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1.
Orthop Traumatol Surg Res ; 102(1): 81-5, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26726099

ABSTRACT

INTRODUCTION: Osteotomy performed below the femoral neck plays a leading role in the treatment of slipped capital femoral epiphysis (SCFE). It results in anatomical reduction. Several modifications have been made to Dunn's original osteotomy technique. We have developed another modification to this technique that uses an anterior surgical approach on a traction table with fluoroscopy control. HYPOTHESES: Will this technique help to reduce the number of complications? Will its results be superior to those achieved with the standard Dunn osteotomy procedure? MATERIAL AND METHODS: This was a retrospective single-center study of 26 cases in 24 patients (2 bilateral cases). Patients were positioned supine on a traction table with fluoroscopy control. An anterior surgical approach was used. A trapezoid-shaped osteotomy was performed below the femoral head. The head's reduction was checked on the fluoroscope and the fixation confirmed. The Postel Merle d'Aubigné (PMA) score was used for the clinical assessment. The radiographic assessment was based on Southwick's angle. RESULTS: The mean slip angle of the femoral head was 57°. A mean correction of 47° was achieved. Based on the PMA score, good and excellent results were achieved in 20 cases (77%) and poor results occurred in 6 cases (23%). The surgical treatment had a significant effect on the PMA score (P=0.0008). In terms of complications, there were five cases of chondrolysis and one case of necrosis associated with chondrolysis. DISCUSSION: The anterior approach provides direct access to the femoral neck, and thereby a cautious osteotomy at the site of the slip itself. Use of a traction table makes the external manipulations, reduction and fixation procedures easier to carry out. The results of this study were comparable to published results. LEVEL OF PROOF: IV, retrospective treatment study.


Subject(s)
Osteotomy/methods , Slipped Capital Femoral Epiphyses/surgery , Adolescent , Female , Femur/diagnostic imaging , Femur/surgery , Fluoroscopy , Follow-Up Studies , Humans , Male , Operating Tables , Orthopedic Equipment , Retrospective Studies
2.
Bull Soc Pathol Exot ; 109(1): 8-12, 2016 Feb.
Article in French | MEDLINE | ID: mdl-26707167

ABSTRACT

Black-grain mycetomas are fungal and cannot be healed by antifungals only.We conducted this study to determine the interest of carcinologic surgery only in the management of those black-grain mycetomas.We led a retrospective study concerning 44 patients over a period of 52 months. The mean age of patients was 32.5 years. The main location of mycetomas was the foot (21 cases), the ankle (10 cases), the knee (8 cases), the leg (3 cases), the chest, the back and the pulp of the fourth finger once each. The bone was affected in 21 cases. The surgery consisted in a carcinologic excision or amputation depending on the extension of the lesion and the degree of bony infringement, with ganglionic cleaning out in case of lymphadenopathy. In the average retrospect of 25.5 months, we noted 8 cases of recurrences among which 2 on the amputated patients and 6 on the patients treated by carcinologic excision. The surgery constitutes the main therapeutic issue of the fungal mycetomas.


Subject(s)
Mycetoma/surgery , Adolescent , Adult , Aged , Female , Hospitals , Humans , Male , Middle Aged , Mycetoma/epidemiology , Retrospective Studies , Senegal/epidemiology , Young Adult
3.
Arch Pediatr ; 22(7): 737-40, 2015 Jul.
Article in French | MEDLINE | ID: mdl-26047739

ABSTRACT

Anterior transolecranon fracture-dislocations of the elbow are rare in children and the literature is poor in recommendations for the management of these lesions. We report a new case with a type of lesion that has not been described previously and discuss this pathology. Based on a literature review, we propose a classification into four types of anterior transolecranon fracture-dislocations of the elbow in children, thereby guiding surgical indications. We recommend reduction and synthesis using a figure-eight tension-band wire in avulsions and transverse type I and II fractures. The bone plate is the best indication in type III oblique fractures in older children.


Subject(s)
Elbow Injuries , Fractures, Bone , Olecranon Process/injuries , Child , Fractures, Bone/complications , Fractures, Bone/surgery , Humans , Joint Dislocations/complications , Joint Dislocations/surgery , Male
4.
Rev. int. sci. méd. (Abidj.) ; 16(4): 256-261, 2014.
Article in French | AIM (Africa) | ID: biblio-1269162

ABSTRACT

INTRODUCTION. Le but de ce travail etait d'evaluer les resultats des embrochages intra-focaux selon Kapandji des fractures de Pouteau-Colles realises dans la plupart des cas sous anesthesie locale et sans amplificateur de brillance. MATeRIEL ET MeTHODE. Il s'agissait d'une etude dynamique sur une periode de 12 mois qui a consiste a l'examen clinique complet et a la radiographie du poignet qui nous permettaient de calculer les indices radiologiques de face et de profil. Nos criteres d'inclusion concernaient les patients presentant une fracture de Pouteau-Colles vraie ages de 18 ans au moins; traites par embrochage intra-focal selon la technique de Kapandji effectivement suivis; revus et evalues. L'evaluation des patients se faisait apres un recul moyen de 9 semaines et nous avons utilise les criteres de Castaing.ReSULTATS. Pendant la periode d'etude nous avons enregistre 57 patients pour fracture de Pouteau Colles Parmi eux 35 ont ete operes selon la technique de Kapandji soit 61;4%. L'age moyen des patients etait de 38 ans. Nous avons note une predominance masculine de 16 hommes avec un sex-ratio de 1;2. Par rapport a la comminution posterieure (classification de Grumillier); nous avons note type I 34%; type II 43%; type III 23%. L'operation a ete realisee sans utilisation de l'amplificateur de brillance dans 74;3% des cas. A l'evaluation nous avons obtenu les resultats suivants ont ete obtenus :- Resultats subjectifs; 74;19% de tres bon et bon resultats ; 6;45% de mauvais resultats; - Resultats objectifs; 90;33% de tres bon et bon resultats ; 3;22% de mauvais resultats - resultats radiologiques; 83;88% de tres bon et bon resultats ; 6;45% de mauvais resultats. CONCLUSION.L'embrochage intra-focal selon Kapandji est une methode qui permet de traiter avec succes la plupart des fractures de Pouteau-Colles. L'aspect particulier de notre etude reside sur le fait que; cette technique chirurgicale s'etait executee dans la majeure partie des cas sous anesthesie locale et sans l'utilisation de l'amplificateur de brillance


Subject(s)
Colles' Fracture , Fracture Fixation , Patient Outcome Assessment , Radius Fractures
5.
Bull Soc Pathol Exot ; 106(2): 100-3, 2013 May.
Article in French | MEDLINE | ID: mdl-23440650

ABSTRACT

Little published data exist on the morbidity and mortality associated with poor trauma care in developing countries. This report highlights our experience with iatrogenic limb gangrene related to fracture management by traditional bonesetters. Children with bonesetter's gangrene were identified from a prospectively recorded paediatric surgery database at the Regional Hospital of Kaolack in Central Senegal. 21 children were treated for bonesetter's gangrene during a 18-month period (January 2007 up to June 2008). The average age was 10 years (range, 5 to 15 years). Bonesetter's gangrene was more common in boys (90.5%) and occurred almost exclusively in children from rural areas where access to health care was limited. 16 children underwent proximal extremity amputation. Complications included one case of tetanus. Bonesetter's gangrene is a preventable complication that results from a failure of child health planners to recognize the importance of basic trauma care. Management of fractures should be considered an essential component of child health programs in developing countries.


Subject(s)
Amputation, Surgical/statistics & numerical data , Braces/adverse effects , Extremities/blood supply , Fractures, Bone/therapy , Gangrene/etiology , Ischemia/etiology , Medicine, African Traditional/adverse effects , Splints/adverse effects , Accidental Falls , Adolescent , Bambusa , Child , Child, Preschool , Developing Countries , Female , Fractures, Bone/complications , Gangrene/epidemiology , Gangrene/surgery , Humans , Ischemia/surgery , Male , Prospective Studies , Rural Population , Senegal
6.
Chir Main ; 30(5): 327-32, 2011 Oct.
Article in French | MEDLINE | ID: mdl-21820935

ABSTRACT

OBJECTIFS: Consensual treatment of the Galeazzi's fracture is a plate osteosynthesis of the radius more or less associated to the confection of a plaster cast in distal radio-ulnar joint (DRUJ) dislocation. The authors are reporting in this study the clinical and functionnal results of the intra-medullary pinning of the radius in this type of fracture in adult. METHODS: During a prospective study from January 2003 to December 2006, 23 patients (20 men and three women), average-aged of 32 years (16-70 years) presenting with a Galeazzi's fracture were treated by an intra-medullary pinning of the radius. The DRUJ dislocations were locked 17 times by a brachio-ante-brachio-palmar plaster cast in the supination position, and six times by an ulno-radial pinning. Only the 16 over-aged patients presenting with closed recent fractures were included in this study. The DRUJ dislocation was ranked according to Mansat, the radial fracture according to Müller (AO). The assessment of the treatment results used Mestdagh's criteria. In this study, each pseudarthrosis of the radius was considered as a failure. RESULTS: The DRUJ dislocation was reparted into six sprains, eight subdislocations, and three Galeazzi's fracture equivalents. The radius fractures were simple (n=20) or wedge fractures (n=3). These fractures were located at the proximal third (n=13), middle third (n=7) and distal third (n=3). The average consolidation delay was 10 weeks (8 to16 weeks). Two pseudarthrosis have been observed and then treated by a plate osteosynthesis. At the mean follow up of 37 months (18 to 41 months), the mean score according to Mestdagh was 7.8 points, with 20 satisfying results. Nineteen patients were satisfied by their treatment; the reasons were: the esthetic care of their scar, and the good functionnal resumption, as well as before the fracture. CONCLUSION: The intra-medullary pinning of radius in Galeazzi's fractures, in contrary to the previous studies, give good results compared to a plate osteosynthesis treatment. The systematic complementary lock by brachio-ante-brachio-palmar plaster cast during 3 to 4 weeks has balanced the stability defect that Mikic was reproaching to it. Moreover, it confers the benefits of elastic closed osteosynthesis. That less simple and less expensive method represents an alternative to a plate osteosynthesis in Galeazzi's fractures in adult, if it is well standardized.


Subject(s)
Fracture Fixation, Intramedullary , Radius Fractures/surgery , Adolescent , Adult , Aged , Casts, Surgical , Female , Humans , Joint Dislocations/surgery , Joint Instability/surgery , Male , Middle Aged , Patient Satisfaction , Prospective Studies , Wrist Joint/surgery , Young Adult
7.
Ann Chir Plast Esthet ; 56(1): 27-32, 2011 Feb.
Article in French | MEDLINE | ID: mdl-21237547

ABSTRACT

AIMS: The object of this work is the study of especially ancient clinical forms of the effusion of Morel-Lavallée, to discuss the place of deep fascial fenestration by Ronceray and to propose criteria of therapeutic indication. PATIENTS AND METHOD: Our study concerns a continuous retrospective series over 20 years from 1989 till 2009. Eleven men and eight women, 36.7 year-old on average were treated for an effusion of Morel-Lavallée. The dominant etiology was represented by the accidents of the public highway. The collection was discovered after 41.4 days on average (extremes of 1-180 days). The volume of the collection was on average of 1237cm(3) (extremes 60cm(3)-12L). RESULTS: The conservative treatment concerned all patients who had a recent collection lower than three weeks and three others who had an ancient collection. The surgical treatment was established after all 10 times among which four in first intention and six times after failure of the previous treatment. The cure was obtained in 91% of the patients who had a recent collection by the only conservative method and among four patients by the method of Ronceray. To the three others, it was obtained after iterative unbridlings and talcage treatment. CONCLUSION: The authors insist on certain rare forms met in Africa in particular the "virtual form", the ancient forms and the too plentiful forms (12L). They plead for use deep fascial fenestrations by Ronceray for these last ones.


Subject(s)
Skin/injuries , Subcutaneous Tissue/injuries , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Orthopedic Procedures , Retrospective Studies , Wounds and Injuries/therapy , Young Adult
8.
Mali Med ; 26(4): 39-43, 2011.
Article in French | MEDLINE | ID: mdl-22766038

ABSTRACT

AIMS: Evaluate the technique of Bristow-Latarjet in the treatment of the recurrent dislocation of the shoulder. PATIENTS AND METHODS: It was a continuous retrospective study on 46 cases selected in the CHU of Dakar over 11 years. From our criteria of inclusion, 41 patients were retained. There were 37 men for 4 women, whose average age at the time of the intervention was 29 years (extreme: 20 - 44 years). The management of the first episode was unsuited in 25 times. The average time of the first repetition was 10 months and its number varied between 5 and 36 episodes. The treatment of the recurrences was also misfit in 23 times. All our patients were treated according to the technique of Bristow-Latarjet. A standard immobilization Mayo clinic during 3 weeks was made with a systematic rehabilitation. The evaluation was done according to the scale of Constant with 45,6 months an average retreat. RESULTS: We found: 7 excellent cases (17%); 14 very good cases (34%); 9 good cases (22%); 6 average cases (15%); 5 bad cases (12%). Five cases of omarthrosis (3 types II and 2 types III of Samilson-Prieto) were found like two surface cases of sepsis. There was neither post-operative recurrence nor iatrogenic nervous attack. CONCLUSION: The recurrent anterior dislocation of the shoulder represents a frequent complication of primary dislocations of the shoulder touching especially young subjects. Stabilization by the anterior coracoid abutment according to the technique of Bristow-Latarjet led well represents one of the best techniques for its treatment.


Subject(s)
Joint Instability/surgery , Orthopedic Procedures , Shoulder Dislocation/surgery , Shoulder Joint/surgery , Adult , Female , Humans , Male , Recurrence , Retrospective Studies , Shoulder Dislocation/prevention & control , Young Adult
9.
Orthop Traumatol Surg Res ; 96(3): 276-82, 2010 May.
Article in English | MEDLINE | ID: mdl-20488147

ABSTRACT

INTRODUCTION: Extension-type supracondylar fractures of the humerus in children are frequent lesions whose orthopaedic treatment remains under debate in Rigault and Lagrange type III fractures and highly controversial in type IV fractures. The objective of this study was to extend the Blount method to fractures with substantial displacement even in patients presenting significant swelling and to evaluate the results. PATIENTS AND METHODS: We conducted a prospective continuous study from December 2005 to August 2007 on 67 children: 49 boys and 18 girls with a mean age of 6 years (range, 3-14 years). The mean time lapsed from consultation to treatment was 30 h. The mean hospital stay was 72 h. In 50 children, the limb was elevated preoperatively for a mean 48 h. The fracture was reduced under fluoroscopy-guided general anesthesia with mask and immobilized with 5-cm cloth banding padded with foam. The follow-up was clinical and radiological. The mean follow-up was 16 months (range, 6-26 months). Assessment followed the 1969 SOFCOT guidelines. RESULTS: At union, mean flexion was 124 degrees , the mean extension lag was 26 degrees . At last follow-up, the mean flexion was 146 degrees , the extension lag was 0.5 degrees , and pronation and supination were free. Immediately after surgery, the mean Baumann and anteflexion angles were 75 degrees and 43 degrees , respectively; at union they were 76 degrees and 44 degrees and at follow-up 79 degrees and 42 degrees . We found no vascular or nerve lesions. According to the SOFCOT criteria, at follow-up we obtained 80.6% very good results and 19.4% good results. LEVEL OF EVIDENCE: Level IV. Therapeutic study.


Subject(s)
Humeral Fractures/therapy , Adolescent , Bandages , Child , Child, Preschool , Combined Modality Therapy , Female , Humans , Humeral Fractures/diagnostic imaging , Immobilization , Length of Stay/statistics & numerical data , Male , Orthopedic Procedures , Prospective Studies , Radiography , Splints , Treatment Outcome
10.
Chir Main ; 29(2): 135-7, 2010 Apr.
Article in French | MEDLINE | ID: mdl-20117955

ABSTRACT

The floating elbow in the child is rare and serious. The authors report a traumatic case of floating elbow without vascular and nervous lesions associated in a 6-year-old child. We treated these both fractures of the distal forearm and the supracondylar humeral by respectively cast plaster and a collar and cuff with an anatomical reduction. The radiological and clinical results were excellent with the 29 months follow-up.


Subject(s)
Casts, Surgical , Humeral Fractures/therapy , Manipulation, Orthopedic/methods , Radius Fractures/therapy , Ulna Fractures/therapy , Accidental Falls , Child , Female , Fracture Healing , Humans , Humeral Fractures/complications , Humeral Fractures/diagnostic imaging , Radiography , Radius Fractures/complications , Radius Fractures/diagnostic imaging , Range of Motion, Articular , Rare Diseases , Treatment Outcome , Ulna Fractures/complications , Ulna Fractures/diagnostic imaging
11.
Chir Main ; 28(3): 171-4, 2009 Jun.
Article in French | MEDLINE | ID: mdl-19443258

ABSTRACT

Entrapment of the median nerve is a rare complication following dislocation of the elbow. The authors report a case of incarceration of the median nerve in a neglected dislocation of the elbow in an 18-year-old right-handed boy. The patient sustained a closed injury of the right elbow during a game. The initial treatment was performed by a traditional bonesetter and consisted of attempts at reduction followed by immobilization in extension. There was persistent pain and limitation of movement in the elbow and paraesthesiae in the long finger. This led the patient to consult us at 45 days postinjury. Radiographs showed a posterolateral dislocation of the elbow. Surgical reduction was carried out 6 months posttrauma. After opening of the capsule, we discovered the median nerve blocking the olecranon fossa, passing at the level of the groove of the trochlea where it was wedged between the latter anteriorly and the olecranon posteriorly before resuming its normal course. Reduction was obtained and the nerve replaced in its normal position. The postoperative course was uneventful with disappearance of the paresthesiae and restoration of a good range of movement of the elbow. The authors discuss the mechanism, the clinical forms and propose a new type according to the classification of Fourrier.


Subject(s)
Elbow Injuries , Joint Dislocations/complications , Median Neuropathy/etiology , Adolescent , Elbow Joint/surgery , Humans , Joint Dislocations/surgery , Male , Median Neuropathy/surgery , Range of Motion, Articular , Splints
12.
Orthop Traumatol Surg Res ; 95(3): 234-6, 2009 May.
Article in English | MEDLINE | ID: mdl-19376001

ABSTRACT

The authors report a case of apophysial fracture of the odontoid process in association with paresis of the upper extremities in a 5-year-old child. The fracture was treated by gradual guided self-reduction without anaesthesia, followed by a Minerva jacket cast immobilisation. Reduction was anatomical, and the neurological problems regressed within 48 hours.


Subject(s)
Casts, Surgical , Manipulation, Orthopedic/methods , Odontoid Process/injuries , Spinal Fractures/therapy , Age Factors , Cervical Vertebrae/injuries , Child, Preschool , Follow-Up Studies , Fracture Healing/physiology , Humans , Immobilization/methods , Male , Odontoid Process/diagnostic imaging , Radiography , Risk Assessment , Spinal Fractures/diagnostic imaging , Time Factors , Treatment Outcome
13.
Chir Main ; 28(2): 93-8, 2009 Apr.
Article in French | MEDLINE | ID: mdl-19231270

ABSTRACT

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.


Subject(s)
Elbow Joint/pathology , Elbow Joint/physiopathology , Humeral Fractures/surgery , Osteotomy/methods , Adolescent , Adult , Aged , Elbow Joint/surgery , Female , Fracture Fixation, Internal/methods , Fractures, Closed/surgery , Fractures, Open/surgery , Humans , Humeral Fractures/pathology , Humeral Fractures/physiopathology , Male , Middle Aged , Range of Motion, Articular , Retrospective Studies , Treatment Outcome , Elbow Injuries
14.
Mali Med ; 23(1): 47-9, 2008.
Article in French | MEDLINE | ID: mdl-19437816

ABSTRACT

The purpose of this work is to estimate our anatomical and functional results of the surgical technique based on the AO principle of tension band wiring. We led a retrospective continuous study on the basis of 70 files brought together from January, 1999 till December, 2006. We had included all the patients who presented a recent fracture of the olecranon treated by tension band wiring and having a follow-up more than 6 month. Seven (7) files were excluded giving to the study one population of 63 patients. The fracture was classified according to the classification of Mayo clinic and the associated hurts were noted. The tension band wiring was the exclusive treatment. The evaluation looked for the complications and appreciated the radiological and functional results according to the score of Mayo Elbow Performance Score. We had found 48 fractures of type II and 15 fractures of type III. There were 5 cases of cutaneous punctiforme opening, a fracture of the ipsilateral forearm in 3 cases, a fracture of the thighbone in 1 case and a dislocation of the elbow associated with a fracture of the humerus in 1 case. The consolidation was obtained at 60 patient's at the end of 4 months on average (extremes: 3 and 6 months). There were 3 cases of non union and 5 cases of pins migrations. On the functional plan, we obtained 15 very good results, 26 good results, 19 average results and 3 bad results. The most frequent and the most common fractures of the elbow, the olecranon fractures treated by tension band wiring give good results.


Subject(s)
Bone Wires , Ulna Fractures/surgery , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Young Adult
15.
Mali méd. (En ligne) ; 23(1): 47-49, 2008.
Article in French | AIM (Africa) | ID: biblio-1265513

ABSTRACT

Le but de ce travail est d'evaluer les resultats anatomiques et fonctionnels du traitement chirurgical des fractures de l'olecrane base sur le principe du hauban de l' Associa- tion suisse d'Orthopedie (A.O.*). Nous avons mene une etude retrospective continue sur la base de 70 dossiers colliges de Janvier 1999 a Decembre 2006. Nous avions inclus tous les patients qui presentaient une fracture de l'olecrane recente traite par haubanage et ayant un suivi superieur ou egal a 6 mois. Sept (7) dossiers ont ete exclus don- nant a l'etude un population de 63 patients. La fracture a ete classee selon la classification de la Mayo clinic et les lesions associees ont ete notees. Le haubanage a ete le traitement exclusif. L'evaluation a recherche les complications et a apprecie les resultats radiologique et fonctionnel selon le score de la Mayo Elbow Performance Score. Nous avions retrouve 3 fractures de type I; 48 fractures de type II et 12 fractures de type III. Il y avait 5 cas d'ouverture cutanee punctiforme; une fracture de l'avant-bras homolaterale dans 3 cas; une fracture du femur dans 1 cas et une luxation du coude associee a une fracture de l'humerus dans 1 cas. La consolida- tion a ete obtenue chez 60 patients au bout de 4 mois en moyenne (extremes : 3 et 6 mois). Il y a eu 3 cas de pseudarthrose et 5 cas de migration de broches. Sur le plan fonctionnel; nous avons obtenu 15 tres bons resultats; 26 bons resultats; 19 resultats moyens et 3 mauvais resultats. Plus frequentes et plus communes des fractures du coude; les fractures de l'olecrane traitees par haubanage donnent de bons resultats


Subject(s)
Case Reports , Fractures, Closed
16.
Chir Main ; 26(6): 288-92, 2007 Dec.
Article in French | MEDLINE | ID: mdl-18023235

ABSTRACT

The authors evaluated the management of malunions of midshaft fractures of the radius and ulna in an Orthopedic and Traumatology departement at Le Dantec University hospital (Dakar, Sénégal). Over a six-year period, there were 10 cases found for analysis. All patients presented with disabilities due to limited pronosupination. Surgical care improved the pronosupination amplitude in all patients. The role of conservative treatment of these fractures in causing malunion is discussed. Correction of these malunions should be by osteotomy, followed by rigid internal fixation with a plate and screws.


Subject(s)
Fractures, Malunited/surgery , Radius Fractures/surgery , Ulna Fractures/surgery , Adolescent , Adult , Bone Plates , Bone Screws , Bony Callus , Diaphyses/injuries , Forearm/physiology , Fracture Fixation, Internal/instrumentation , Humans , Middle Aged , Osteotomy , Pronation , Radiography , Radius Fractures/diagnostic imaging , Supination , Treatment Outcome , Ulna Fractures/diagnostic imaging
17.
Surg Radiol Anat ; 29(8): 671-4, 2007 Dec.
Article in English | MEDLINE | ID: mdl-17952364

ABSTRACT

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.


Subject(s)
Elbow Joint/anatomy & histology , Elbow Joint/surgery , Humerus/anatomy & histology , Humerus/surgery , Adult , Cadaver , Humans , Male , Muscle, Skeletal/surgery , Osteotomy/methods , Photography
18.
Chir Main ; 26(4-5): 221-6, 2007.
Article in French | MEDLINE | ID: mdl-17888711

ABSTRACT

"Traffic elbow" is a condition occurring when high energy trauma involves a patient's elbow resting on the window of the car or completely outside it. This is a prospective study over 30 months of 9 patients with "traffic elbow" and therefore sufferring complex open trauma to the elbow. There were 8 men and 1 woman with a median delay of 4 hours before arrival in hospital. The dominant member was affected in 3 cases. The severity of the lesions, using the Mangled Extremity Severity Score (MESS), was more than 7, comprising lesions corresponding to type 1 of the complex trauma of the superior member (TCMS) in 2 patients and a MESS score of between 3 and 6 corresponding to types 2 or 3 of the TCMS for the other 7 patients. The therapeutic possibilities are limited considering the frequent context of polytrauma. In 4 cases we performed a debridement and external humero-ulnar fixation, in 3 cases a debridement and stabilization with Kirschner's wires completed by a fenestrated cast, and in 2 cases a lifesaving amputation. All patients, except those that had had amputation, developed deep sepsis that resolved after adequate treatment. Assessment of the non-amputee patients according to the Mayo Performance Score, yielded more than 70% of bad results. The authors stress the gravity of these lesions whose prognosis is guarded both concerning mobility of the elbow and the frequent neurovascular complications.


Subject(s)
Accidents, Traffic , Elbow Injuries , Elbow/surgery , Adult , Amputation, Surgical , Casts, Surgical , Debridement , Female , Fracture Fixation , Humans , Humeral Fractures/surgery , Injury Severity Score , Male , Middle Aged , Prospective Studies , Ulna Fractures/surgery
19.
Rev Chir Orthop Reparatrice Appar Mot ; 91(2): 173-9, 2005 Apr.
Article in French | MEDLINE | ID: mdl-15908889

ABSTRACT

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.


Subject(s)
Femoral Neck Fractures/etiology , Hip Dislocation/complications , Hip Dislocation/therapy , Orthopedic Procedures/adverse effects , Accidents, Traffic , Adult , Aged , Fracture Fixation , Humans , Joint Instability , Male , Middle Aged , Treatment Outcome
20.
Chir Main ; 24(2): 92-8, 2005 Apr.
Article in French | MEDLINE | ID: mdl-15861978

ABSTRACT

PURPOSE OF THE STUDY: Many methods have been proposed for treatment of displaced humeral shaft fractures in adults. This study was designed to evaluate the anatomical and functional results of patients treated by retrograde intramedullary nailing through the lateral condyle. MATERIALS AND METHODS: Sixty-three fresh traumatic fractures of the humerus were treated between January 2000 and January 2003. Five patients were lost to follow-up. The AO classification and the Hackethal classification modified by De La Caffinière were used. Outcome was assessed according to the modified Stewart and Hundey classification. RESULTS: We had 23 very good results, 26 good results, five passable results and four bad results. The bad results were three cases of non-union and one case with poor function (stiffness of elbow and shoulder). Mean delay to union was ten weeks four days. There were no cases of iatrogenic radial nerve palsy or pin migration. CONCLUSION: Retrograde intramedullary nailing is a reliable method, easy to perform and of low economic cost. We propose it for all types of displaced shaft humeral fractures.


Subject(s)
Fracture Fixation, Intramedullary/methods , Humeral Fractures/surgery , Adolescent , Adult , Aged , Female , Fracture Fixation, Intramedullary/adverse effects , Fracture Healing , Fractures, Ununited/etiology , Humans , Humeral Fractures/classification , Humeral Fractures/physiopathology , Male , Middle Aged , Prospective Studies , Range of Motion, Articular/physiology , Treatment Outcome
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