Non-Transfusion orthopaedic Surgery in complicated fractures among Jehovah’s witnesses in Calabar, Nigeria: Case report

摘要

We report two cases of unusually complicated fractures in indigent Jehovah’s witnesses that were treated at the university of Calabar teaching hospital without any form of blood transfusion. Case reports Case OneA fifty-two year old male Jehovah witness presented to our facility with bilateral multisegmental fractures of the femur following a road traffic accident. After resuscitation and while plans were concluded on operative management of the fractures, patient left against medical advice. He reappeared two years later with multisegmental malunions and nonunions in both femurs. This time he came with severe hypertension (BP range 180/120-210/160). His haemoglobin was 7g/dl (PCV 29%) on admission but rose to 14 grams within 6 weeks of administering erythropoietin, dextran, and vitamin C. Patient also refused autologous transfusion. After the first open osteoclasis, reduction and plating his haemoglobin dropped to 7.5 g/dl and similar protocol of building up his haemoglobin was adopted before the second stage of operation. His major problems were: Poverty; but for the help from members of the Jehovah witness congregation, he had no funds to carry out the least investigation (Urinalysis) Anaemia Faith-based refusal of blood transfusion Severe hypertension Ankylosis of right knee joint Osteoporosis Complications of fractures comprising of multiple nonunion and malunion as shown below: