ABSTRACT
PURPOSE OF THE STUDY: The aim of this study was to report the different anatomical types, associated injuries, morbidity and mortality of pelvic ring disruption in child in Dakar traumatological centers. MATERIAL AND METHODS: [corrected] Forty seven children were admitted in two of three traumatology centers in Dakar between 1968 and 1992. This retrospective and intermittent study excluded tendon-bone avulsions and acetabular fractures. Twenty eight boys and nineteen girls presented a fracture with or without ring disruption according to Ducloyer and Filipe classification. In this first group, they make difference between an isolated or combined fracture and distinguished an anterior and a posterior one. Forty five children were treated by a non-operative methods. RESULTS: Forty three boys and girls sustained their injuries in a pedestrian-motor vehicle accidents and 4 among were struck by a truck. A massive fracture-dislocation with complete pelvic disruption was found in 70.3 per cent. Half of them (34.4 per cent) presented an anterior isolated anatomic type. In the other group the high energy forces caused major pelvic instability and also various associated soft-tissue injuries. The majority of complications were open pelvic fractures (21.1 per cent), genito-urinary (34.4 per cent), vascular (16.6 per cent), neurological and perineo-rectal injuries. Four children (8.4 per cent) died. At the last review others presented orthopaedic, genito-urinary, neurological or perineo-rectal sequelae. DISCUSSION: The frequency of pelvic fractures in child present a peak between 6 and 12 years old. These types of fractures are the results of a high energy injury in pedestrian motor vehicle accidents in Dakar suburbs. The anatomo-radiographic types had an interesting bimodal pattern: Among the benign types: a double fracture of the iliopubic ramus is dangerous for the bladder (1 case), and leads to a dysplastic acetabulum with time (1 case). Unstable fractures (70.3 per cent): some of them (23.3 per cent) present a complex dislocation of the pelvis. The present review focuses on double urethral injuries (2 cases), open pelvic fractures (10 cases) and mortal hemorrhagic shock (4 cases). The morbidity rate is high (38.4 per cent) caused by skeletal and soft-tissue sequelae and also management difficulties. CONCLUSION: Pelvic fracture in children requires early diagnosis and management. In our countries, morbidity and mortality of these injuries must decrease with the popularization of road safety, multidisciplinary management and improvement of working conditions.
Subject(s)
Accidents, Traffic , Fractures, Open/surgery , Pelvic Bones/injuries , Adolescent , Child , Child, Preschool , Emergencies , Female , Follow-Up Studies , Fractures, Open/diagnostic imaging , Fractures, Open/etiology , Humans , Male , Multiple Trauma/complications , Pelvic Bones/diagnostic imaging , Pelvic Bones/surgery , Postoperative Complications , Prognosis , Radiography , Retrospective Studies , Senegal , Ureter/injuriesABSTRACT
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.
Subject(s)
Acetabulum/injuries , Fracture Fixation, Internal , Fractures, Bone/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , SenegalABSTRACT
In a single case review the authors recapitulate the different methods for the presentation of sacro-ilial infectious and underscore imagery techniques which are of prime importance in diagnostic work. X-rays can only reveal advanced sacro-ilial bone joint lesions which are under-evaluated. In the absence of HI-Tech imagery, surgical biopsy must be widely recommended to identify the germ and allow early diagnosis.
