagnosed in the study group. Osteomyelitis ranked first (45.4%) followed by hand and foot syndrome (dactylitis) (24.4%) in the clinical diagnosis. Entities of respective orthopaedic aspects of sickle-cell disease such as haemoglobin electrophoresis, anatomical sites, treatment, results and complications are discussed.