ABSTRACT
In trauma and orthopaedic practice, the management of segmental bone loss constitutes a major challenge to the surgeon. Several methods have been employed in bone reconstruction with varying objectives depending on the size of the defect in question. A gap of not more than 2cm may benefit from acute docking and fixation, 4cm gap can be managed by non-vascularized structural or non-structural graft with fixation. Gaps of more than 4cm can be managed by numerous options which include allograft, vascularized structural graft and distraction osteogenesis with either linear rail system (LRS) or Ilizarov device. Masquelet technique of induced membrane formation is used to bridge a gap of more than 5cm and up to 25cm using bone cement as a spacer in first stage and use of autologous cancellous bone graft in the second stage.
En traumatologie et en orthopédie, la prise en charge de la perte osseuse segmentaire constitue un défi majeur pour la chirurgien. Plusieurs méthodes ont été employées dans la reconstruction d'os avec des objectifs variables en fonction de la taille du défaut en question. Un écart de pas plus de 2 cm peut en bénéficier de l'amarrage et de la fixation aigus, un écart de 4 cm peut être géré par structurelle non vascularisée ou greffe non structurelle avec fixation. Les espaces de plus de 4 cm peuvent être gérés par de nombreux options qui incluent allogreffe, greffe structurelle vascularisée et ostéogenèse par distraction avec l'un ou l'autre des systèmes de rails linéaires (LRS) ou appareil Ilizarov. Technique de Masquelet d'induit la formation de la membrane est utilisée pour combler un espace de plus de 5 cm et jusqu'à 25 cm en utilisant du ciment osseux comme espaceur dans la première étape et l'utilisation d'une greffe d'os spongieux autologue dans la deuxième étape. Mots clés: Défaut osseux segmentaire, ostéogenèse par distraction, technique de membrane induite, espaceur de ciment osseux.
ABSTRACT
Extremity gangrene is a fairly common pathology, which complicates systemic vascular and endocrine diseases. Most often, it is encountered in diseases like uncontrolled Diabetes Mellitus, presenting as diabetic foot gangrene, severe peripheral arteriosclerosis with gangrene of the extremity complicating severe uncontrolled systemic hypertension and meningococcal septicaemia with peripheral gangrene. It also occurs in some cases of snake bite as well as frost bite (in regions with extreme cold weather conditions). Some of them present as monolateral extremity gangrene. However, others present as bilateral symmetrical peripheral gangrene (SPG) characterized by bilateral extremity ischaemia resulting in gangrene in which there is no major vascular occlusive disease. There is disseminated intravascular coagulation with the gangrene being considered as a cutaneous marker and some of the patients that survive ultimately require amputation of the affected limb(s) in the severe cases. The mild cases end up losing some of the digits or just exfoliation of the dead cutaneous layer. The effects are generally more severe in the lower limbs than in upper limbs. Notable among these are some of those complicating meningococcal sepsis resulting from peripheral intravascular coagulation. We present here, five patients who presented with varying degrees of peripheral gangrene during an epidemic of meningitis and the treatments that were carried out depending on the severity of their cases.
