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Orthopedic disabilities in leprosy patients in Guinea-Bissau, West Africa
Leprosy is a chronic condition. Even after successful medical cure, skin and nervous lesions may persist and progress. Orthopedic lesions resulting in deformities and leading to disabilities may subsequently develop. These lesions are preventable by physical therapy and surgical interventions. Objectives: To describe the orthopedic lesions and disabilities associated with leprosy in Guinea-Bissau; to evaluate the adequacy of the provided care. Methods: Newly (ND) and previously diagnosed (PD) leprosy patients were enrolled at the Cumura Hospital. This Hospital manages and the totality of leprosy cases in Guinea-Bissau. We studied 82 leprosy patients (54 ND, 28 PD). Data was obtained from the direct observation of 36 patients and from the clinical records of 46 patients diagnosed during 2008. The usual clinical criteria for neurological impairment, WHO's "Maximum Impairment Score" (grades 0, 1, 2 of disability) and WHO's classification for leprosy - paucibacillary (PB) and multibacillary (MB) patients - were used to evaluate all patients. Results: The mean age at diagnosis was 41. In the ND group 37,0% were classified as being PB and 63,0% as MB. 10% of the PB presented with a grade 2 disability, while this degree of disability was found in 41% of the MB patients. The frequencies for each grade of disability in the ND group were: grade 0-48%; grade 1-22%; grade 2-29%. In the PD group these frequencies were respectively: 0%, 4% and 96%. In NDs, Grade 2 (maximum) disabilities were associated with involvement of the following nerves: median 38,7%; posterior tibial 35,5%; ulnar 19,4%; radial 3,2%; popliteal 3,2%. In PDs these frequencies were respectively: 28,7%, 30,4%, 32,2%, 0% and 8,7%. The more prevalent grade 2 disabilities included mutilation of the upper limbs (similarly present in NDs and PDs) and of the lower limbs (significantly higher in PDs). Plantar wounds and ulcers were more frequent in NDs. Claw hand was mostly observed in PDs. Conclusion: The mean age at diagnosis is high among NDs. MB patients constituted the majority of NDs and this form was associated with a greater disability. These findings must be considered in relation to the epidemiological situation and to the quality of diagnosis at the community level. Grade 2 disability affected preferentially PDs, possibly reflecting the combined effects of the standard of care and the progressive character of the disease itself. Observed affected nerves are in accordance with those described in the literature. Deformities potentially corrected by simple measures such as wound care were less frequent in PDs. Conversely, deformities requiring a more complex orthopedic approach were more frequent in this same group. Our results suggest that there is room for improvement in the preventive measures and orthopedic surgical procedures in leprosy patients in Guinea-Bissau.
Year of Publication
The Journal of bone and joint surgery. British volume
Number of Pages
J Bone Joint Surg Br