Fréquence et prise en charge des pseudarthroses traumatiques des os longs des membres à l'hôpital Matanda, en République Démocratique du Congo / Prevalence and risk factors for traumatic longbone pseudarthrosis at the Matanda Hospital, Butembo, eastern Democratic Republic of the Congo

Introduction : La pseudarthrose compte parmi les complications les plus redoutées des fractures et les plus difficiles à traiter. L'objectif de notre étude était de ressortir le profil épidémio-clinique des pseudarthroses à Matanda dans la région Nord-Est de la RDCongo. Méthodes : Notre étude était du type descriptif transversale ayant couvert une période allant du 01 Juin 2016 au 31 Mai 2019. Les données ont été tirées des dossiers d'hospitalisation. Le traitement des données a été réalisé par SPSS Statistics 17.0. Nous avons calculé la fréquence. Résultats : La fréquence des pseudarthroses a été de 3,72%, touchant surtout les femmes (83,3%), les adultes de 21-30ans (27,7%) et ceux de 61-70 ans 22,2%, les ruraux (69,4%), les cultivateurs (61,1%) et les moins instruits (50% niveau primaire et 36,1% niveau illettré). Le type de pseudarthrose le plus fréquent a été le type flottant (69,4%). Tous les cas de pseudarthrose ont été pris en charge par un Chirurgien orthopédiste, avec, dans la plupart des temps, une amélioration (77,7%). La complication la plus fréquente a été l'infection (19,4%) et l'issue défavorable la plus fréquente, l'amputation (11,1%). Conclusion. La pseudarthrose des os longs des membres demeure une complication fracturaire très invalidante à évolution imprévisible. La maitrise de sa chirurgie s'avère donc plus qu'urgente dans nos milieux.

Profil épidémiologique et clinique des fractures de la jambe à Kisangani-RDC

Introduction. Les fractures de la jambe sont des fractures diaphysaires ou métaphyso-diaphysaires, extra articulairesd'un ou deux os de la jambe.Elles constituent l'urgence la plus fréquente et la plus difficile à prendre en charge en traumatologie-orthopédique.La présente étude a pour objectif de ressortir le profil des patients avec fractures de la jambe et les classifierselon CAUCHOIX et DUPARC.Méthodologie.Une étude descriptive transversalea étééconduite du 1erseptembre 2007 au 1erseptembre 2017. L'étude a portésur 100 patients âgés de 10 à plus de 40 ans.Résultats.Les fractures des os de la jambe ont représenté15,8%des cas.Les adultes jeunes de 21 à 40 ans(53% des cas) etdusexe masculin(76% de cas) ont été plus affectés.Les fractures ouvertes ont prédominé sur les fractures fermées avec 57% de cas contre 43%dues aux accidents de trafic routier (84%).Elles étaient essentiellement de type I selon Cauchoix et Duparc (50,88%).Le traitement orthopédique a été le plus appliquée soit 72% de cas.Conclusion.Les fractures de la jambe sont fréquentes dans nos milieux et leurs prises en charge essentiellementorthopédique. Un effort doit être fourni dans la régulation de la circulation routière pour réduire leurs fréquences

Influence of positions on the incidence and severity of middle third facial fractures in vehicular and motorcycle crashes seen in a Tertiary Health Facility

Objective: The incidence of middle third facial fractures due to traffic crashes has increased tremendously. In developed countries, there is a gradual decline in traffic crashes as a result of effective compliance with road safety measures unlike in developing countries where the incidence is increasing due to non-compliance and ineffective enforcement of road safety laws, among other factors. The objective was to present the influence of positioning on the incidence and severity of Maxillofacial injuries in vehicles and motor bike crashes in a Nigerian tertiary health facility. Methods: A cross-sectional descriptive study of the influence of position of the patient on the incidence of middle third facial fractures presenting at a tertiary institution. Data were analysed using SPSS version 17. Results: There were more male than female in the ratio of 2.3:8:1 (M:F) and the mean age was 23.2 ± 3.4. Road traffic crash was the major cause of middle third fracture with 231 cases. Pillion passengers and front passengers on both motorcycles and vehicles were the most vulnerable passengers. Conclusion: There is a strong association between patient positioning and middle third fractures

Percutaneous fixation of fractures of forearm bones in children

Background: Forearm fractures are the most common fractures in children, representing 40 to 50 percent of all childhood fractures. The aim of this work is to evaluate the results of percutaneous intramedullary fixation of fractures of forearm bones in children. The aim of this work is to evaluate the results of percutaneous intramedullary fixation of fractures of forearm bones in children. Methods: Between February 2017 and February 2018, 12 patients who are younger than the age of closure of epiphysis exhibited to Zagazig General Hospital suffering from displaced fractures of shaft of both bones of the forearm, all patients were treated by closed reduction and percutaneous intramedullary fixation by K-wires with a period of (6 - 12) month with mean 6.6 moths follow up. Results: At the end of follow up, the operations were succeeding in all cases. According to Price et al criteria, 8 patients (66.7%) were classified as excellent results, 4 patients (33.3%) were classified as good results and no patients were classified as fair or poor results. No complication detected after the end of follow up period.Conclusions: Closed reduction percutaneous intramedullary fixation of pediatric displaced diaphyseal forearm fractures by K-wires is a safe, reliable, minimally invasive procedure and effective method of treatment. Based upon this study, it is concluded that displaced fractures of both forearm bones in children are preferred to be intramedullary fixed with K-wires when surgery is indicated with excellent and good results

Utilization of traditional healers services for the management of fractures in the town of Ngaoundere

Introduction. Dans les pays en voie de développement, particulièrement au Cameroun, la population utilise encore largement la médecine traditionnelle pour soigner les fractures. L'objectif de notre étude était d'étudier les facteurs favorisant les consultations chez les guérisseurs traditionnels et les conséquences de ce comportement sur la prise en charge. Méthodologie. Il s'agit d'une étude descriptive, transversale sur une période de six (6) mois. Nous avons colligé 102 patients. La collecte des données a éét faite au niveau des registres de consultation et des registres de compte rendu opératoire. Résultats. Le sexe masculin représentait 70,59%. Dans 35,30% il s'agissait des patients jeunes. Les accidents de la voie publique étaient la cause la plus fréquente (77,45%). Les conducteurs de motos étaient majoritaires (30,40%) et leurs jeunes passagers (étudiants et écoliers). Le manque des moyens financiers a été évoqué dans 53,92% des cas come facteur favorisant. En outre, 63,73% des enquêtés disaient être mal accueillis dans les formations sanitaires. Les complications les plus fréquentes étaient la nécrose cutanée (38,24%) et la gangrène (28,43%). Conclusion. L'importance de la prise en charge des fractures par les guérisseurs traditionnels est due à la fois à des raisons économiques et culturelles, et à la mauvaise qualité des soins dans les services de santé publics. Toutefois, cette prise en charge comporte des complications. La sensibilisation des usagers et des personnels de santé devrait contribuer à une meilleure fréquentation des formations sanitaires en cas de fractures

Open intramedullary nailing for segmental long bone fractures: an effective alternative in a resource-restricted environment

Background: Closed, locked intramedullary nailing has been accepted as the gold standard in the care of femoral fractures, with reported union rates as high as 98-100%. Closed, locked intramedullary nailing often requires expensive equipment which is a challenge in developing countries.Segmental long bone fractures are often a result of high-energy trauma and hence often associated with a lot of injuries to the surrounding soft tissues. This consequently results in higher rates of delayed or nonunion. This study was proposed to review the outcome of management of segmental fractures with locked intramedullary nails, using an open method of reduction. Methods: A retrospective analysis was made of data obtained from all segmental long bone fractures treated with intramedullary nailing over a 1-year period. Records were retrieved from the folders of patients operated on from January 2011 to December 2011. Patients were followed up for a minimum of 1 year after the surgery. Results: We managed a total of 12 segmental long bone fractures in 11 patients. Eight of the 12 fractures were femoral fractures and 10 of the fractures were closed fractures. All but one fracture (91.7%) achieved union within 4 months with no major complications. Conclusions: Open method of locked intramedullary nailing achieves satisfactory results when used for the management of long bone fractures. The method can be used for segmental fractures of the humerus, femur, and tibia, with high union rates. This is particularly useful in low-income societies where the use of intraoperative imaging may be unavailable or unaffordable. It gives patients in such societies, a chance for comparable outcomes in terms of union rates as well as avoidance of major complications. Larger prospective studies will be necessary to conclusively validate the efficacy of this fixation method in this environment

Notre experience sur la traction des fractures des os des membres inferieurs chez l'enfant a partir de la botte platree

Les auteurs rapportent leur experience de la traction des fractures des membres inferieurs chez l'enfant en se servant de la botte platree. Methodes: 296 tractions ont ete appliquees a l'hopital de Ndjili/ ISTM entre l'an 2000 et 2010. Resultats : avec 12 d'escarres par compression. Ce resultat parait meilleur en le comparant a celui obtenu par traction au sparadrap (34;7 des phlyctenes); en l'absence des bandes adhesives appropriees. Les escarres apres usage de la couche d'ouate suffisamment epaisse au talon et au dos du pied n'ont pas ete rapportees

Notre experience sur la traction des fractures des os des membres inferieurs chez l'enfant a partir de la botte platree

Les auteurs rapportent leur experience de la traction des fractures des membres inferieurs chez l'enfant en se servant de la botte platree.Methodes 296 tractions ont ete appliquees a l'hopital de Ndjili/ ISTM entre l'an 2000 et 2010 Resultats avec 12 d'escarres par compression. Ce resultat parait meilleur en le comparant a celui obtenu par traction au sparadrap (34;7 des phlyctenes); en l'absence des bandes adhesives appropriees. Les escarres apres usage de la couche d'ouate suffisamment epaisse au talon et au dos du pied n'ont pas ete rapportees.Conclusion Les auteurs ont resolu la difficulte materielle vecue devant les fractures des enfants dans les milieux a ressources limitees

Injuries in Children and Adolescents seen during 2006 at the Emergency Department of the National District Hospital; Bloemfontein

Most children and adolescents recover fully from injuries. However; permanent disabilities may occur. The objective of the study was to investigate the prevalence and profile of injuries in children and adolescents five to 19 years of age seen at the emergency department of the National District Hospital in Bloemfontein. Methods: A retrospective descriptive study was conducted. Demographic and injury-specific information obtained from hospital records of 2006 was entered into a data-capturing form. Data were analysed by using descriptive statistics.and 43.5 of injuries occurred in the age group 15 to 19 years. Approximately half (51.7) were Afrikaans-speaking and resided in suburban areas (50). Most injuries occurred at home (40.2) between 12h00 and 17h00 (38.7). Falls (33.7) were the most common cause of injury. Soft tissue injuries (35.9) occurred most commonly; fol lowed by lacerations (33.0) and fractures (16.7). Upper limb injuries (42.1) were seen more than lower limb injuries (27.8). Facial injuries occurred in 12 of cases. X-rays were performed in 57.9 of cases. Most patients (93.3) received medication; while 22 were referred for specialist treatment. All cases except one were discharged from the emergency department. Parents accompanied patients in 65.6 of cases. Results: The prevalence of injuries in this age group was 20.3. Two hundred and nine records were investigated. The majority of cases were male (68.3). The median age was 15 years; Conclusions: Optimal treatment should be given to the injured child or adolescent to avoid possible long-term injuryrelated sequelae. Preventive strategies should be formulated; enforced and evaluated

The Experience and Psychosocial Needs of Patients with Traumatic Fractures Treated for More than Six Months at Doctors on Call for Service Hospital; Goma; Democratic Republic of Congo

Trauma-related consultations; admissions and complications are the leading problems at Doctors on Call for Service (DOCS) Hospital; Goma; Democratic Republic of Congo; and yet no studies have been carried out to document the experience of long-stay traumatic-fracture patients in this hospital. Aim: The aim of this study was to explore the experience and psychosocial needs of patients with traumatic fractures treated for more than six months at DOCS Hospital. Methods: Six free-attitude interviews were conducted with purposively selected patients. The interviews were recorded with a tape recorder and transcribed verbatim; and content analysis was used to identify themes from the interviews. Results: All patients could clearly connect the injury experience to severe pain that lingered on for weeks or months for some patients; accompanied by other symptoms such as insomnia; poor appetite and psychological symptoms. Most patients felt disabled; were abandoned by relatives or friends and experienced financial problems. Some benefited from the injury by way of strengthened marital links. Some patients complained of poor information about their illness and the management plan and did not appreciate the treatment from caregivers; while some disclosed their needs and expectations and appreciated the caregivers who showed interest in them. Conclusions: The experience of long-term trauma has negative effects on the whole person of the patient; including his or her work and family; and some patients continue to suffer from the effects of the traumatic event up to six months later. The needs of patients suffering from trauma include reassurance by physicians and nurses; more information and participation in the decision-making process; regular visits from friends and family; and better bedside manners from caregivers

Osseous Union in Cases of Non-Union in Long Bones Treated by Osteosynthesis

Objective: To determine the incidence of osseous union in cases of nonunion of long bones managed by open reduction and compression plating. Patients and methods: Between November; 2003 and June; 2005; 53 patients with nonunion of long bones were treated by open reduction and internal fixation and followed up. The follow up period for each case was 6 months. Immediate post- operative x-ray was done in each case. Patients were seen in the post- operative period at 4 weeks; 6 weeks; 12 weeks; and 6 months. At each visit; clinical and radiological assessments were done. Result: The male to female ratio was 3:2; and the average age at presentation was 39.7 years (range: 19-64years). The average time from injury to presentation was 19.98 months (range: 6-132months). The commonest bone involved was the humerus (18); followed by the femur (17); the Tibia (11); the ulna (5); and the radius (2). Osseous union was achieved in 44 patients (83). There was no significant difference in incidence of osseous union among the various bones. It was observed that previous infection at the fracture site adversely affected osseous union. Conclusion : The management of nonunion in long bones by compression plating was found to be satisfactory

Radiological and clinical details of major adult limb fractures in a teaching hospital, AAU, Ethiopia

Background: This prospective study done at Addis Ababa University; Medical Faculty; Department of Radiology; Tikur Anbessa Hospital was aimed at determining the causes; magnitude; radiological and Clinical patterns of major limb fractures in adults in a half-year period from March to August 2007.In Addis Ababa University; fractures are managed both conservatively and operatively; but for lack of implants or expertise; patient which should have been treated surgically are managed conservatively and stay very long (average hospital stay of 11 days) in the Hospital. Such knowledge helps to plan on the management of the fractures and resource-recruitment. . Methods: This was a half-year cross-sectional higher institution based study of 422 adult patients with major fracture/s on the limbs. The study included all the major limb trauma patients who attended the 'surgical' and orthopedic Emergency department of T.A.U.H and had fracture at the same time. Data collection related to radiological variables was done by the research team to help reduce inter-observer measurement variability. ""Difficult"" patterns were discussed further. Results: During the study period there were a total of 422 orthopedic adult patients who sustained a major fracture of their limbs. Mean age was 35 years with a male to female ratio was 3:1. Pathological fractures were encountered only in two (0.5) patients. Nearly half (202; 48) of the traumatic fractures were due to road traffic accidents. The highest frequency of fracture occurred on the femur (68; 15); tibiofibular bones (63; 14) and the humerus (61; 13.5). A little less than half (44.1) half of the femur fractures were in the proximal one-third and about half of the tibiofibular fractures were in the distal third. Transverse fracture pattern was seen in about half of the fractures. Compound fracture occurred in 90 (21.3) of the cases. Thirty four (7.6) of the fractures involved the hand and only 13 (2.9) involved the foot bones. Conclusion: The very high proportion of closed long bone shaft fractures in a center with limited number of beds compels short Hospital stay using efficient operative fixations; including SIGN interlocking nails; plates and other implants.. Road traffic accidents (RTAs) were responsible for almost half of the fractures. Machine injuries and fall injuries were second and third respectively. As the proportions and patterns of the leading causes of adult traumatic fractures remained steadily high over the many years (other similar studies published by the author on this journal); due mutisectorial attention should be emphasized once again to dwindle their burden

Sport Related Stress Fracture of the Clavicle with Non-Union: Case Report and Review

Stress fractures are relatively uncommon sports injuries and when they do occur; are mostly found in the lower limb. Stress fractures of the clavicle are particularly rare; having been described in a number of non-sport related pathologies; such as nervous tics and post radical neck dissection. In sport; there have only been seven cases reported in the literature. We report on a clavicle stress fracture in a 47-year-old male; partaking in recreational weight lifting activities. This is the first reported case of a non-union stress fracture of the clavicle. The patient underwent an open reduction and internal fixation and made a full recovery

Etude des fractures du pied dans service d'orthopedie et traumatologie de l'hopital Gabriel Toure sur dix ans

L'objectif de ce travail etait de determiner les aspects epidemio-cliniques et therapeutiques des fractures des os du pied dans le service d'Orthopedie et de Traumato- logie de l'Hopital Gabriel Toure. Patients et Methodes : Il s'agit d'une etude retrospective descriptive portant sur 454 patients dans une periode allant de janvier 1996 a decembre 2005. Ont ete inclus les patients admis et soignes dans le service pendant la periode d'etude; qui avaient des fractures isolees du pied ou associees a d'autres fractures. N'ont pas ete inclus les patients avec des fractures du pied qui ont interrompu leur traitement hospitalier pour un traitement non conventionnel. Resultats : Le sexe masculin etait predominant (321 hommes; 133 femmes; sex-ratio 2;41). Les tranches d'age de 21-30 ans et de 31-40 ont ete les plus atteintes avec respectivement 32;38et 20;48(Tableau I). Les ouvriers etaient les plus atteints avec 28;41(Tableau II). Sur les dix ans; 2001 a enregistre le plus grand nombre de cas de fracture de pied avec 12;56(Tableau III). Les accidents de la voie publique et les accidents de travail ont ete les etiologies les plus frequentes avec respectivement 70;48et 20;71. Le pied droit a ete le plus frequemment fracture avec 55;95. Le metatarse a ete le plus atteint avec 50. Les fractures fermees du pied representaient 88;33; les ouvertes 11;67. Le traitement des fractures fermees a ete exclusivement orthopedique. Dans les cas de fractures ouvertes le parage chirurgical a ete effectue suivi de la contention orthopedique. La guerison a ete obtenue dans 60;79des cas. Les complications ont ete de 39;21parmi lesquelles les cals vicieux ont predomine avec 34;83(Tableau IV). Le resultat du traitement a ete bon dans 73;57des cas; moyen dans 17;62des cas et mauvais dans 8;81des cas. Conclusion : Les fractures du pied ont concerne plus les hommes et la profession ouvriere. Ainsi la couche la plus active de la societe a ete la plus exposee aux accidents de la voie publique et de travail. L'osteosynthese dans les formes complexes ou compliquees aurait pu ameliorer le pourcentage de nos resultats

Fractures pathologiques des membres; a propos de 43 cas Colliges sur 49 mois au service d'orthopedie-traumatologie de l'Hopital National Lamorde Niamey (Niger)

Introduction : Une fracture pathologique est une solution de continuite osseuse qui survient sur un os remanie. La fracture pathologique pose un double probleme : la gestion de la fracture et celle du processus pathologique fragilisant l'os. But : Le but de cette etude travail etait de contribuer a une meilleure connaissance des fractures pathologiques afin d'ameliorer la prise en charge. Materiels et Methode : Il s'agissait d'une etude prospective et retrospective lineaire; qui avait ete menee de Janvier 2003 a Janvier 2007.Durant cette periode de 49 mois ; qui avait concerne 43 patients. L'etude retrospective avait concerne 15 patients ; et l'etude retrospective 28 patients. Ont ete inclus dans cette etude les patients souffrants de fracture pathologique des membres; qui ont ete traites dans la periode de l'etude et qui avaient des dossiers exploitables. Resultats : Les fractures pathologiques touchent en grande majorite les adultes (age moyen 43 ans 5 mois).Le sexe masculin est legerement predominant; la couche socioprofessionnelle la plus affectee par ces fractures pathologiques est representee par les menageres. La douleur; la tumefaction et l'impotence constituent les principaux signes cliniques. La radiographie standard; face et profil; et la biopsie sont des examens permettant de faire le diagnostic. Le femur est le principal os touche : 26 cas sur 43. Les principales etiologies demeurent : les tumeurs osseuses malignes (37;2); l'osteoporose (23;2); l'osteomyelite 23;2; le rachitisme (6;2); l'osteogenese imparfaite (6;9) et la tumeur osseuse benigne (2;3). Le traitement a ete chirurgical dans 81;4des cas et orthopedique dans 18;6des cas. Conclusion : La prise en charge de la fracture pathologique des membres est souvent multidisciplinaire; et son but est de donner un meilleur confort au malade et de prendre en charge la maladie causale

Les fractures bilaterales de jambe de l'adulte traitees au Centre Hospitalier Universitaire d'Antananarivo

Objectif : Analyser les aspects epidemiologiques; diagnostiques; anatomopathologiques et therapeutiques des fractures bilaterales de jambe chez l'adulte au Centre Hospitalier Universitaire d'Antananarivo et d'en evaluer les resultats de leur prise en charge. Patients et methodes : Il s'agit d'une etude retrospective; sur une periode de 3 ans; colligeant 12 cas de fracture bilaterale de jambe; traites et suivis pendant au moins 6 mois. L'age; le sexe; les circonstances de l'accident; les types anatomo-pathologiques des lesions selon la classification de Gustilo et de Winquist; la conduite therapeutique ainsi que les resultats obtenus sont analyses. Resultats : Neuf cas de fractures de type I; 7 cas de type II; 4 cas de type III et 4 cas de type IV de Winquist etaient enregistres. Quatorze fractures etaient ouvertes chez 11 patients. Une amputation bilaterale de jambe etait realisee en urgence dans 1 cas. Le traitement orthopedique etait realise dans 1 cas. Dix patients avaient beneficie d'une osteosynthese en un seul temps operatoire. L'enclouage centromedullaire bilateral etait la methode de traitement dans la moitie des cas. Un cas d'osteite tibiale sur plaque vissee etait observe. Nos resultats anatomiques et fonctionnels sont juges satisfaisants malgre nos moyens techniques limites. Conclusion : Les fractures bilaterales de jambe sont relativement rares; le plus souvent observees dans le cadre d'un polytraumatisme. L'osteosynthese en un seul temps et en differee; quel que soit l'etat cutane est notre strategie therapeutique. L'enclouage centromedullaire; a foyer ouvert reste une alternative efficace dans notre serie

A self-assessment pilot study of facial aesthetics following prosthetic obturation in patients with surgically acquired partial maxillary defect

"Background: Improved and satisfactory facial aesthetics following prosthetic obturation of surgically acquired partial maxillary defect had been reported in several case reports involving one patient or two; but this number is grossly inadequate for a reliable deduction. Besides; literature is scarce on the relationship between facial aesthetics and the ""class of surgical defect"". Surgically acquired partial maxillary defect has earlier been classified into classes I to VI. Aims: To assess the perception of patients regarding their facial aesthetics following prosthetic obturation and to relate this finding to their classes of surgical defects. Methods: This prospective study was conducted in a tertiary dental centre; University College Hospital; Ibadan. Consecutive patients who had maxillary resection resulting in partial maxillary defect seen over a period of two years were admitted to the study."

Pattern and outcome of management of fractures in a Nigerian community

"Background: There has been increasing incidence of road traffic accidents and gun shot injuries in Benin City in the recent past. A major complication of these events is fracture of the bones. Various patterns of fractures are reported from different communities.Aim: To determine the pattern and outcome of fractures in Ikpoba Hill; a sub-urban community in Edo State.Methods: A retrospective study of all cases of fractures that presented to ""Our Medical Centre"" in Ikpoba Hill; a sub-urban community in Edo State between January 1998 and December 2004 was carried out. Parameters analysed included age; sex; and occupation; cause of fracture; site of fracture; associated injuries; treatment offered and outcome of management.Results: A total of 285 cases of fractures were seen over the period of study. There was a steady increase in the number of cases of fractures over the period of study. The 20 -29 years age group was more commonly affected (25.61). The male: female ratio was 1.9: 1. Civil servants and business people were most commonly affected (36.49and 24.56respectively). The humerus was the bone most commonly affected (24.32). Road traffic accident was the commonest aetiological factor accounting for 80. Some 69.47of the cases discharged themselves against medical advice to seek help with a traditional bonesetter. Head injury was the commonest cause of death (44.44). The average duration of hospital stay was 21 days.Conclusion: Road traffic accident was a common cause of fracture. The humerus was the bone most commonly fractured. Most patients with fracture prefer to patronize the traditional bone setters. Public enlightenment campaign should be mounted to discourage the attitude of most patients with fracture seeking help in traditional bonesetters' place."

A self-assessment pilot study of facial aesthetics following prosthetic obturation in patients with surgically acquired partial maxillary defect

"Background: Improved and satisfactory facial aesthetics following prosthetic obturation of surgically acquired partial maxillary defect had been reported in several case reports involving one patient or two; but this number is grossly inadequate for a reliable deduction. Besides; literature is scarce on the relationship between facial aesthetics and the ""class of surgical defect"". Surgically acquired partial maxillary defect has earlier been classified into classes I to VI. Aims: To assess the perception of patients regarding their facial aesthetics following prosthetic obturation and to relate this finding to their classes of surgical defects. Methods: This prospective study was conducted in a tertiary dental centre; University College Hospital; Ibadan. Consecutive patients who had maxillary resection resulting in partial maxillary defect seen over a period of two years were admitted to the study."

Primary unreamed and unlocked intramedullary nailing for open tibial fractures

Objective: The purpose of this study is to present our experience with the use of primary unreamed and unlocked nailing by the curved Kuntscher nail for open tibial fractures.Design: A retrospective study carried out between 1993 and 2003.Setting: Department of Orthopaedics Surgery; Yopougon Teaching Hospital; Abidjan; Coted'Ivoire.Patients and methods: A total of 154 open tibial shaft fractures in 149 patients were operated on by primary stabilisation with an unreamed and unlocked Kuntscher nail. Postoperatively; patients wore a leg plaster cast. Results: There were 124 men and 25 women with a mean age of 35 (16 to 72) years. Fractures werecaused in the majority of cases (130 cases; 87.2) by traffic accidents. Fractures were classified according to Cauchoix system into 96 grade I; 55 grade II; and 3 grade III. The duration of follow-up averaged nine (3 to 25) months. Infections (softtissue and bone) were encountered in 30 (19.5 ) fractures. 113 fractures (86.25 ) were primarily united with an average of 4.7 (two to six) months.Bone union was delayed for seven (5.3 ) fractures. Eleven (8.45 ) fractures developed nonunion. Malunion in valgus 10o was seen in three patients and in varus 10oin two. Rotational malalignment 10o was encountered in five patients