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 g/dl 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 typhirr\urium 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.