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Publications


2011

Njogu, SW, King’ori J, Obimbo MM, Ogeng’o JA.  2011.  OUTCOME OF DIABETES RELATED AMPUTATION IN RURAL KENYAN HOSPITALS. The Journal of Diabetic Foot Complications. 3(1):17-21. Abstract

Objective: To compare the outcome of diabetes related amputation with that of non-diabetic
cases in rural Kenyan Hospitals.
Research Design and Method: This was a retrospective study at Kikuyu and Tenwek hospitals in
rural Kenya involving 291 patients (228 males, 63 females) who underwent amputation between
January 2001 and December 2008. The cases were divided into those related to diabetes mellitus
and those due to other causes. Each category was examined for length of hospital stay, change
of amputation site, revision and infection.
Results: The majority (69.7%) of patients who underwent non diabetes related amputation had
a successful outcome compared to 41.7% of those related to diabetes mellitus. In diabetes
related amputation, hospital stay was longer, change of amputation site and infection were more
frequent compared to those due to other causes (p<0.05). n. Data were analyzed using statistical
package for social sciences (SPSS) for Windows version 11.50.

2010

Wandia, NS, John K'ori, M OM, A O'o J.  2010.  Pattern of Limb Amputation Among Rural Kenyan Children and Adolescents. JPO Journal of Prosthetics & Orthotics. 22(3):157-161. Abstractpattern_of_limb_amputation_among_rural_kenyan_children_and_adolescents.pdf

The causes of limb amputation among children differ between and within countries. These data
are valuable in prevention and planning of rehabilitation strategies for the victims but are
scarcely reported. The aim of this study was to investigate the causes of amputation in children
and adolescents in rural Kenya. Records of patients aged 18 years and younger who underwent
major limb amputation in PCEA Kikuyu and Tenwek Hospitals between January 1998 and
December 2008 were analyzed retrospectively for cause and age. Data were analyzed by SPSS
(version 11.50). Only complete records for age and confirmed diagnosis were included. Eightyeight
of 290 (30.3%) amputation cases were in individuals aged 2 weeks to 18 years. Trauma was
the most common cause (42%), followed by congenital defects (29.5%), infection (12.5%), and
tumors (11.4%). Of the trauma cases, burns were the most common cause (27%), followed by
animal bites (18.9%), road traffic accidents (16.2%), and falls (13.5%). A total of 77.2% of the
patients presented after the age of 5 years. The male:female ratio was 2:1. These data imply that
more than 70% of amputations among rural Kenyan children result from preventable causes that
may be related to poor socioeconomic status. Improvement of living standards, formulation of
public health education, and planning for rehabilitation programs are recommended.

2009

Kingori, J, Sitati C.  2009.  Outcome of Management of Humerus Diaphysis Non-union. East and Central African Journal of Surgery. 14(2):15-16. Abstract

Background: The majority of diaphyseal humerus fractures heal uneventfully when treated nonoperatively,
however, nonunion is not a rare event. Nonunion after conservative treatment can
be successfully treated by open reduction and internal fixation. A nonunion of a diaphyseal
fracture of the humerus can present a major functional problem. The main of our study was to
document the outcome of management of non-united diaphyseal humerus fractures with plate
or plate and rush pin fixation. Methods: A 4 year retrospective study was undertaken at
Presbyterian Church of East Africa (PCEA) Kikuyu Hospital, Orthopedic Unit in Kenya from April
2004 to April 2008. Records of consecutive patients with nonunion of the humeral diaphysis were
reviewed. Four cases were lost to follow up. The rest were treated with a single posterior,
anterior or anterolateral plate while four with a plate and rush pin construct. Autogenous iliac
crest bone graft was utilised in most of the cases. A clinical evaluation for union, range of motion
and complications. Radiological assessment for union was also done. Results: A total of 46
patients with humerus diaphysis non-union met the inclusion criteria. Their ages ranged from 23
to 95 years with a mean of 43.6 years. The overall healing rate was 92.8 % (39/42 cases) at 6
months follow up. 3 failures occurred of whom one was a smoker and diabetic, another had a
loose plate and screws following replating. The third case went to nonunion. Three cases of
postoperative radial nerve palsy all of which resolved within six weeks were documented. All four
treated with a plate and rush pin construct healed uneventfully. Conclusion: The results of this
study indicate that our standard surgical procedure for treatment of nonunion of the humeral
shaft is reliable with a 92.8% union rate in our study with few complications. The plate and rush
pin construct is useful in dealing with nonunion involving osteoporotic bone.
East

Kingori, J, Nguku L, Gakuu LN.  2009.  MELORHEOSTOSIS. MELORHEOSTOSIS. 3(1):10-11. Abstractmelorheostosis.pdf

This case study is a report on the rare mesodermal disorder typically characterized by abnormalities of the skeleton and soft tissues. We present a 56 years old woman who was diagnosed with melorheostosis affecting the left arm. Chronic pain odema and cosmetic deformities were her presenting problems. Melorheostosis is a bony dysplasia with characteristic X-ray appearance resembling wax dripping down one side of the candle. Soft tissue calcification and even ossification may rarely be seen. In some rare and complicated cases corrective surgery or amputation may be done in very painful and ischemic limbs (1). Until very recently the aetiology of melorheostosis was unknown but now it has been established that melorheostosis is due to a loss-of-function mutation in LEMD 3 gene (also called MAN 1), which encodes an inner nuclear membrane protein (2). This is the first reported case in this region. The purpose of this case report is to describe the presentation and course of the disease. A comprehensive review of literature describing etiology, clinical aspects, diagnosis and treatment is included. Patients symptoms vary considerable in melorheostosis and consequently their treatment should be individualized.

J. K. Kingori, Gakuu LN.  2009.  EPIDURAL INJECTION USE FOR LOW BACK PAIN ASSOCIATED WITH SCIATICA AT AN ORTHOPAEDIC CENTRE IN KENYA . East Africa Orthopaedic Journal. 6:61-62. Abstractepidural_injection_use_for_low_back_pain_associated_with_sciatica_at_an_orthopaedic_centre_in_kenya.pdf

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.

Kingori, J, Sitati FC.  2009.  Chronic bilateral heel pain in a child with Sever disease: case report and review of literature. Cases Journal. 2:10-11. Abstractchronic_bilateral_heel_pain_in_a_child_with_sever_disease.pdf

We are presenting a case report of a 10-year-old male with a 1 year history of bilateral heel pain. Sever disease is self limiting condition of calcaneal apophysis. It is the most common cause of heel pain in the growing child. There is no documented case of this condition in this region. This case highlights the clinical features of this self limiting disorder as seen in this patient and reviews the current literature.

Sitati, F, Kingori JK.  2009.  A Novel Treatment for Severely Porotic Humerus Non Union with Plate and Rush Pin: A Report of 2 Cases. The Internet Journal of Orthopedic Surgery . 14(2):7-19. Abstracta_novel_treatment_for_severely_porotic_humerus_non_unionwith_plate_and_rush_pin.pdf

The management of humerus non-union in severely porotic bone mainly encountered in the elderly is challenging .The incidence of nonunion is higher in cases involving porotic bones. Non unions can result in significant patient morbidity by limiting activities of daily living due to pain and loss of function especially in the elderly. The literature is replete with studies outlining the various methods of treating humeral shaft non unions with severely porotic bones following primary operative management. However no study describes combining a plate and rush pin together with cancellous bone graft for severely porotic humerus non unions. We have applied this technique in 2 cases of previously plated porotic humerus non unions in the elderly with good results. This technique could be a very useful procedure in underdeveloped countries and rural hospitals where facilities like methylmethacrylate, a plate with a blade and spiked nuts that lock the screws to the plate are not available.

Ogeng’o, JA, Obimbo MM, King’ori J.  2009.  Pattern of limb amputation in a Kenyan rural hospital. International Orthopaedics. 33(5):1449-1453. Abstract

Causes of limb amputations vary between and within countries. In Kenya, reports on prevalence of diabetic vascular amputations are conflicting. Kikuyu Hospital has a high incidence of diabetic foot complications whose relationship with amputation is unknown. This study aimed to describe causes of limb amputations in Kikuyu Hospital, Kenya. Records of all patients who underwent limb amputation between October 1998 and September 2008 were examined for cause, age and gender. Data were analysed using the statistical package for Social Sciences (SPSS) for Windows Version 11.50. One hundred and forty patients underwent amputation. Diabetic vasculopathy accounted for 11.4% of the amputations and 69.6% of the dysvascular cases. More prevalent causes were trauma (35.7%), congenital defects (20%), infection (14.3%) and tumours (12.8%). Diabetic vasculopathy, congenital defects and infection are major causes of amputation. Control of blood sugar, foot care education, vigilant infection control and audit of congenital defects are recommended.

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