Management of floating knees in adults: experience from tertiary hospital

Background: Floating knee is the term applied to the flail knee joint segment resulting from a fracture of the shaft or adjacent metaphysis of the ipsilateral femur and tibia. The fractures are often a result of high­energy trauma. Objectives: The aim of this study was to determine the pattern and distribution of these fracture types, mechanism of injury, associated injuries, method of treatment, complications, and the challenges encountered during the course of managing these patients. Patients and Methods: This is a retrospective study of all cases of floating knee injuries presenting to the Orthopedic Unit of Federal Medical Center and Surgery Department of Sir Yahaya Memorial Hospital all in Birnin Kebbi, Kebbi State, Northwest Nigeria, from January 2011 to December 2017. Data were extracted from the accident and emergency register, operation register, and patients' case folders. Data collected were analyzed using the Statistical Package for the Social Sciences for Windows version 22 (SPSS Inc. Chicago, Illinois, USA). Results: A total of 29 cases of floating knee injuries presented to the accident and emergency units. Males constituted 27 (93.1%) while females constituted 2 (6.9%). Motor vehicle accident was the most common mechanism of injury in 25 (86.3%) of the patients. The most common fracture type according to Fraser et al. classification is Type I which occurred in 12 (41.4%) of the patients. Conclusion: Floating knee injury occurs mostly in the productive age group. Head injury is the most common associated injury seen. This is mostly caused by motor vehicle accidents

Enclouage centromédullaire type « SIGN»: un traitement des fractures adapté aux conditions africaines

Objectif: Évaluer les résultats radiologique et fonctionnel des patients traités par enclouage centromédullaire verrouillé type SIGN pour fractures du membre pelvien. Matériel et méthodes: Cette étude prospective a été réalisée entre janvier 2012 et décembre 2013. Elle a concerné 82 patients traités pour fractures récentes du fémur ou du tibia par clou SIGN. Le recul moyen était de 7,2 mois. On notait 63(77%) hommes et 19(23%) femmes dont l'âge moyen était de 37ans avec des extrêmes de 15 et 85 ans. La cause des fractures a été un accident de la voie publique dans 60 (73%) cas. La fracture siégeait au fémur dans 53 (65%) cas et au tibia dans 29 (35%). Au fémur, l'enclouage était fait par voie antérograde (n=30;57%) ou rétrograde (n=23; 43%). Au tibia, l'enclouage a été fait à foyer fermé dans quatre cas. Le délai moyen d'hospitalisation était de 10 jours. Résultats: Soixante-quinze (91%) patients avaient un cal radiologique à 3 mois. Le délai moyen de consolidation était de 11 semaines. Une dynamisation a été nécessaire pour les autres patients. Soixante-treize (89%) patients n'avaient aucune douleur et pouvaient faire leurs courses et utiliser le transport public à trois mois de l'intervention. Trente-deux (39%) patients qui avaient un travail sédentaire l'ont repris dans un délai moyen de 7semaines. Nous avons noté deux cas d'échec de verrouillage et quatre cas d'infection superficielle. Conclusion: Le clou SIGN nous a permis d'obtenir de bons résultats anatomiques et fonctionnels avec une reprise de l'activité professionnelle et sportive dans les meilleurs délais

Les fractures des epines tibiales chez l'enfant : a propos d'un cas

Les fractures des epines tibiales chez l'enfant sont rares. Elles peuvent cacher une entorse grave du genou. Le diagnostic est evoque devant la triade clinique associant une hemarthrose; une douleur du genou et une impotence fonctionnelle du membre. Le plus souvent; ces signes se presentent a un degre variable pouvant faire errer le diagnostic qui est confirme par une radiographie standard en incidence de profil. Le traitement est orthopedique ou chirurgical en fonction du type lesionnel. Dans les 2 cas; l'immobilisation du genou en flexion ou en extension reste un sujet a contreverse. Notre cas etait traite chirurgicalement suivi d'une immobilisation platree de 6 semaines; genou en flexion a 15-20o. L'evolution etait favorable apres un an de recul

Epidemiology of open Tibial Fractures in a Teaching Hospital

) were males and the majority had at least a secondary education (86.7) and were single (95.1). Most of them (82.2) were aware of sexually transmitted infections; and 77.9were aware that condoms prevent transmission of HIV. Seventy-one percent of the young persons were sexually experienced (i.e. previously had sex); 12.9admitted they had previously had sex in exchange for money; and 63.4reported ever using a condom. Median age of sexual debut (sexarche) was 15.7 years. Most (82.1) of the sexually experienced were currently sexually active reporting sexual intercourse within the 6 months preceding survey. Nearly half (47.1) of these had sex with a casual and/or commercial sex worker without a condom.Conclusion: Young people are adopting sexual practices that are essentially high-risk; with severe implications for regional and national socio- economic development. This underscores the fact that they know only little and lack skills to protect themselves from being infected with HIV infections; even when they are sexually active. There is therefore need to advocate for and support initiatives that address reproductive health needs of young people in the Niger Delta region

Major trauma : from the grand surgical rounds: a presentation in the Makerere University Medical School Davies Lecture Theatre; August 1st 1996

A case was presented of a 60 year old male patient from Mubende who had met with the bonnet of a fast moving vehicle and sustained injuries to both lower limbs (with an open fracture of the right tibia). Primary suture of the pretibial laceration had been done. On the second day; he had been found to be tender in the epigastrium; and there was some swelling and pain under the rib margin on the left; so; with a diagnosis of rupture of the spleen; he was referred from Mityana Hospital to Mulago; after emergency splinting of the lower limb. At Mulago; he was found to be dehydrated; apyrexial; with a rapid pulse but a normal blood pressure. The wound just above the right ankle was dirty with a crusting of blood over it. His abdomen was distended; with guarding; dullness and tenderness in the left hypochndrium. Accordingly; he was diagnosed as having a ruptured spleen; and the injured organ was removed totally as he had an accessory spleen; so splenic conservation was not indicated. He made a reasonably straightforward post-operative recovery apart from an infection of the right tibial fracture. The article includes highlights on pathophysiology; complications; prognostic factors and lessons which include the danger of missing a rupture of an internal organ when there is an obvius fracture; and the danger of doing immediate primary suture of a tibial fracture in a case with multiple injuries

Enclouage centro-medullaire à foyer ferme à l'Hopital National de Niamey: à propos de 27 cas

Il a ete mene une etude prospective du traitement des fractures diaphysaires des os longs par enclouage centro-medullaire a foyer ferme. Ont ete traitees; 19 fractures femorales; 6 tibiales; 2 humerales. Vingt et une fractures siegeaient au tiers moyen et de trait transversal pur. Les complications ont ete rares; comparees aux autres methodes therapeutiques et les resultats fonctionnels bons : 21 patients sur 25 marchaient avec une canne a la fin du 1er mois; et 20 patients sur 25 marchaient sans canne a la fin du 2eme mois

Use of the Kalnberz external fixator on comminuted open fractures of the upper tibia caused by war injuries

Gunshot wounds of the tibia with considerable overlying skin loss frequently need flap cover; external fixation possibly bone grafting. Treatment of such injuries requires time. Rigid fixation of bone can be achieved by the use of an external fixator. If fractures are located in the upper third of the tibia only a few types of the external fixator will not compromise joint function. One such fixator is the Kalnberz apparatus. The Kalnberz fixator is a simplified version of the Ilizarov fixator. Its use involves a cruciform introduction of two pins in the plane. External fixation was first suggested by R Wittimoser (1949); but it was C A Ilizarov who began to develop the method in 1954

The use of cutaneous turnover flaps to replace skin loss in the leg

Soft tissue loss is a frequent accompaniment to open fractures of the tibia and chronic osteomyelitis associated with pseudarthrosis. In Mozambique most of these problems follow war injuries. There are many methods of closing these soft tissue defects; but the best way is the use of a flap. This paper describes the use of a one stage de-epithelialised cutaneous turnover flap in three patients. It is applicable to many circumstances and is quick and easy to perform