Traitement par fixateur externe des fractures ouvertes des membres : à propos de 38 Cas

Introduction / But. De nouveaux types de fixateurs externes sont utilisés dans le traitement des fractures ouvertes, seuls ou associés aux techniques d'aide à la consolidation. Leur application varie en fonction du contexte médical et technologique. L'objectif de ce travail était d'étudier les résultats du traitement des fractures ouvertes dans notre contexte de sous équipement. Matériel et Méthodes. Notre étude transversale descriptive rétrospective réalisée entre janvier 2012 et décembre 2014 a concerné 38 patients totalisant 40 fractures ouvertes dont 28 étaient classées type III de Cauchoix ­ Duparc et 12 type IIb de Cauchois ­Duparc. L'âge moyen des patients était 33,7 ans (18 et 63 ans). La fixation externe des lésions osseuses était réalisée dans un délai moyen de 5 jours (6 heures et 14 jours). Les résultats anatomiques et fonctionnels ont été analysés. Résultats. La cicatrisation des parties molles a été obtenue en moyenne à 5 mois (1 mois et 13 mois) et la consolidation osseuse était acquise en moyenne à 6 mois (4 mois et 9 mois) chez 36 patients. Un cas de pseudarthrose septique du tibia traité par greffe inter-tibio-fibulaire après guérison de l'infection et un cas de pseudarthrose aseptique du fémur traité par greffe et ostéosynthèse ont été observées. La durée d'hospitalisation des malades variait entre 24 et 330 jours. Sur le plan fonctionnel, la marche était normale, indolore et sans boiterie chez 11 patients ; elle était douloureuse avec boiterie chez 14 patients et nécessitait l'aide d'une canne chez 13 patients. Conclusion. Le fixateur externe a une place indiscutable dans le traitement des fractures ouvertes graves des membres en Afrique subsaharienne. Tout chirurgien traumatologue doit désormais maitriser non seulement la technique de fixation mais aussi la réalisation des lambeaux de divers types

Genoux flottants. Résultats thérapeutiques à propos de 15 cas traités au CHU de Brazzaville

Objectif : Evaluer les résultats thérapeutiques des 15 genoux flottants, obtenus à la lumière des différentes méthodes de traitements utilisées au CHU de Brazzaville. Matériel et méthodes : Il s'agit d'une étude rétrospective menée du 1er octobre 2005 au 30 septembre 2013, dans le service d'orthopédie-traumatologie du CHU de Brazzaville. L'étude a porté sur 15 patients traités pour genou flottant et répondant aux critères d'inclusion. Les genoux flottants ont été répartis selon la classification de Fraser et selon l'ouverture cutanée classée selon la classification de Cauchoix-Duparc. Les résultats anatomiques et fonctionnels ont été analysés selon les critères de Karlström et Olerud.Résultats : Trente patients (2,04%) ont été colligés sur 1475 hospitalisation pour fractures des os des membres. Quinze patients dont 14 hommes et 1 femme ont été retenus pour l'étude. L'âge moyen était de 35,4 ans (extrêmes 20-72 ans). Des 15 patients, 6 ont été traités par la méthode chirurgicale, 2 patients par la méthode orthopédique et 7 patients par la méthode mixte. Les résultats fonctionnels appréciés selon les critères de Karlström et Olerud ont permis de juger avec un recul de 12 mois : 2 résultats excellents, 6 bons résultats, 4 résultats acceptables et 3 mauvais résultats.Conclusion : Les genoux flottants constituent une pathologie peu fréquente en traumatologie. Leur traitement doit être chirurgical et précoce pour minimiser les séquelles fonctionnelles

Arthroplastie cervico-céphalique pour fracture du col fémoral à Brazzaville: résultats anatomiques et fonctionnels au recul de 28 mois

Introduction: Les fractures du col du fémur sont fréquentes chez le sujet âgé. Elles sont en général traitées par des prothèses cervico-céphaliques. Le but de cette étude était d'évaluer les résultats anatomiques et fonctionnels obtenus avec ce type de prothèse. Matériel et méthodes: Cette étude rétrospective réalisée entre janvier 2008 et mai 2014 a concerné 30 patients totalisant 31 fractures. L'âge moyen était 71 ans (42 -87ans). On notait quatre fractures Garden III et 27 Garden IV. Vingt-sept patients étaient classés ASA II et trois patients ASA I. Le score de Parker était côté à 9/9 chez 23 patients et à 6/9 chez sept. Les prothèses étaient la prothèse de Moore (n=28 ; 90%), la prothèse de Thompson (n= 2 ; 7%) et la prothèse de Merle d'Aubigné(n= 1; 3%). Les résultats anatomiques ont été évalués selon les critères de Sharif. Les résultats fonctionnels ont été analysés selon Postel Merle d'Aubigné et Parker. Le recul moyen était 28 mois (6-61 mois). Résultats: Initialement toutes les prothèses étaient bien implantées. Au dernier recul, les complications anatomiques étaient une cotyloïdite (n=7), une bascule en varus (n=4) une prothèse perchée par lyse de l'éperon de Merckel (n=3), un enfoncement de la prothèse (n=7), une fracture périprothétique (n=1), et une subluxation de la prothèse (n=1). Selon Postel Merle d'Aubigné les résultats étaient très bons (n=1 ; 3%), bons (n=3 ;10%), moyens (n=4 ; 13%) , médiocres (n=14 ; 47%), et mauvais (n=8 ; 27%).Selon Parker, 24 patients étaient côtés à 7/9, cinq à 6/9 et un à 0. Conclusion: Au recul moyen de 28 mois les résultats des prothèses cervico-céphaliques n'étaient pas satisfaisants. Par nécessité, elles restent une option thérapeutique dans notre contexte socio-économique

[The urological complications of pelvic fractures: about 22 cases at the University Hospital, Brazzaville]. / Les complications urologiques des fractures de la ceinture pelvienne : à propos de 22 cas au CHU de Brazzaville.

OBJECTIVE: To analyze the epidemiology, injury mechanisms and therapeutic aspects of urological complications of fractures of the pelvic girdle. PATIENTS AND METHODS: Retrospective study including 22 cases of urological complications of pelvic fractures analyzed between 2003 and 2010 at the University hospital, Brazzaville. Tile classification modified AO was used to understand the mechanisms underlying urological complications. The variables studied were: frequency, age, sex, origin, etiology, type of pelvic fracture, type of urological complications, clinical urological lesions, the therapeutic delay, the therapeutic method, the long-term prognosis. RESULTS: In total, 22 cases (11.40%) of urological complications were collected on 193 pelvic fractures. Men dominated the series with a sex ratio of 4.5, the average age was 33.8 years (12 to 64). Street accidents were the leading cause with 13 cases (59.09%). The urethra was the most affected in 16 cases (72.73%), the membranous portion in 10 cases (45.45%), the bladder in six cases (27.27%). Type A fractures were complicated four bladder lesions, types B, 12 urological lesions (1 bladder and urethra 11) and six type C lesions (1 bladder and urethra 5). Bone lesions were supported functionally in 18 cases (81.82%). Urethral injuries in men were repaired remotely by anastomotic urethroplasty. Urethral injury in females has been repaired urgently delayed. The bladder lesions were repaired by emergency laparotomy and suture of the breach, or urethral catheterization. In monitoring, seven patients had urological sequelae: erectile dysfunction in one case and urethral stenosis in six cases, they have been treated by dilatation (4 cases) and endoscopic internal urethrotomy (2 cases). CONCLUSION: The urological complications of pelvic fractures were rare in our experience, and must be systematically searched. Unstable fractures (types B and C) were the major providers of these complications. Remote processing was possible with good functional results.

[Pathological fracture revealing an osseous histoplasmosis. A case report on a 60-year patient]. / Fracture pathologique révélant une histoplasmose osseuse. A propos d'une observation chez une patiente de 60 ans.

The authors report a new case of African Histoplasmosis in a 60-year-old patient. It was an humeral localization revealing a pathological fracture which grew into an extension of osteolysis and a cutaneous fistulization likely to be a malignant bone tumor. The case has been diagnosed by surgical biopsy and histological analysis. Its antifungal treatment in progress resulted in the drainage of the out-flow that should permit the bone reconstruction by graft. The authors stress on the need to focus on this affection whenever, in a tropical area, one is faced with any chronic bone fistula that cannot positively be cured in spite of sound medical cares.

[Multiple myeloma and HIV/AIDS infection. Three case reports]. / Myelome multiple et infection à VIH/SIDA. A propos de 3 observations.

HIV/AIDS infection rages at the endemic state in Sub Saharan African and especially in our country. We are reporting 3 observations of patients, all of females affected by HIV/AIDS and multiple's myeloma. They are all in-patients in the department of haematology, University hospital of Brazzaville, from 2000 to 2002. In two cases out of three, multiple's myeloma is discovered after the tracking of HIV/AIDS infection. In the other case, the tracking HIV/AIDS seems to be posterior to the multiple's myeloma diagnostisis. HIV/AIDS is symptomatic in the tree cases and under antiviral treatment. Multiple's Myeloma is diagnosed at an advanced stage. It is about IgG myeloma in two cases and IgA myeloma in the other. The rate of the T4 lymphocytes is noted spontaneously to 204 and 486 by mm3, and 390 by mm3 in a patient under antiviral treatment before her hospitalisation. The measure of the viral intensity is not achieved. The poly chemotherapy of type VMCP and VAMCP is driven without major complications and under anti-infectious prophylaxis. The receding is still insufficient to affirm the medium-term evolution and to determine the prognosis of the malign blood disease. The description of these three observations confirms the implication of the human retrovirus and in particular of the VIH/SIDA in the lymphoma genesis.

[Multiple myeloma and HIV infection: report of 3 cases]. / Myélome multiple et infection a VIH/SIDA : a propos de trois observations.

HIV infection rages at the endemic state in Sub Saharan African and especially in Congo Brazzaville. We report the observation of three female patients infected with HIV and developing multiple myeloma. The three patients were treated at the University hospital of Brazzaville between 2000 and 2002. In two cases multiple myeloma was discovered after the diagnosis of HIV infection. In the other case, the diagnosis of HIV infection was posterior to the occurrence of multiple myeloma. HIV infection was symptomatic in two cases who received consequently antiviral treatment. Multiple myeloma was diagnosed at an advanced stage in the three cases. The paraprotein was an IgG in two cases and an IgA in the other one. The CD4 counts before treatment were around 200/mm3 in two cases and within normal limits in the third case. Viral load was not measured. VMCP and VAMCP regimens were administered without major complications and under anti-infectious prophylaxis. The follow-up is still insufficient to assess the medium-term evolution and to determine the prognosis of multiple myeloma. The description of these three cases confirms the involvement of HIV in B cell lymphoma genesis.

[Subacute osteomyelitis in adults. Apropos of 3 cases]. / Ostéomyélites subaiguës de l'adulte. A propos de 3 cas.

We report three cases of subacute osteomyelitis in 25, 31 and 38-year old adults. The clinical presentation was an insidious condition with persistent nondisabling pain. Radiographical signs suggested a bone tumor. Diagnosis was established from the bacteriological and pathology examinations of the surgical biopsy taken when evacuating the abscess. Cure was obtained in all three patients with combination antibiotic regimens. In two cases immobilisation was required because of bone fragility.

[Tibialization of the fibula for a large bone loss. A case report]. / Tibialisation de la fibula pour une grande perte de substance osseuse. A propos d'un cas.

A 10-centimeter tibial bone loss was treated by inter-tibiofibular bone grafting on each part of the pseudarthrosis, resulting in tibialization of the fibula. The patient was reviewed after 10 years; the clinical result was satisfactory and stable. The tibial forces were deviated on the fibula, which expressed radiologically by important thickening of its cortices. This case illustrates the interest of preserving the fibula for tibial bone loss reconstruction.

[Importance of intertibio-peroneal graft in pseudoarthrosis of the leg at risk for sepsis. Apropos of 21 cases]. / Intérêt de la greffe intertibio-péronière dans les pseudarthroses de jambe à risque septique. A propos de 21 cas.

PURPOSE: The purpose of our study was to analyze the use of intertibio-fibular bone grafting (I.T.F.G.) in non-union presenting a septic risk. MATERIAL AND METHODS: Twenty one non-unions of the tibial diaphysis presenting a septic risk were treated by intertibio-fibular bone grafting through a postero-lateral approach, over a seven year period (1988-1995). There were 2 septic non-unions and 19 non-unions following open fractures, all treated initially by external fixation. Seventeen patients were male, four were female. Mean age was 33 years (range 19 to 70 years). RESULTS: Healing was obtained in 20 cases, only one patient had a second bone grafting. Postoperative complications included two infections (one deep and one superficial) without consequences on bone healing. Functional results were good and excellent in 18 cases (85.7 per cent). DISCUSSION-CONCLUSION: Our study showed that among techniques for the treatment of non-union presenting a septic risk, the I.T.F.G. is one of the most reliable, with low morbidity and low cost. The authors recommend this type of surgery particularly in developing countries.

Decollements epiphysaires traumatiques chez les adolescents congolais : a propos de 15 cas

Les auteurs analysent 15 cas de decollements epiphysaires traumatiques chez des adolescents congolais (age moyen 16 ans et 9 mois). La population atteinte est essentiellement masculine; a la suite; dans 60 pour cent des cas d'un accident de football. Les lesions concernent l'extremite distale du femur dans 80 pour cent des cas. Le traitement realise; chirurgical dans 75 pour cent des cas; a conduit a 14 bons et tres bons resultats (93 pour cent). Ces lesions survenant en fin de croissance; sont d'un bon pronostic

[Open fractures caused by gunshot in civilian practice. Apropos of 31 cases]. / Fractures ouvertes par armes à feu en pratique civile. A propos de 31 cas.

The authors report their experience of the treatment of 31 gunshot open fractures in civilian practice. The fractures, comminuted in two thirds of cases, were produced by various fire-arms. Two vascular injuries were observed. Conservative treatment was performed in 80% of cases. 13 septic complications were observed (6 superficial and 7 deep infections). The were also 7 cases of delayed union, 3 mal unions and 7 cases of joint stiffness. To improve the prognosis of these lesions, the authors emphasize that surgeons must be familiar with ballistic wounds and carry out an early initial and appropriate treatment.

[Results of an open fixation treatment of 131 fractures of the femoral diaphyses in a Congolese hospital setting]. / Résultats du traitement à foyer ouvert de 131 fractures de la diaphyse fémorale en milieu hospitalier Congolais.

From 1987 to 1991, 196 fractures of the femoral diaphysis were treated at the University Hospital Center of Brazzaville. A retrospective perusal of the files of these patients produced 131 analyzable cases, all treated by open osteosynthesis using either screw-attached plates (n = 84) or nails (n = 47). The overall infection rate was 5.4% (7/131). This rate was 5.9% (5/84) using screw-attached plates and 4.2% (2/47) using nails, i.e. only slightly higher than in the literature. Bone fixation was successful in 90% of cases. Mechanical complications (11.4%) were due mainly to technical errors during the initial fixation. With a follow-up of 3 years, analysis according to the criteria of GENESTE showed that open osteosynthesis of fractures of the femoral diaphysis in an African orthopedic department led to 90% of good (32%) and excellent (58%) results. In this African series, the main problem was the initial fixation.

[Reoperations for mechanical complications of femoral osteosynthesis. Analysis of 20 cases]. / Les réinterventions pour complications mécaniques des ostéosyntheses fémorales. Analyse de 20 cas.

Based on a study of 220 femoral osteosynthesis, the results of 20 second surgical operations because of mechanical complications sat in 19 patients. These complications occurred on 15 screwed plates (6 breakings, 6 angulations, 3 dismounting) and 5 nailings (4 proximal migrations, 1 angulation). The critical analysis about the first osteosynthesis showed some technical error in several cases. Pseudarthrosis (9.2 p.c.) was observed in all mechanical complications at the plates A second surgical operations, thanks to a new osteosynthesis associated, in 8 cases, with a cortico-spungoïd osseous graft led to 85 p.c. of good and very good results and 15 p.c. of satisfactory results. No post surgery complication was observed.

[Galeazzi fracture. 9 cases in the orthopedic-traumatology service (Brazzaville-Congo)]. / La fracture de Galeazzi. A propos de 9 cas service orthopédie-traumatologie (Brazzaville-Congo).

The authors give an account of nine cases of Galeazzi fractures, observed on a four-year period (1987-1991). These uncommon and unstable injuries were treated, in all cases, by rigid osteosynthesis of the radius. The treatment of the distal radio-ulnar dislocation, depending on its importance, was K-wire stabilization (4 cases), plaster-cast immobilization in supination (2 cases). There was no peculiar treatment in 3 cases. The results were influenced by operative delays. However we obtained 4 excellent results, 3 good results and 2 fair results.

[Acute osteomyelitis of the patella]. / Ostéomyélite aiguë de la rotule.

The authors report on an observation of acute osteomyelitis of the patella in a non-sickle-anemic 8-year-old child. The literature helps confirm the scarcity of the disease, the difficulties of diagnosis and the good prognosis of the lesion in the child.