Type III open tibia fractures in low-resources setting. Part 3: achievement of bone union and treatment of segmental bone defects.

After presentations of the principles of limb salvage and soft-tissue coverage for Gustilo III open tibia fractures, this third part is dedicated to management of tibial non-unions in low-resource settings. Inter-tibiofibular grafting and the induced membrane technique are preferred because they make it possible to deal with almost all situations. Key technical points of these methods are presented, followed by treatment guidelines based on Catagni's classification and bone defect size.

Type III open tibia fractures in low-resource setting. Part 2: soft-tissue coverage with simple, reliable and replicable pedicle flaps.

After limb salvage based on debridement and external fixation, Gustilo IIIB open tibia fractures must undergo soft-tissue repair within 7 days. In low-resource setting, the coverage is performed with pedicled flaps only, which can be used by any orthopedic surgeon after minimal training. The authors describe here the simplified use of 7 basic flap transfers that can deal with almost all soft tissue defects. The diffusion of these techniques in developing countries is crucial for limiting functional and trophic effects related to prolonged exposure of the fracture site.

Type III open tibia fractures in low-resources setting. Part 1: strategy and principles of limb salvage.

In developing countries, road traffic accidents result in many cases of open trauma, especially fractures, with the tibia area at particular risk in motorcycle crashes. Despite a high prevalence of severe leg trauma with multi-tissue injuries, few studies have focused on the challenge of their reconstruction in these limited-resource settings. The first part of this review presents the surgical strategy. Limitations and principles of initial limb salvage are detailed. Orthopedic procedures for early damage control, based on debridement and temporary bone stabilization, are often required. The priority is to shorten the time to initial surgical management to avoid infection, which jeopardizes reconstruction.

[Severe leg trauma in a resource-poor environment: indications for amputation in emergencies]. / Traumatismes graves du segment jambier en milieu précaire: place de l'amputation en urgence.

Although the development of multitissue limb reconstruction has reduced the role of post-traumatic primary amputation of the leg, some patients should nonetheless undergo emergency amputations. In developing countries, the socioeconomic context associated with the limited health care supply compromises still further the prognosis of preservation efforts. The decision criteria for surgery are thus different in these settings. The choice of emergency leg amputation or attempted preservation in developing countries depends on the epidemiology of severe leg trauma, the local and general prognosis, and the practice conditions. Three factors must be combined before limb preservation can be attempted: adequate local and general adequate wound elements, an available, experienced surgeon with a competent care structure, and a favorable social context.

[Total hip arthroplasty after avascular necrosis due to sickle cell disease in Senegal: series of 48 replacements]. / Arthroplastie totale de hanche dans l'ostéonécrose aseptique du drépanocytaire au Sénégal: série de 48 prothèses.

The purpose of this study is to describe the outcome of total hip arthroplasty for management of aseptic osteonecrosis of the femoral head due to sickle cell disease. This consecutive series carried out over a 7-year period in 38 patients with a sickle-cell anaemia includes a total of 48 cemented prosthesis. The mean follow-up period was 5 years. Arthroplasty restored normal hip function (PMA score = 18) in 64% of cases. In 32% of cases the PMA score was more than 15. Pain was greatly reduced with total relief being achieved in 94% of cases. Walking ability also improved with 85% of patients having an unlimited walking distance. Radiological examination demonstrated edging on 36% of cupulas and 29% of the shafts. Complications were observed in 19% of cases. The main complications were loosening and dislocation of the prosthesis. Although the complication rate was high, functional outcomes in this series were good. These findings indicate that arthroplasty should be considered as the treatment of choice for aseptic osteonecrosis due to stage 3 and 4 sickle-cell disease in young patients. Use of uncemented implant and type of frictional torque are discussed.

Arthroplastie totale de hanche dans l'osteonecrose aseptique du drepanocytaire au Senegal : serie de 48 protheses

Trente-huit patients drepanocytaires presentant une osteonecrose aseptique de la tete femorale ont beneficie d'une arthroplastie totale de la hanche sur une periode de 7 ans; soit une serie consecutive de 48 protheses cimentees. Avec un recul moyen de 5 ans; l'arthroplastie a permis d'obtenir dans 64des cas une fonction normale (score PMA = 18); et dans 32des cas un PMA superieur a 15. Le gain sur la douleur etait tres important puisque l'indolence a ete obtenue dans plus de 94des cas; de meme que sur la marche car 85des patients n'avaient pas de limitation du perimetre de marche. Sur le plan radiologique; 36des cupules et 29des tiges presentaient des liseres. Les complications ont ete retrouvees chez 19des patients; dominees par les descellements et les luxations. Les resultats fonctionnels obtenus dans la serie; avec un taux de complication important mais qui reste inferieur a ceux deja publies dans la litterature pour cette pathologie; incitent a retenir l'arthroplastie comme traitement de choix de l'osteonecrose aseptique du drepanocytaire au stade 3 et 4 du sujet jeune. Ils amenent a discuter le choix de l'implant; et du couple de frottement