Reconstruction of traumatic bone loss using the induced membrane technique: preliminary results about 11 cases.

INTRODUCTION: The use of Masquelet technique is a serious option to consider for biologic reconstruction of severe bone loss. Here is exposed a continuous and prospective study on bone loss management using that technique. The aims of this study were to assess epidemiology of bone loss due either to trauma or to non-unions and to give preliminary results. PATIENTS AND METHODS: It was a prospective study from April 2015 to december 2016 involving patients treated using the induced membrane technique for a diaphyseal bone defect due either to trauma or non-unions. AO plates or Orthofix external fixators were used for osteosynthesis. Bone healing was radiologically assessed and any complications were listed. RESULTS: During the study period, 11 patients were treated using the induced membrane technique. There were 8 males and 3 females. Their mean age was 40.45 years (21-59). The skeletal segments concerned were 2 humerus, 6 femurs and 3 tibias with a mean bone defect length of 4,45 cm (2.5-8). The delay between reconstruction and trauma was 8 months (20 days - 3 years). After a mean follow-up of 6.54 months (3-11) six patients presented a good radiological healing (4 femurs, 2 humerus) whereas in four patients, autograft osteointegration was still ongoing (2 femurs, 2 tibias). A tibia secondary infection was observed in a patient with the graft partial resorption. In another patient, an initial gangrene lead to a leg amputation. CONCLUSION: The induced membrane technique is an excellent option for bone defect reconstruction compared to other usual bone graft techniques. It helped us to manage large bone loss in various skeletal segments.

Hand replantation: First experience in a sub-Saharan African country (Togo).

Fifty years after Chen has performed the first forearm replantation, we report our first case of hand replantation in a sub-Saharan African country. The etiology of the amputation was machete due to interpersonal violence. The amputation was trans-carpal, guillotine-type, subtotal non-viable maintained with a small skin bridge. The replantation procedure was successful. At one year follow-up, the functional result according to Chen's criteria was excellent. Through this first experience, we can state that hand replantation can be performed successfully both in survival and function in a non-specialized hospital of a sub-Saharan African country.

Open Anterior Dislocation of the Hip in Togo

Anterior traumatic dislocations of the hip are much less common than posterior dislocations. To date, 14 cases of open anterior dislocation of the hip associated with such injuries, acetabular and femoral head fractures and femoral vascular and nerve damage have been reported. We present a case of a 23-year-old male who sustained open anterior dislocation of the hip with ipsilateral fracture of the greater trochanter after an accident on the public highway. Additional lesions included an iliac wing fracture and a perineal wound. We report this case because of the rarity and seriousness of this injury due to its progressive complications and difficulties related to its management, which are typical to a developing country like ours.

Open Anterior Dislocation of the Hip in Togo

Anterior traumatic dislocations of the hip are much less common than posterior dislocations. To date, 14 cases of open anterior dislocation of the hip associated with such injuries, acetabular and femoral head fractures and femoral vascular and nerve damage have been reported. We present a case of a 23-year-old male who sustained open anterior dislocation of the hip with ipsilateral fracture of the greater trochanter after an accident on the public highway. Additional lesions included an iliac wing fracture and a perineal wound. We report this case because of the rarity and seriousness of this injury due to its progressive complications and difficulties related to its management, which are typical to a developing country like ours.

Extremity injuries in soldiers during the conflict in Mali: experience of Togo Level two Hospital.

PURPOSE: The aim of this study was to analyse war-related and non-war-related extremity injuries in soldiers in the Mali conflict. MATERIALS AND METHODS: This prospective study was performed from 1 May 1 to 31 December 2014. It concerned extremity injuries in soldiers treated at Togo Level 2 Hospital. RESULTS: Seventy-nine patients with an average age of 31.19 years were assessed. Among them, 50 were admitted after war injury and 29 from nonwar injury. Most war-related injuries were due to improvised explosive devices (IEDs) (36 %); road traffic accidents (51.72 %) were the main mechanism of non-war injury. A total of 125 injuries were analysed. Limb fractures were identified in 37 patients (29.6 %), and 22 cases (59.46 %) were open fractures. Twenty-six (20.8 %) patients had soft tissue wounds. The other injuries were sprains (18.4 %), muscle contusions (15.2 %), dislocations (8.8 %), traumatic amputations (4 %) and burns (3.2 %). Surgical debridement and external fixator application were the most frequently performed surgical procedures. Thirty-nine per cent of patients were evacuated to a level 3 hospital for better care. CONCLUSION: The severity of injuries and their rapid treatment require orthopaedic surgeons to have high levels of surgical experience and knowledge pertaining to military or disaster surgical doctrine.

Open reduction and internal fixation of humeral non-unions: radiological and functional results.

This study aimed at assessing the effectiveness of open reduction and plate fixation combined with autogenous bone grafting in the treatment of non-united fractures of the humeral shaft. Forty six patients (27 men, 19 women; mean age, 35.6 years; range, 23-53 years) were operated on for non-union of a diaphyseal fracture of the humerus. Sixteen patients had surgical treatments and 30 patients had non-surgical treatments prior to operation. They were operated on average 7.8 months (6-17) following their initial treatment. None of the nonunions were infected. Radial nerve deficit was present in no patient. Treatment included open reduction and plate fixation combined with autogenous bone grafting. The mean follow-up period was 26 months (range: 13-41). No patient was lost to follow-up. The operative time averaged 91 minutes (range: 68-123). Union was achieved in all patients in a mean of 6.1 months (range: 5-13). There were nine postoperative complications (superficial infection in 5 and radial nerve palsy in 4). The infections resolved after local treatment. The radial nerve palsies recovered spontaneously. On clinical evaluation, shoulder range of motion was excellent in 41 patients (89.1%), and moderate in five patients (10.9%). Elbow range of motion was excellent in 30 patients (65.2%), moderate in 14 patients (30.4%) and poor in 2 patients (4.4%). Functional results were excellent in 24 patients (522%), good in 14 patients (30.4%), fair in 6 patients and poor in 2 patients (04.4%). In this study, plate fixation combined with autogenous bone grafting appeared as a safe and effective option in non-infected non-union of the humeral shaft.

Risk factors for surgical wound infection in HIV-positive patients undergoing surgery for orthopaedic trauma.

PURPOSE: To identify risk factors associated with surgical wound infection in patients infected with human immunodeficiency virus (HIV) undergoing surgery for orthopaedic trauma. METHODS: Records of 29 male and 7 female HIV-positive patients aged 18 to 47 years who underwent surgery for orthopaedic trauma were reviewed. Data on HIV-specific variables (HIV clinical classification, CD4+ lymphocyte count) and highly active antiretroviral therapy were retrieved, as were data on wound class, fracture type, surgery type, surgical wound infections, and outcomes. Possible risk factors associated with surgical wound infection were analysed. RESULTS: The median follow-up period was 27 (range, 19-41) months. Of the 36 patients, 14 (39%) developed surgical wound infections (4 were deep and 10 superficial). 89% and 67% of them were in HIV clinical category B and in CD4+ T-lymphocyte category 3, respectively. 12 of these infections resolved after debridement and prolonged antibiotic treatment, and 2 developed chronic osteomyelitis. Four of the patients had non-union. Surgical wound infections were associated with HIV clinical category B (p<0.001), CD4+ T-lymphocyte category of more than or equal to 2 (p=0.041), and contaminated wounds (p=0.003). CONCLUSION: Identification of risk factors may help minimise morbidity in HIV-positive patients.