[Early evaluation of surgical treatment for patella fractures]. / Evaluation précoce du traitement chirurgical des fratures de la patella (rotule).

From mars 1989 to mars 1992, 26 fractures of the patella were treated surgically in the "Orthopaedic and Traumatological center in Dakar". We have evaluated the functional and the anatomical results. The mean age of the patients was 45 years. The most common mechanism was direct trauma (24 cases). We have registered 12 opened fractures, 24 displaced fractures and 13 comminutive fractures. Surgical methods were modified tension band internal fixation (18 cases), tension band wiring for fixation (5 cases) and circumferential wire loop fixation (3 cases). The mean follow-up was ten months. Only eight patients have adequate post-operative kinesitherapy. So functional results was poor in 50% of cases. The anatomical reconstruction of the patella were achieved in 18 cases. We have observed a relation between: anatomical results and inadequate indications; excellent functional results and adequate kinesitherapy. So the authors recommend modified tension band internal fixation in transversal fractures and fracture with central communication. Tension band wiring for fixation is used in others comminutive fractures. Post operative kinesitherapy must be realized in a adequate center and criteria of functional evaluation be wider theses.

[Chronic osteomyelitis at Dantec UHC , at Dakar]. / Ostéomyélite chronique au CHU A. Le Dantec, a Dakar.

The authors report 82 cases of osteomyelitis treated and followed up at the CHU Le Dantec, from March 1979 to September 1991. The patients were young, with an average age of 18 and a half years. Some susceptibility factors were identified: malnutrition (12.20%) and sickle cell anemia (26.83%). The infection was more frequently located on long bones of the lower limber (62.77%) and mainly on the metaphysis. Fistula forms with sequestra were the most frequent ones. Sixty-six patients were healed right after the first operation, 13 after two operations, 3 after three operations, the laters were mainly relapsing cases related to insufficient curreting of the infected bone or persisting sequestrum.

[Indications for arthrodesis of the knee in Africa (apropos of 24 cases)]. / Indications d'arthrodèse du genou en milieu africain (à propos de 24 observations).

29 knees arthrodesis was performed in 24 patients at the Orthopaedic Department in Dakar. The indications were: post-operative complications following poliomyelitis knee contractures in 11 cases, knee fusion following septic arthritis in 9 cases. The miscellaneous indications were tuberculosis of the knee (5 cases), post traumatic injuries (3 cases) and 1 case of knee osteo-arthritis. The authors pointed out the nature and diversity of those different indications and, now uncommon in developed countries, where knee arthroplasty is primary indication, whereas, arthrodesis is indicated for failures. They also point out the interest of the CHARNLEY procedure for this operation.

[Osteosynthesis of displaced fractures of the acetabulum with Letournel plate. Apropos of 14 cases]. / Ostéosynthèse des fractures déplacées du cotyle par plaque de Letournel. A propos de 14 cas.

Up to 1989, conservative treatment was used for fractures of the acetabulum at the Dakar teaching hospital, with in previous study, of poor result. The same authors present here their first experience of surgical treatment of displaced fractures of acetabulum using LETOURNEL plate at the "Centre de Traumatologie" of Dakar for three years. Fourteen patients (12 men and 2 women) presented after traffic road accident: fracture of posterior wall: 7 cases transversal fracture: 1 case complex fractures: 6 cases. Those displaced fractures were associated with hip dislocation in 8 cases. The initial emergency treatment by reducing the dislocation, associated with transfemoral pin traction was realized. At the day 7 through a posterior surgical approach in 11 cases and through a combined anterior and posterior approach in three cases. The anatomical reconstruction of the acetabulum was achieved in 12 cases. It's still early to make a final clinical assessment, but the early functional results using MERLE D'AUBIGNE's criteria (pain, lamenliss, mobility) are very good in 10 cases and poor in 2 cases. The reliability of the procedure, and the adequate post operative kinesitherapy is according to the authors the main indication for displaced fractures of the acetabulum.

[Mycetoma of the fingers. Apropos of 5 case reports]. / Mycétomes des doigts. A propos de cinq observations.

The authors report 5 cases of mycetomas of the fingers observed over a period of 5 years in a series of 18 mycetomas of the hand. In 3 cases, the lesion only involved the soft tissues, which were excised with 2 apparent cures after 2 and 5 years and one recurrence. In the other 2 cases, the bone was invaded and 2 digital amputations were performed without recurrence after 2 and 6 years. The authors review the epidemiology and histopathology of this disease as well as the absence of any truly effective medical treatment. In the presence of bone invasion, only excision can ensure cure.

[Neurotraumatic emergencies at the University Hospital Center in Dakar. Apropos of 120 injuries of the cervical spine]. / Urgences neuro-traumatiques au C.H.U. de Dakar. A propos de 120 traumatismes du rachis cervical.

In Senegal, traumas of spinal column are characterized not only by their high frequency and their etiology, but also and mainly by the extreme severity of their neurological lesions. A review of 120 traumas of cervical spine revealed: The importance of the neurological lesions (75%). The influence of the factors of severity and of the treatment. Global mortality rate of 35% raises to 46.46%, consequent on neurological lesion and to 85.71% consequent on total tetraplegia.

[Severe mutilations of the hand. Preliminary evaluation of a study of 24 cases in an African milieu]. / Mutilations graves de la main. Bilan préliminaire d'une étude de vingt-huit cas en milieu africain.

Mutilations of the hand are very frequent in Africa. More than any other disease, they destroy the hopes for a normal active life. The authors report the preliminary results of a study of 28 severe mutilations occurring between September 1983 and December 1985. The principal cause was traumatic, dominated by work accidents and household accidents. In the majority of cases, the anatomical defect was severe, but not always proportional to the functional and psycho-social repercussions. The inadequacies of the final result do not always depend on the simple and effective techniques used, but rather on a lack of appropriate rehabilitation and ignorance of the patient's needs, which include aesthetic aspects.