Dr Micheni Muthuuri - Orthopaedic & Trauma Surgeon

Orthopaedic & Trauma Surgeon

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Publications & Research Papers

The Evaluation of Unstable Lumbar-Sacral Junction with Function X-Rays Films

Dynamic radiographs are commonly used to demonstrate segmental instability by demonstrating a varying range of motion and sometimes paradoxical movement of its articulating elements. The disparity is observable and measurable at the opposite extremes of motion; maximum extension and fl exion. The level of dissociation within a segment that is responsible for the instability may be partial or complete. Partial dissociations are of two types, anterior or posterior and are referred to as anterior or posterior resistant failure. Complete dissociation is also referred to as circumferential failure.

Theoretically, measurement values should refl ect and diff erentiate these pathological processes. This study will look at any discernible patterns that would be useful indicators of instability.

These findings are correlated with MRI scans which show the level of disease.

Full Report [pdf]

Outcome of Plate Osteosynthesis in the Management of Proximal Humeral Fractures in Adults

This paper reports the aetiology, presentation and management of proximal humeral fractures (PHF) in our setup. Objective: To share our experiences with this relatively uncommon injury. The secondary objective is : to assess the functional outcome of plate osteosynthesis in management of displaced proximal humerus fractures (displacement of> 5mm or/ and angulation of > 45°).

This was a retrospective analytical study between January 2000 and December 2009 done at The Mombasa Hospital, Mombasa, Kenya.

All skeletally mature patients with fractures of proximal humerus that were seen and managed by the author between January 2000 and December 2009 were included in the study. Three patients who had pathological fractures from tumour and infection were excluded from the study. 

Full Report [pdf]

Determination of Posterior Tibia Slope and Slope Deterioration with Osteoarthritis: A Radiological Study in an African Population

The posterior inclination of the tibia plateaux relative to the longitudinal axis of the tibia is referred to as the posterior tibia slope (PTS). Posterior tibial slope is an important player in the kinematics of the knee joint.

The depth of the slope affects the pre and post-operative range of motion (ROM). Fore knowledge of the mean PTS in a given population is important in order to keep it as close to the normal range as possible during knee replacement. The PTS is also reported to affect the integrity of both cruciate ligaments, but perhaps more the anterior cruciate ligament. Theoretically, slope deterioration should lead to anterior cruciates strain and eventual degeneration.

In various studies and using diverse methods the slope has been found to range in adults from 0 to 18 degrees. Most of these studies have been done among the Caucasians, Asiatic or racial mixtures. There is paucity of information regarding PTS in the indigenous African population.

Full Report [pdf]

A Comparison of Accuracy of Clinical Tests and MRI in the Diagnosis of Meniscal and Anterior Cruciate Ligament Injuries

A careful clinical examination can safely diagnose almost all ACL injuries and most of the meniscal injuries. MRI should be reserved for more complicated and confusing cases. The routine ordering of an MRI scan of the knee before examination by a well-trained orthopaedic surgeon is not recommended.

This is more so true in resource limited economies and public hospitals in the developing world.

Full Report [pdf]

Management of Acute Musculoskeletal Pain

Acute musculoskeletal insult (injury and surgery) is very common. It is also one of the commonest sources of acute pain. Unfortunately, this pain is also commonly undertreated. This is because of various factors that include poor understanding of the subject, fear of pharmacologic agents, there uses and limitations. Untreated acute pain evolves to chronic pain which is more difficult to treat; and the result is the younger population of workers loose valuable time and the elderly become more morbid and incapacitated.

The purpose of this paper is to discuss the broad principles of multimodal and multi-agent approach to acute pain management for better patient care.

Full Report [pdf]

Characteristics of Patients With Diabetic Foot Ulcer Disease Between 2001 – 2005 in a Private Hospital, in Mombasa, Kenya.

The mortality associated with diabetic foot ulcer disease may be predicted by measurable characteristics. These parameters point to conditions that are themselves complications of diabetes mellitus and whose management will reduce mortality.

The management of diabetic foot is therefore, multidisciplinary. Amputation appears to carry an added risk and should not be rushed until the patient is fully resuscitated.

Full Report [pdf]

Prevalence of “Congenital Lumbar Spinal Stenosis” In Patients With Chronic Low Back Pain in Mombasa

Chronic low back pain is one of the commonest maladies of man. There are multiple causes of chronic low back pain that will include degenerative, inflammatory and mechanical causes. Developmental lumbar spinal stenosis (DLSS) is known to cause symptoms of axial back pain with or without leg pain in the young adult.

These symptoms become severer when patients with DLSS develop degenerative changes in the spine as the severity of theca sac and foramina compression increases.

We hypothesized that developmental lumbar spinal stenosis is a major predisposing factor for chronic low back pain (CLBP) in adult population.

Full Report [pdf]

Early Weight-Bearing after Ankle Fracture Fixation; a Prospective, Randomized And Non-Blinded, Outcome Study

In early 2006 during AO-scholarship training at Hadassah Hospital in Jerusalem, I witnessed patients being walked on the same day after fixation of ankle fractures. This was contrary to my original teaching of protected non-weight bearing for six weeks. Literature review in this subject was inconclusive.

I then determined to study and compare the functional benefit of early weight-bearing as compared to non- weight-bearing in these patients.

Full Report [pdf]

Non-Pulmonary Causes of Acute Respiratory Distress In Neonates: 2 Case Reports

Congenital diaphragmatic hernia (CDH) and oesophageal atresia with tracheo-oesophageal fistula (TOF) is known to cause respiratory distress in neonates. Both conditions are uncommon and have an incidence of about 1 out of 4,000 live births. Differential diagnoses include pneumonia and/or meconeum aspiration.

We present two cases that were managed in our health facilities in Mombasa, Kenya.

Full Report [pdf]

Outcome of Management of Supracondylar Fractures of Humerus in Children

Supracondylar fracture of humerus in children is very common indeed.  Every doctor has some idea of how to manage this injury.  Often however, the treatment is inadequate or inappropriate and this occasionally leads to severe complications such as cubitus varus, elbow stiffness and ischaemic contracture formation following compartment syndrome.

There are various treatment modalities i.e. casting, traction, percutaneous pinning and open reduction and internal fixation.  The treatment modality chosen should be informed and aimed at optimum result.

Full Report [pdf]

Mirizzi Syndrome, A Case Report

Mirizzi syndrome causing obstructive jaundice is rarely seen in Africans.  Obstructive jaundice due to gall bladder calculi is even less common in young African men.  A case of this condition in an adult male is presented.  More common precipitating factors for lithiasis such as haemolytic diseases, sickle cell disease and obesity were not found.   Cholecystojejunostomy was performed for suspected periampularly tumour but jaundice recurred within 9 months. 

Diagnosis was suspected after cholangiography and confirmed at surgery.  The biliary ducts were dilated with complete stenosis of the distal CBD.  The cystic duct was completely stenosed.  No calculi were found in the cystic duct or the Hartman’s pouch.  Choledochojejunostomy was finally performed and the patient recovered.

Full Report [pdf]

Priapism in Type II Diabetes Mellitus, a Case Report

Priapism in type II diabetes mellitus is an uncommon event.   A case of this condition in an adult male is presented.  More common precipitating factors such as use of medications such as sildenafil or use of an intracarvenosal vasodilator was absent, although diagnostic investigations postulated the cause as thrombotic factors in type II diabetes. 

A cavernosal-spongiosal shunting procedure was performed and a cystofix inserted to divert urinary flow.  However, due to the late presentation of the priapism and the concurrent infection, much erectile tissue was damaged and normal function of the organ could not be restored.

Full Report [pdf]

Male Infertility, an Original Report

Male infertility in Mombasa appears to be primarily due to hypogonadism (23%), although in an equal proportion the cause is not obvious (idiopathic). A significant number of the infertility cases can be attributed to easily treatable conditions such as infections and infestations (16%).

The sample available is however not big enough to warrant any major conclusions as to the overall male infertility status in Mombasa.

Nevertheless, this study is important in its groundbreaking function of establishing possible avenues for future research.

Full Report [pdf]

Common myths about Total Joint Replacements

Only Surgeons from outside Kenya can perform these surgeries.

Nowadays all facilities for TKR & THR are available in Mombasa. The facilities include competent & experienced Orthopaedic surgeons along with required infrastructure. Special care is also given in the crucial postoperative period & rehabilitation.

Read more: Common myths about Total Joint Replacements

Featured Research Papers

The Evaluation of Unstable Lumbar-Sacral Junction ...
25 May 2018
Dynamic radiographs are commonly used to demonstrate segment... More detail
Outcome of Plate Osteosynthesis in the Management ...
25 May 2018
This paper reports the aetiology, presentation and managemen... More detail

About Dr J. M. Muthuuri

Orthopaedic & Trauma Surgeon.

Dr J M Muthuuri is a registered board surgeon who has undergone training in various countries (UK, Israel and South Africa). He has 28 years of experience as a doctor, 10 years of Orthpaedic Trauma. He is based at The Mombasa Hospital.

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