Embrochage centromédullaire des fractures diaphysaires des os de l'avant bras chez l'adulte

Introduction - Les méthodes thérapeutiques des fractures diaphysaires déplacées de l'avant bras chez l'adulte sont variées. Le but de cette étude était d'évaluer les résultats de l'embrochage centromédullaire. Patients et méthodes - Cette étude rétrospective a concerné 45 patients opérés pour une fracture diaphysaire d'un ou des deux os de l'avant bras chez l'adulte. Les fractures étaient fermées (n=25), ou ouvertes (n=20 ). Le siège de la fracture était le 1/3 supérieur (n=5), le 1/3 moyen (n=35), et le 1/3 inférieur (n=5 ). L'ostéosynthèse a été réalisée à foyer ouvert avec des broches de Kirschner de 2,5 mm de diamètre (n=37) ou de 2 mm ( n= 8 ). Un plâtre de 8 semaines était posé après l'intervention. Nous avons étudié la réduction de la fracture, la cicatrisation cutanée, la consolidation, la fonction selon les critères d'Anderson, et les complications. Résultats - La réduction postopératoire était satisfaisante chez 43 patients. La cicatrisation a été obtenue chez tous les patients dans un délai moyen de deux semaines. La consolidation osseuse a été obtenue chez 43 (95%) patients dans un délai moyen de 90 jours. Au recul moyen de 24 mois, 32 patients ont été revus. Les résultats finaux étaient excellents (n=18) bons (n=5), moyens (n=5), et mauvais (n= 3). Un seul cas d'infection (2%) a été noté. Conclusion - Cette méthode donne de bons résultats. Elle est simple, rapide, et peu onéreuse. Cette étude suggère que l'embrochage centromédullaire peut constituer une alternative dans le traitement des fractures diaphysaires des os de l'avant bras chez l'adulte

[Surgical tetanus in Abidjan, Cote d'Ivoire]. / Tétanos à porte d'entrée chirurgicale à Abidjan, Côte d'Ivoire.

OBJECTIVE: To describe the epidemiological and clinical features and the outcome of tetanus with a surgical wound (open fracture, burn, incision, curettage, etc) as the portal of entry. METHODS: Cross-sectional analysis of records of patients hospitalized in the department of infectious and tropical diseases in Abidjan for surgical tetanus from 2003 to 2008. RESULTS: During the 6-year study period, 29 cases were identified. They accounted for 11% of all tetanus cases admitted to the hospital: 8% from 2003 through 2006 and 14% in 2007 and 2008. The patients' average age was 36 years (range: 11-72). Most cases (86%) involved recent surgery, in both public (51%) and private (49%) health facilities. All patients had generalized tetanus at admission, and 24 (86%) paroxysms. Moderate forms predominated (69%). The lethality of tetanus in these surgical wound cases was 45%. The characteristics statistically associated with death were: age >44 years, time of hospitalization >4 days, the presence of paroxysms, and a Dakar prognosis score ≥4. CONCLUSION: The severity of surgical tetanus remains a concern for practitioners. Its high prevalence in recent years demonstrates the need to increase surgeons' awareness of tetanus prevention.

[Relevance of the systematic culture of the intraoperative swab and drain tip of Redon in orthopaedic-traumatology surgery]. / Intérêt de la culture systématique du prélèvement per opératoire et du drain de Redon en chirurgie orthopédique et traumatologique.

BACKGROUND: Post operative infections are more severe complications in bone surgery. The first stage culture on drain tip or intraoperative swab are not well known according to clear, open and aseptic orthopaedic surgery to predict wounds infections. OBJECTIVE: To show the place of the systemic bacteriological culture of an intraoperative swab and the proximal tip of the Redon in bone surgery. METHODS: This was a prospective continuous series of 92 interventions performed in the service of Orthopaedics Traumatology of Treichville University Hospital (Abidjan, Côte d'Ivoire). The lesions included were allocated into three groups based on the National Research Council classification. Group 1 consisted of 50 subjects with clean lesions and hyper clean. Group 2 was made up of 25 subjects with clean lesions contaminated or contamined ab initio while Group 3 consisted of 17 patients with the septic lesions. Fifty six men and 36 women with an average age of 36.9 years had two types of swabs culture. In the first type sample of intra operative haematoma or the pus before using antiseptic products was used; the second type of culture used the proximal tip of Redon at the time of its ablation. These two swabs were put in a sterile vial and sent to the same laboratory for culture. RESULTS: The overall sepsis rate was of 24(26,1%). The microbial population was dominated by the gram negative bacilli, bacilli positive intraoperative cultures were most frequent in the group 3. 15 (88,2%). The positivity of the culture of the Redon was high in the group 2 (32%) and in the group 3 (52.9%). There was a significant difference between these two groups of surgery. The sensitivity, the specificity, and the predictive values were low. For all groups, the reports of likelihood observed didn't permit to establish a relation of cause or effect between a positive culture and the occurrence of post operative infection. CONCLUSION: The gram negative bacilli were mostly observed on the culture of the site of infection. Although there was no significant relationshionship, it appears from the frequency that there may be a clinical link between the positive culture and open fracture.

[The recovery process after orthopedic surgeries in CHU of Treichville, Abidjan]. / Les reprises precoces en orthopedie traumatologie au CHU de Treichville--Abidjan.

OBJECTIVES: Determine the frequency of early chirurgical recaptures, their causes and therapeutic indications in order to prevent them. INTRODUCTION: The early chirurgical recaptures have been proposed to prevent early post operative infections. This repeat intervention must stop post operative sepsis and the evolutive process. The therapeutic indications have been opened to different complications as mechanic and technical complications. This study permitted to determine the causes of this treatment and its interest in our daily hospital practice. TOOLS AND METHODS: This retrospective study covered a period of 5 years between January 2000 and December 2005. During this period, 2562 operations have been realised in our service, and 68 cases (2.65%) concerned early chirurgical recaptures. Only 46 patients were concerned by the study according to our criteria which was that the early intervention would be realised before 4 weeks after the first operation. RESULTS: The average age of patients was 37.6 does not equal 13.3 years with a frequency of ages from 20 to 39 years about 47.8%. The initial injuries were varied and dominated by open fractures (12 cases) and foot diabetic gangrenes (08 cases). The deadline of the help and technical short comings has equally formed etiologic factors. CONCLUSION: The indications of early recaptures in orthopaedic traumatology are various. The knowledge of these indications is necessary for the prevention of certain post-operation difficulties.

[Aneurismal bone cyst of clavicle: A case report]. / Kyste anévrismal de la clavicule: à propos d'un cas.

Aneurismal bone cyst is a rare tumour. The authors report an exceptional case in its clavicle localization. They review the diagnosis circumstances and treatment modalities of this pathology. The occurrence of the cyst is linked to vascular homodynamic disturbance and its discovery in a post-traumatic context has been assessed by the histology exam. Although numerous therapeutic trials, radical removal versus conservatory methods avoid relapse. Finally, resection of the clavicle leading to few functional consequences should be recommended for the cure of evoluted aneurismal bone cyst.