Gold panner blast hand.

"Blast hand" is a traumatic hand injury related to an explosion. Artisanal gold miners use dynamite to excavate gold pits; such activities expose them to blast hand injuries. This work aims to study blast injuries to gold miners' hands. A 25-month retrospective study was performed. Data on the traumatic event, patients, and injuries were collected and analyzed. Dedicated classifications and scores were used to evaluate the injury topography, injury severity, physical dependence, and aesthetic impact. Data were analyzed statistically. Thirty patients with 46 blast hand injuries among 516 hand injuries were collected. All patients were males and full-time artisanal gold miners. They were seen in the emergency room an average of 10.2hours (1-72) after the explosion. Explosions were caused by a 500g dynamite charge in all cases. The detonation was mainly thermal (n=13), triggered by the patient himself (n=24) and inside the gold pit (n=20). Injuries were bilateral (53%) or left side predominant (59%). Complex injuries were present in 21 hands. The MHISS (Modified Hand Injury Severity Score) was severe (n=7) and major (n=32). Associated injuries were musculoskeletal (n=12), ophthalmologic (n=14) and maxillofacial (n=10). Complexes injuries were correlated to being inside the pit at the time of the explosion. Treatment was conservative more often (n=33) than amputation (n=13). The functional recovery was complete in 22 hands (10 patients). Return to work at the same level was possible for only eight hands (5 patients). The presence of local sequelae or associated injuries negatively impacted the return to work. In Burkina Faso, gold miner's blast hand injuries cause post-traumatic social and professional reintegration issues. Better regulation of artisanal gold mining and expansion of treatment modalities (microsurgery, hand rehabilitation, splinting) may improve the outcome.

Fractures de stress dans un centre hospitalier et universitaire en Afrique Subsaharienne

Introduction: La fracture de stress est une lésion de surmenage osseux. L'objectif de cette étude était décrire le profil de ces fractures dans un centre hospitalier et universitaire en Afrique subsaharienne. Matériels et méthodes: Cette étude prospective de janvier 2008 à décembre 2011 a concerné tous les patients ayant des douleurs ostéo-articulaires récentes et survenues après le début d'un entraînement physique intensif (entraînement militaire ou sportif). Nous avons étudié les caractéristiques sociodémographiques, les circonstances de survenue, le diagnostic, le traitement, et l'évolution. Résultats: Cette étude a concerné 17 patients. Treize fractures de stress ont été notées chez 11 patients. Il s'agissait de huit femmes et trois hommes âgés en moyenne de 21 ans. La symptomatologie douloureuse évoluait depuis trois semaines en moyenne. La fracture a concerné les os longs des membres pelviens. Le siège le plus fréquent était la jonction métaphysaire proximale du tibia. Deux fractures bilatérales ont intéressé la fibula. Le traitement a été non opératoire. La consolidation sans séquelle a été obtenue après six semaines. Au recul moyen de 20 mois tous les patients avaient une excellente récupération fonctionnelle. Conclusion: La fracture de stress est rare dans notre contexte et touche les recrues féminines de l'armée. La fracture siège surtout sur la corticale postéro-médiale du tibia. Leur évolution est simple

Traumatismes corporels chez les femmes enceintes a Bobo-Dioulasso; Burkina Faso

Objectifs : Determiner la frequence intra-hospitaliere des traumatismes corporels sur grossesse; identifier les circonstances de survenue et les types de traumatismes puis decrire le pronostic maternel et foetal Patientes et methodes : Il s'est agi d'une etude retrospective descriptive allant de 2007 a 2009; menee dans les services des urgences chirurgicales et obstetricales du CHU de Bobo-Dioulasso. Nous avons analyse les dossiers de toutes les femmes enceintes admises pour traumatisme corporel a la periode de l'etude. L'analyse des donnees a ete realisee avec le logiciel epi info version 6.0. Resultats : A la periode d'etude; nous avons enregistre 16053 admissions de femmes enceintes; soit une prevalence de 3;6. Les traumatismes ont concerne des femmes d'age moyen egal a 24 ans; menageres (74;1); citadines (81;1) et enceintes de 25 semaines d'amenorrhee. Les circonstances de survenue des traumatismes etaient les accidents de circulation (51;7); les rixes (29;30) et les chutes d'arbres (18;96). Il s'agissait de traumatismes abdominaux fermes (19); traumatismes des membres (10); traumatismes craniens (9); pelviens (4) et rachidiens (1). Le taux global des complications foto-maternelles etait 8;6 avec 17;2 de patientes decedees et 34;5 de morts fotales in utero. Conclusion : Les traumatismes au cours de la grossesse sont rares mais graves. L'on a deplore le deces d'une patiente et deux morts in utero dans cette serie. Se deplacer avec les engins a deux ou grimper dans les arbres doivent etre deconseilles aux femmes enceintes

[Bacterial profile of surgical site infections at Souro Sanou National Hospital Center in Bobo Dioulasso, Burkina Faso]. / Profil bactériologique des infections du site opératoire au centre hospitalier universitaire Souro Sanou de Bobo Dioulasso.

OBJECTIVE: The purpose of this study was to evaluate the bacterial profile and antimicrobial susceptibility of surgical site infection (SSI) as a basis for optimizing probabilistic antibiotherapy. MATERIALS AND METHODS: A 6-month transversal retrospective study was carried out at the Souro Sano Hospital Laboratory from November 1st, 2006 to April 30th, 2007. All positive pus samples collected for etiologic diagnosis of SSI were included. RESULTS: In a series of 681 patients who underwent surgery at the hospital, SSI was observed in 159 cases for an incidence of 23.4%. Pus samples for etiologic diagnosis were collected from 112 patients and led to identification of 103 bacterial strains. The most common strains were enterobacteriaceae in 54.0%, gram-positive cocci in 29.0% and non-fermenting Gram-negative bacilli in 16.5%. Escherichia coli was the most common species (30%) followed by Staphylococcus aureus (16.5%) and Pseudomonas aeroginosa (12.0%). Enterobacteriaceae resistance rates were 71% to amoxicillin, 64% to clavulanic acid-amoxicillin and 15% to third generation cephalosporin. Most S. aureus isolates (85%) were sensitive to methicillin. Non-fermenting Gram-negative bacilli resistance rates were 68.5% to carboxypenicillin and 56% to fluoroquinolones. CONCLUSION: These findings indicate that SSI can be treated using third generation cephalosporin-aminosides in combination with oral fluoroquinolones.

[Intrauterine ischemia of the right upper limb and hemiface: a case report]. / Ischémie in utero du membre supérieur et de l'hémiface droits: à propos d'une observation.

A case of ischemic gangrene of the right upper limb and hemiface noticed at birth is reported. It was a male baby born at term vaginally from a non diabetic mother. He was allowed in the surgical emergencies, 24 hours after the birth. The injuries were irreversible and required an arm amputation and a debridement of necrotic areas of the hemiface. The authors discuss the aetiology, the clinical features and the management of this rare condition.

[Olecranon osteotomy in the treatment of distal humeral fractures in adults: anatomical and functional evaluation of the elbow in 14 cases]. / L'ostéotomie de l'olécrâne dans le traitement des fractures de la palette humérale de l'adulte : évaluation anatomique et fonctionnelle du coude à propos de 14 cas.

Osteotomy of the olecranon is commonly used to gain exposure for reconstruction of bi-condylar fractures of the distal humerus (type 13-C of classification AO), but there is controversy because of the considerable complications inherent in this technique. The aim of our study is to examine the anatomical and functional consequences of this technique of exposure on the elbow. This is a retrospective study over a continuous 7-year period. We confined ourselves to patients more than 15 years old who had presented with a bi-condylar fracture (type C of the AO) of the distal humerus, internally fixed through an osteotomy of the olecranon. We reexamined and evaluated 14 treated patients who had been operated in our service. There were nine men and five women with an average age of 34 years (range 17 to 70 years). According to the AO classification, we found 14 fractures distributed in the following way: three type C1, seven type C2 and four type C3; the fracture was open in two cases. The osteotomy was carried out in all the cases using an osteotome, extra-articular in six cases and intra-articular way in eight cases. Repair was always performed using tension band wiring. The evaluation was based on anatomical and functional criteria (Mayo Elbow Performance Score). No case of radial and ulnar paralysis was found. Thirty-six percent of the olecranon fixations were of bad quality and we found one case of olecranon pseudarthrosis. No case of heterotypic calcification was found, on the other hand, there was a case of post-traumatic osteoarthritis of the elbow. On the functional level, we obtained 36% of excellent results, 28.5% of good results, 7% of average results and 28.5% of bad results. Osteotomy of the olecranon is one of the techniques for exposure of the articular surface during reconstruction of fractures of the distal humerus. A rigorous technique allows one to avoid complications.

Posterior surgical approaches to the elbow: a simple method of comparison of the articular exposure.

PURPOSE OF THE STUDY: Bilaterotricipital approach, triceps splitting and olecranon osteotomy are the three most common posterior approaches to the elbow. The aim of this study was to propose a simple technique to measure the exposure of distal articular surfaces of the humerus through these posterior surgical approaches. MATERIALS AND METHODS: Each approach was performed on ten cadaver elbows. After the completion of each approach, the visible articular surface was painted yellow. The elbow was then disarticulated. The unexposed articulated surface (by the approach) was painted blue. The painted surfaces were then wrapped using a net with meshes. The articular percentage of exposure was measured by calculating the mesh occupied by each painted surface. RESULTS: The median exposed articular surface for the bilaterotricipital approach, the triceps splitting and the olecranon osteotomy was 26, 37 and 52%, respectively. CONCLUSION: The method is easy to perform and is reproducible.

[Femoral neck fracture complicating orthopedic reposition of a dislocated hip: four cases]. / Fracture du col fémoral compliquant la réduction orthopédique d'une luxation de hanche: á propos de 4 observations.

Posterior dislocation of the femoral head with fracture is an exceptional hip injury. Emergency reduction is required. Reposition into the acetabular cavity of the dislocated femoral head may not be feasible. Irreducibility, instability, and more rarely accidental fracture of the femoral neck may also occur. We encountered this latter complication in four patients and report here its frequency and mechanism and propose preventive therapeutic measures. Seventy dislocations and fracture-dislocations of the hip were treated in our unit from March 1997 to February 2003. Among these cases, fourteen hip dislocations were complicated by femoral head fractures. Fracture of the femoral neck occurred during reduction in four. All four cases occurred in men, mean age 49.7 years, who were traffic accident victims (drivers or passengers). There were two Pipkin IV fracture-dislocations and two Pipkin II. The first reduction, achieved under general anesthesia in an emergency setting, was performed by an orthopedic surgeon in one patient and a general surgeon in three patients. Arthroplasty was used to treat the femoral neck fracture in three patients and pinning in one. We reviewed retrospectively the clinical and imaging data before and after reduction. Sub-capital fracture situated 4.0 cm (mean, range 3.5-4.5 cm) from the lesser trochanter occurred in all four cases. The head remained attached above and posteriorly to the acetabulum and was rotated less than 90 degrees . The fragment remaining in the acetabulum was displaced in two cases. In one patient, the fracture-dislocation of the head was associated with a fracture of the posterior rim of the acetabulum. This complication appears to result from an abrupt inappropriate reduction movement. The neck fracture would occur when capsulomuscular retention of the femoral head is associated with a head defect which catches on the rim of the acetabulum during the reduction movement. Neck fracture during reduction of traumatic hip dislocation is a serious complication. Prevention of this iatrogenic event requires a slow, progressive reduction limiting the trauma to a minimum; first intention open surgery may be required in selected cases.