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Publications


2013

Kigera, JW;, Gakuu LN.  2013.  Incidence of early post operative surgical site infection after primary total hip arthroplasty in the African setting. Abstract

Background: Implant orthopaedic surgery is associated with a risk of post operative Surgical Site Infection (SSI). This can have devastating consequences in the case of arthroplasty. Due to the less than ideal circumstances under which surgery is conducted in Africa, there are concerns that the risk of SSI may be high. Objective: To determine the incidence of post operative SSI after primary total hip arthroplasty. Design: A retrospective cohort study. Methods: All primary total hip arthroplasties done from 1998 to 2011 were reviewed. The incidence of infection was determined on follow-up of the patients. The study was approved by the hospital ethics committee. Results: The overall incidence of post operative SSI was 1.5%. Co-morbidities identified were not associated with an increased risk of infection. Increased duration of surgery and increased body weight were also not found to increase the risk of post operative SSI. Conclusion: The risk of post operative SSI after total hip arthroplasties is low in the African setting. Further investigation is recommended to identify modifiable risk factors that may increase the risk of SSI. Key words: Post operative, Surgical site infection, Arthroplasty, Primary total hip

2012

Gakuu, LN, H.Saidi, Ogeng'o J.  2012.  Prolapsed Intervertebral Disc In An African Population: Kenyan Experience. East African Orthopaedic Journal. 6 Abstract

Background: Characteristics of Prolapsed Intervertebral Disc (PID) in Africa, reports are scanty and
often disparate.
Objectives: To evaluate the distribution of PID by location, age, gender and predisposing factors among
African patients at our hospital, the largest regional referral and teaching hospital in Kenya.
Patients and Methods: Six hundred and three cases (267 males, 336 females) of prolapsed intervertebral
disc over 11 years between January 1997 and December 2007 were analyzed for location, number of
prolapsed disks, gender, age and predisposing conditions.
Results: Of the determined locations L4/5 was the commonest (42.3%), followed by L5/S1 (25.5%).
Seventy seven (20.9%) of the patients had multiple prolapsed disks. 1.4% were in the cervical region,
and only one in the thoracic. PID was commonest in the 31 – 50 year age group females (M: F is 1:1.26,
p=0.00), with mean age 40.90+13.80 years, (range between 11- 85 years).
Conclusions: PID in Kenya is commonest in the lower lumbar region of young people more in females
and is associated with trauma.

Gakuu, LN, Kingori JK.  2012.  EPIDURAL INJECTION USE FOR LOW BACK PAIN ASSOCIATED WITH SCIATICA AT AN ORTHOPAEDIC CENTRE IN KENYA. East African Orthopaedic Journal. 6 Abstract

Objective: To assess the effects of lumbar epidural steroid injections in patients with radiculopathy
(sciatica), by assessing reduction of pain at short term (3 weeks) and intermediate term (12 weeks).
Design: This was a prospective study done between August 2005 and July 2011 at Kikuyu Orthopaedic
and Rehabilitation Centre in Kenya involving 121 patients.
Methods: Patient selection was consecutive as the need for the epidural injection arose or was found
necessary. After the epidural injection, patients were followed up for 12 weeks.
Results: Of those followed up to the end, 58% reported significant pain reduction at 12 weeks. Four
patients had a repeat injection and two patients ended up being operated on.
Conclusion: Epidural steroid injection reduces pain in the majority of well selected patients with low
back pain associated with radiculopathy. This seems to be short lived though. There is need for this
patients to be followed up longer.

2009

Gakuu, LN, Bundi PK, Ogeng’o JA, Ongeti KW.  2009.  Treatment and Outcome of Herniated intervertebral Disk in A Referral Hospital in Kenya. Abstract

Prolapsed lumbar intervertebral disk (PID) disease can be managed conservatively or surgically with different outcomes. Objective: The present study aimed at assessing the management and outcomes of slipped intervertebral disk disease at the Kenyatta National hospital. Design: A retrospective cross-sectional study. Setting: Kenyatta National Hospital (KNH) a referral and teaching hospital in Kenya. Patients and Methods: Consecutive files of all cases of slipped intervertebral disk disease from January 1997 to December 2007 were retrieved from the Medical records at the Kenyatta National Hospital. The biodata, management methods and the outcomes of the procedures were recorded. The collected data were analyzed using the SPSS 17.0 for Windows. Results: Six hundred and three cases were reviewed. All patients received analgesics and bed rest. Five percent of the patients were put on bilateral traction for two weeks while 4% of the patients had corsets. Thirty five per cent of the patients were surgically managed. Over a third of the surgically managed patients had laminectomies. Microdiscectomy was increasingly popular in the latter half of the study period. Of the managed patients 95% reported improvement while 92% were complication free. The rate of reherniation and reoperation was 1.5% and 1.2% respectively. Conclusion: The management of PID at Kenyatta National Hospital is largely successful with few cases of complications. In selected patients both conservative and surgical care are used in tandem. Microdiscectomy is an increasingly popular surgical procedure at the KNH.

2005

Gakuu, LN.  2005.  Surgical wound infections: their causes and management.Review. East Afr Med J. 2005 Jul;82(7):329-30.. East Afr Med J. 2005 Jul;82(7):329-30.. : F.N. kamau, G. N Thothi and I.O Kibwage Abstract

Effects of calcium supplementation in patient at risk of pregnancy induced Hypertension. (This was an experimental double blind randomized clinical trial.) J. Obset. Gynaecol. East Cent.Afr 2005, 18:49-59

1999

Gakuu, LN, Kanyi SM.  1999.  Bennett's fracture: a direct volar surgical approach . East and Central African Journal of Surgery.. 4(2):21-24. Abstract

From cadaver dissections of the recurrent motor branch of the median nerve, we determined the exact relationship of its terminal branches at the base of the thumb. This enabled us to surgically approach the first carpometacarpal joint directly on the volar aspect for management of Bennett's fractures in 18 consecutive patients.

As compared with the different surgical approaches advocated and commonly used, the direct volar approach affords clear direct exposure of the intra-articular fracture at the base of the thumb so aiding appropriate reduction and fixation of the fracture. The proposed approach is safe and requires minimal dissection or soft tissue resection. The results were excellent and no case of nerve injury was encountered.

Gakuu, LN.  1999.  Avulsion of subscapularis muscle tendon leading to recurrent anterior dislocation of the shoulder . East and Central African Journal of Surgery. 4(4):35-38. Abstract

Fifteen patients, ten males and five females, were identified as having recurrent anterior dislocation of the shoulder after trauma due to avulsion of the subscapularis muscle tendon from its humeral attachment. The usual mechanism of injury was traumatic hyperextension or external rotation of the abducted arm. The right arm was involved in 12 patients and the left arm in only three patients.

The presenting symptoms were pain and weakness of the affected shoulder. Physical examination showed reduction of the passive range of joint movement and tenderness on the anterior aspect at the shoulder at the level of the intertubercular groove and a reduced range of internal rotation of the shoulder. The diagnosis was suspected from the history, physical examination and radiographs and was finally confirmed by surgical exploration.

The ages of the patients ranged from 20 to 45 years (mean 33 years). The dislocation was found to be due to a complete tear of the subscapularis tendon (12 patients) and partial tears in three patients, without fracture of the lesser tuberosity in any of the patients. The repair consisted of mobilization of the subscapularis muscle and its reinsertion into an osseous trough created in the humerus. The shoulder was splinted for six weeks in a Velpeau bandage before mobilization and physiotherapy. In two patients the subscapularis tendon was frayed and could not take sutures and therefore an allograft of tendo Achilles was used.

The patients have been followed up for an average of three years postoperatively. All have acceptable functional results but a reduced range of external rotation.

Keywords:Shoulder, recurrent dislocation, subscapularis tendon avulsion

1997

Gakuu, LN, Kabetu CE.  1997.  An overview on management of the traumatised elderly patient. . East Afr Med J. 1997 Jan;74(1):12-3.. : F.N. kamau, G. N Thothi and I.O Kibwage Abstract

The elderly are predisposed to injuries due to consequences of ageing and presence of disease process commonly seen in the old people. Age-related deterioration of senses such as decrease in hearing capacity, presbyopia, changes in co-ordination, balance, motor strength and postural stability render the elderly vulnerable to environmental hazards. Diseases such as dementia, congestive cardiac failure, postural hypotension, osteoporosis and arthritis further contribute to compound problems of the elderly. Age and chronic factors further blunt the reserves to enable an elderly individual meet the demands of trauma. The challenge to the clinician is to be aware of the subtle changes and deviation from the norm that may suggest development of complications. With careful attention and appropriate physiological support the elderly patient has a good chance of survival. The primary condition must be assessed, necrotic tissues must be debrided by thorough surgical toileting, pus must be drained, wounds sutured and fractures must be set while cardiopulmonary activity must be monitored accurately. The patient should be re-assured, kept warm and adequate analgesia given to relieve pain. Intravascular volume and composition of extracellular fluid must be maintained. Nutritional support should be provided in amounts needed to meet the higher demands of trauma and preferably by oral feeding. Above all multidisciplinary approach to the traumatised elderly is mandatory involving surgeons, physicians, physiotherapists and other paramedical staff and relatives.

NDEGWA, PROFGAKUULAWRENCE.  1997.  Gakuu LN. Recurrent anterior dislocation of the shoulder. East Afr Med J. 1997 Jan;74(1):12-3.. East Afr Med J. 1997 Jan;74(1):12-3.. : F.N. kamau, G. N Thothi and I.O Kibwage Abstract
Department of Orthopaedic Surgery, University of Nairobi, Kenya. Results of recurrent anterior dislocation of the shoulder are reported. The procedures used were mainly Putti-Plat in 35 patients; Eden-Hybinette in five patients and Webers derotation osteotomy of the humerus in five patients. Recurrence rates in the 45 patients reviewed and followed up at three years post-operatively were: six in Putti-Plat and two in Eden-Hybinette and none in Webers osteotomy patients. Clinically, the functional post-operative results were "excellent" in 32 patients (71%), "satisfactory" in eight patients (18%); while they were "unsatisfactory" in three patients and "poor" in two patients. There were no appreciable differences depending on the operative method used. Radiologically, the Hill-Sachs defect on the posterolateral aspect of the humeral head was seen in 30 patients (67%) while Bankarts lesion of the glenoid rim osteoarthritis was seen in five patients (11%), while rotator cuff calcification was seen in nine patients (20%).
NDEGWA, PROFGAKUULAWRENCE.  1997.  Gakuu LN.Review of methicillin resistant Staphylococcus aureus with special reference to handling of surgical patients. East Afr Med J. 1997 Mar;74(3):198-202. Review.. East Afr Med J. 1997 Mar;74(3):198-202. Review. : F.N. kamau, G. N Thothi and I.O Kibwage Abstract
Department of Orthopaedic Surgery, College of Health Sciences, University of Nairobi, Nairobi. The causes of post operative pyrexia in an orthopaedic unit was studied prospectively in 520 patients who underwent surgery. Two hundred patients (38.4%) developed postoperative pyrexia as defined by having recorded high temperatures of over 38 degrees C on two occasions within 24 hours (excluding the first 24 hours post-operatively). The commonest causes of post-operative pyrexia were wound infection in 70 (13.4%), respiratory tract infections in 40 (7.6%) and malaria in 30 (5.7%) patients, while other causes were urinary tract infection in 20 (3.8%), thrombophlebitis in 15 (2.8%) and deep vein thrombosis in 15 (2.8%) of the patients; while ten (1.9%) patients had pyrexia of undetermined cause despite exhaustive clinical and laboratory workup. The other associated conditions in patients who developed pyrexia were diabetes mellitus in 20 (3.8%), HIV seropositivity and malignancy in 30 (5.7%) and six (1.1%) patients, respectively.
NDEGWA, PROFGAKUULAWRENCE.  1997.  Gakuu LN. Solitary unicameral bone cyst. East Afr Med J. 1997 Jan;74(1):31-2.. East Afr Med J. 1997 Jan;74(1):31-2.. : F.N. kamau, G. N Thothi and I.O Kibwage Abstract
Department of Orthopaedic Surgery, University of Nairobi. This study discusses the results of the 24 patients who had unicameral bone cyst treated by the author surgically and conservatively between 1982 and 1992. The patients were sixteen males and eight females giving a male to female ratio of 2:1. Their ages ranged from two to 34 years with a mean age of 18 years. The long bones were commonly affected as follows: humerus in eight patients; femur in six patients; tibia in two patients. All were affected on the proximimal part of the bones, and there were three cysts found in the calcaneus. The main complaint was mild dull pain on the affected site. In some cases the pain was severe and associated with inability to use the affected limb. X-ray findings showed medullary cavity and adjacent inner cortical destruction with mild subperiosteal new bone formation causing an expansile appearance and multiloculation. At surgery, an area of bone expansion was found with weakened periosteum and underlying thin cortex which easily collapsed on pressure leading to a cavity containing yellowish fluid. The wall consisted of a thin membrane with ridges which was histologically reported as connective tissue with a few bone spicules. Surgical results were graded as "good" in 73% and "poor" in 27% due to recurrent, shortening or occurrence of sepsis. The bone metabolism studies and total blood count were normal.
NDEGWA, PROFGAKUULAWRENCE.  1997.  Gakuu LN. Post-operative pyrexia in an orthopaedic unit. East Afr Med J. 1997 Aug;74(8):530-2.. East Afr Med J. 1997 Aug;74(8):530-2.. : F.N. kamau, G. N Thothi and I.O Kibwage Abstract
Department of Orthopaedic Surgery, College of Health Sciences, University of Nairobi, Nairobi. The causes of post operative pyrexia in an orthopaedic unit was studied prospectively in 520 patients who underwent surgery. Two hundred patients (38.4%) developed postoperative pyrexia as defined by having recorded high temperatures of over 38 degrees C on two occasions within 24 hours (excluding the first 24 hours post-operatively). The commonest causes of post-operative pyrexia were wound infection in 70 (13.4%), respiratory tract infections in 40 (7.6%) and malaria in 30 (5.7%) patients, while other causes were urinary tract infection in 20 (3.8%), thrombophlebitis in 15 (2.8%) and deep vein thrombosis in 15 (2.8%) of the patients; while ten (1.9%) patients had pyrexia of undetermined cause despite exhaustive clinical and laboratory workup. The other associated conditions in patients who developed pyrexia were diabetes mellitus in 20 (3.8%), HIV seropositivity and malignancy in 30 (5.7%) and six (1.1%) patients, respectively.
NDEGWA, PROFGAKUULAWRENCE.  1997.  Kabetu CE, Gakuu LN.Anaesthesia in the elderly with special reference to management of orthopaedic patients. East Afr Med J. 1997 Oct;74(10):652-5. Review.. East Afr Med J. 1997 Oct;74(10):652-5.. : F.N. kamau, G. N Thothi and I.O Kibwage Abstract
Kenyatta National Hospital, Nairobi, Kenya. Elderly patients are placing increased demands on the health care resources in Kenya. The population of old patients has increased and complex surgical/orthopaedic procedures are being done on old patients. Due to the normal physiological alterations that occur with age, as well as the effects of common chronic diseases, elderly patients are less resilient than younger patients and are at risk of developing a variety of intraoperative and postoperative complications peculiar to their age. If and when complications develop in the elderly patients they have no reserves to withstand them and recovery is prolonged. In this article we review the factors that affect the peri-anaesthetic patients with special reference to orthopaedic and trauma elderly patients and we highlight the factors that may modify the treatment and surgery in these patients. We also recommend modifications for developing countries to lessen the financial burden on health care units.

1996

NDEGWA, PROFGAKUULAWRENCE.  1996.  Gakuu LN. An unstable fracture dislocation of the hip due to an occult free intra-articular fragment: case report. East Afr Med J. 1996 Sep;73(9):625-6.. East Afr Med J. 1996 Sep;73(9):625-6.. : F.N. kamau, G. N Thothi and I.O Kibwage Abstract
Department of Orthopaedic Surgery, College of Health Sciences, University of Nairobi, Kenya. A case report is presented of a 53 year old man who presented with posterior dislocation of the hip after a road traffic accident. Initial management by closed reduction failed due to presence of an occult free intra-articular fragment. This fragment was not visualised on plain A-P and lateral X-ray views. The cause of the failed closed reduction was eventually detected by CT scan. Open reduction and removal of the bone fragment was done and the hip remained stable thereafter. It is concluded that plain X-rays are not adequate in the diagnosis of free intra-articular bone fragments within the hip joint and CT scanning is advised for accurate detection of such occult bine fragments.
NDEGWA, PROFGAKUULAWRENCE.  1996.  GAKUU L.N. Unstable Fracture dislocations of the Acetabulum due to free intra articular fragments. East Afr Med J. 1996; 73: 625 . East Afr Med J. 1996; 73: 625 . : F.N. kamau, G. N Thothi and I.O Kibwage Abstract
The elderly are predisposed to injuries due to consequences of ageing and presence of disease process commonly seen in the old people. Age-related deterioration of senses such as decrease in hearing capacity, presbyopia, changes in co-ordination, balance, motor strength and postural stability render the elderly vulnerable to environmental hazards. Diseases such as dementia, congestive cardiac failure, postural hypotension, osteoporosis and arthritis further contribute to compound problems of the elderly. Age and chronic factors further blunt the reserves to enable an elderly individual meet the demands of trauma. The challenge to the clinician is to be aware of the subtle changes and deviation from the norm that may suggest development of complications. With careful attention and appropriate physiological support the elderly patient has a good chance of survival. The primary condition must be assessed, necrotic tissues must be debrided by thorough surgical toileting, pus must be drained, wounds sutured and fractures must be set while cardiopulmonary activity must be monitored accurately. The patient should be re-assured, kept warm and adequate analgesia given to relieve pain. Intravascular volume and composition of extracellular fluid must be maintained. Nutritional support should be provided in amounts needed to meet the higher demands of trauma and preferably by oral feeding. Above all multidisciplinary approach to the traumatised elderly is mandatory involving surgeons, physicians, physiotherapists and other paramedical staff and relatives.

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