Les cals vicieux diaphysaires du fémur de l'adulte traités par ostéotomie et ostéosynthèse à ciel ouvert à Bangui (République centrafricaine)

Introduction: Les cals vicieux diaphysaires du fémur sont le plus souvent les complications du traitement traditionnel des fractures. Cette étude avait pour objectifs de préciser les formes anatomo-cliniques des lésions, décrire la technique utilisée, et évaluer les résultats obtenus.Matériel et méthodes. Cette étude prospective incluait tous les cals vicieux diaphysaires du fémur de l'adulte traités entre juin 2011 et mai 2015. Leur gravité de la déformation était classée selon des critères propres. Les résultats du traitement étaient évalués au recul minimum de 12 mois avec les critères de Thorensen.Résultats L'étude incluait 34 patients (28 hommes et 6 femmes) avec un âge moyen de 30 ans (16 et 65). Les patients ont consulté après un délai moyen de 7,6 mois (4 et 24). Les cals vicieux siégeaient au tiers supérieur (n=6), au tiers moyen (n=16) et au tiers inferieur (n=12). Le traitement initial des fractures était traditionnel (n=22), chirurgical (n=8)et orthopédique (n=4). Les motifs de consultation étaient mixtes associant boiterie à la marche et douleurs articulaires (n=17), douleur isolée (n=8), boiterie (n= 8). Un patient a consulté pour raison esthétique (n=1). Le raccourcissement du membre était en moyenne de 2,6 cm (2 à 4). L'angulation moyenne était de 26,7° (4 à 45°). La mobilité du genou était de 90,4° en moyenne (45 à 120°). Le délai moyen de réalisation de l'ostéotomie était de 7 mois (4 et 25) après le traumatisme. L'ostéotomie était faite après décortication ostéo musculaire selon Judet. Un enclouage avec clou de Kuntscher a été faite pour 29 fractures médiodiaphysaires. Une plaque vissée a été utilisée pour 5 fractures proximales et distales. Aucun patient n'a été perdu de vue. Nous n'avons noté ni fracture iatrogène, ni lésion vasculaire et/ou nerveuse. Aucune infection du site opératoire n'était notée. La mobilité moyenne post-opératoire du genou était de 124° (110 et 135). Au recul moyen de 21 mois les résultats selon les critères de Thorensen étaient bon (n=12) et moyen (n=22).Conclusion Les cals vicieux fémoraux avec un raccourcissement maximal de 4 cm et une angulation à 45° peuvent être corrigés à foyer ouvert en un temps opératoire après une décortication ostéomusculaire

[Congenital malformations of the forefoot]. / Les malformations congénitales de l'avant-pied.

Malformations and deformations of the forefoot are a frequent reason for consultation. The most frequent malformations viewed at birth are syndactylies (second web space), clinodactylies (quintus varus, halllux), polydactylies (hallux, fifth toe). The macrodactylies, hypoplasia, amniotic bands are rare. The management of these defects requires knowledge of surgery adult foot, plastic surgery and especially collaboration with physiotherapists, podiatrists and orthotists. The fast growth of the foot the first year and the development of walking at one year require to start early the treatment of deformations and to anticipate the evolution of malformations.

Traitement orthopedique des fractures deplacees du quart inferieur du radius chez l'enfant

But : rapporter les resultats du traitement orthopedique en fonction des analyses radiologiques et fonctionnelles. Patients et methode : etude prospective sur les fractures deplacees du quart inferieur du radius au CHU de Nancy (France) de janvier 2003 a aout 2004. La reduction etait faite sous anesthesie generale et l'immobilisation brachio-antebrachio-palmaire. Les mesures radiologiques ont ete : les angulations radiales de face et profil; la translation radiale a J1; J7; J14; J45 et au recul maximum ainsi que l'angle de flexion du poignet dans le platre. Resultats : vingt-sept fractures deplacees du quart inferieur du radius ont ete suivis dont 22 avaient repondu parfaitement aux criteres de l'etude tandis que 5 translations radiales ont etes notees. 11 deplacements secondaires (41) ont ete notes a six semaines du deplatrage dont 6 bascules posterieures de 12 a 26 o; 2 bascules anterieures de 5o et 28o; 3 inclinaisons radiales de 20 a 30o. Les translations radiales n'ont pas ete deplacees secondairement. Selon les criteres de Clarke; nos reductions ont ete anatomiques malgre de nombreux deplacements secondaires. Les translations radiales initiales n'ont pas ete deplacees secondairement. Nous n'avons pas note l'influence de l'hyperflexion palmaire; se pose alors la question du moulage platre. Conclusion : le traitement orthopedique a ete marque par un taux eleve de deplacements secondaires. Mais le remodelage radiologique et les resultats fonctionnels ont ete parfaits au recul maximum. Notre attitude actuelle est d'immobiliser en supination et en legere flexion palmaire tout en veillant a un bon moulage du platre

Complications post-operatoires dans le service de chirurgie pediatrique de Bangui

Objectifs : determiner la frequence hospitaliere; identifier les facteurs de risques des complications post operatoires (CPO) dans le service. Patients et methodes : etude retrospective realisee du 1er janvier au 31 decembre 2009 sur les enfants ages de 0 a15 ans operes en chirurgie reglee ou en urgence. Resultats : 612 cas dont 50 avaient presente des CPO soit 8;2. L'age moyen etait de 8;1 ans. Parmi nos sujets compliques; 31 (62) etaient des garcons et 19 (38) des filles. Nous avons enregistre 73 cas de CPO dont l'infection du site operatoire 55;9; le lachage superficiel 20;5; l'occlusion 9;6; l'anemie 8;2; l'eventration; les fistules digestives 2;7 et l'inegalite des membres inferieurs (raccourcissement) 1;4. La duree moyenne d'apparition des CPO etait de 10;48 jours (extremes 3 et 64 jours). Un germe a ete retrouve a l'examen cyto-bacteriologique du pus chez 14 patients et une association des germes chez 5 patients. Les staphylocoques et l'Escherichia coli etaient frequemment retrouves avec des taux respectifs de 36;8 et 26;3. Le taux de deces etait de 1;3. Notre proportion d'infection de la plaie operatoire; majoritairement monomicrobienne est triplement superieure aux autres observations. Mais leur infection etait plutot polymicrobienne. Concernant la classification de RENGGLI et l'indice de GUILLON; nos taux beaucoup plus eleves devraient nous amener a ameliorer les conditions d'hygiene et materielles afin de reduire la mortalite a la clinique chirurgicale de Bangui. La classification d'Altemeier; le mode de recrutement et la duree d'intervention chirurgicale ont ete des facteurs determinants dans la survenue des

Hernie ombilicale de l'enfant : aspects epidemiologiques; cliniques et therapeutiques au complexe pediatrique de Bangui (RCA)

Les objectifs de ce travail sont de decrire les aspects epidemiologiques; cliniques et therapeutiques de la hernie ombilicale. A cet effet; une etude retrospective a ete conduite de juin 2005 a juin 2010 sur 93 cas de hernie ombilicale. Celle-ci representait 12 de toutes les interventions chirurgicales; 33;7 des hernies de l'enfant et 5;2 des cas d'hospitalisation. La population etait masculine avec un sex-ratio de 2;2. L'age moyen etait de 2;3 ans avec des extremes d'un mois et 15 ans. La tranche d'age la plus touchee etait celle des enfants de moins d'un an. Les malades se plaignaient dans 51;3 de douleurs abdominales. L'etranglement etait la complication la plus representee avec 22;6 de cas. 11 engouements etaient observes soit 11;8. Les hernies ombilicales dont le diametre etait superieur a 2 cm etaient les plus representees (57). Le paludisme et la typhoide etaient les principales pathologies associees. La hernie ombilicale; pathologie frequente en pratique pediatrique africaine; a ete rapportee dans la litterature comme nous; et le sexe masculin semble etre un facteur de risque. C'est une affection non douloureuse en general et notre fort taux de douleur pourrait etre lie aux formes compliquees ou pathologies medicales associees. Le traitement chirurgical etait notre seul mode de traitement. Les etranglements herniaires; les engouements et les hernies ombilicales simples persistantes etaient systematiquement operes. Les dernieres categories devraient desormais faire l'objet d'un examen approfondi car une hernie ombilicale simple; souvent associee a une douleur ou autres signes peut cacher une pathologie medicale ou chirurgicale

[Treatment of complications of intramuscular injection of quinine salts in Africa]. / Le traitement des séquelles d'injections intramusculaires de sels de quinine en milieu africain.

Intramuscular injection of quinine is a mainstay treatment for malaria in children. However it can lead to severe orthopedic complications including sciatic paralysis after intragluteal injection and quadriceps contracture after intraquadricipital injection. This report based on a 98-case series of complications following intramuscular quinine injection that were treated surgically in 88 cases describes clinical findings with special emphasis on the severity. Therapeutic alternatives for these complications are presented and discussed including the use of medial release or double subtalar and midtarsal arthrodesis for correction of foot deformity in function of age. Correction may be associated with anterolateral transposition of the posterior tibialis tendon that is generally not paralyzed. For correction of complications involving the knee, the authors recommend extended proximal quadriceps release that is more invasive but achieves better results than lengthening plasty of the distal quadriceps.

[Surgical site infection survey in the orthopaedic surgery department of the "Hôpital communautaire de Bangui," Central African Republic]. / Infections du site opératoire dans le service de chirurgie orthopédique de l'hôpital communautaire de Bangui, République centrafricaine.

As we have been confronted to frequent surgical site infections (SSI) in our practice in Bangui, CAR and because of the scarcity of studies about this subject in Central Africa area, we conducted a prospective survey in order to determine the frequency the causative bacteria and the main risk factors of SSI in Bangui. All patients who underwent surgery in the orthopaedics surgery department of the "Hôpital Communautaire de Bangui", CAR, between May 2003 to April 2004 were enrolled. We included all consenting patients responding to the following criteria: Altemeir class 1 to 3 and operated for the first time. The following risk factors have been studied: ASA score, time length of the procedure, pre operative stay in the ward, type of procedure, and use of antibioprophylaxy. Bacteriological study was performed at the Institut Pasteur in Bangui. During the study period, 278 cases were included (207 were male and 71 were female) and 51 SSI (18%) were diagnosed among which 48 cases during hospitalization and only 3 cases after discharge. The infections were superficial in 31 cases (61%) and deep in 20 cases (39%) and often requiring new surgery procedure. The following factors were found to be predictive for a SSI: Altemeier class and a long time of surgery procedure. No difference in the frequency of SSI was noted in patients who received antibioprophylaxy or not. Methicillin-susceptible S. aureus was the most frequent species isolated in SSI, followed by Enterobacteriaceae and P. aeruginosa. A strain of E. cloacae harbouring an extended spectrum beta-Lactamase was also identified. SSI occurs at very high frequency in our practice in the "Hôpital Communautaire de Bangui", CAR. The antibioprophylaxy scheme used in our hospital (generally penicillin G), is not adapted to prevent SSI. It is of great importance to control and improve hygienic procedures in surgical practices in Bangui, to modify the antibioprophylaxy schemes and to implement SSI surveillance.

[Abdominal trauma in Bangui (Central Africa). Epidemiologic and anatomical aspects]. / Les traumatismes abdominaux a Bangui (Centrafrique). Aspects épidémiolgiques et anatomocliniques.

The authors achieved a retrospective study about abdominal traumas in Bangui (Central Africa) during 7 years (1995 to 2001). The aim of the study was to come out epidemiologic and anatomoclinical aspects of those injuries, which outcome during war periods. From the 202 patients of the study, 166 of them were men (sex ratio at 4.6) and the middle age was 27.1. There were 151 penetrating abdominal injury (75%) and 51 cases of abdominal injury.The main aetiologies of penetrating abdominal injuries was due to war guns (23%), fights (23%). Traffic accidents (56.8), fights (21.5%) were the main causes in abdominal contusions. The spleen was more injured in contusions (58.5%) and the colon was more in penetrating abdominal injuries. There were also any multivisceral lesions. In 28 cases of laparotomy (16.6%), not any organ has been injured.

Le traitement des sequelles d'injections intramusculaires de sels de quinine en milieu africain

L'injection intra-musculaire de quinine; traitement habituel de l'acces palustre chez l'enfant; est trop souvent a l'origine de complications orthopediques graves : paralysie sciatique apres injection intrafessiere; raideur du genou en extension apres injection intraquadricipitale. A partir d'une serie de 98 cas; dont 88 operes; les auteurs etudient les tableaux cliniques presentes et ils insistent sur la gravite des sequelles fonctionnelles. Ils analysent les possibilites therapeutiques des sequelles : au niveau du pied correction selon l'age par liberation interne ou double arthrodese sous-talienne et mediotarsienne; associee a une stabilisation par transposition antero-externe du tendon du tibial posterieur qui est tres habituellement non paralyse. Au niveau du genou; les auteurs proposent une correction par desinsertion large du quadriceps; intervention plus lourdemais dont les resultats sont meilleurs que la simple plastie d'allongement du tendon quadricipital

Le traitement des sequelles d'injections intramusculaires de sels de quinine en milieu africain

L'injection intra-musculaire de quinine; traitement habituel de l'acces palustre chez l'enfant; est trop souvent a l'origine de complications orthopediques graves : paralysie sciatique apres injection intrafessiere; raideur du genou en extension apres injection intraquadricipitale. A partir d'une serie de 98 cas; dont 88 operes; les auteurs etudient les tableaux cliniques presentes et ils insistent sur la gravite des sequelles fonctionnelles. Ils analysent les possibilites therapeutiques des sequelles : au niveau du pied correction selon l'age par liberation interne ou double arthrodese sous-talienne et mediotarsienne; associee a une stabilisation par transposition antero-externe du tendon du tibial posterieur qui est tres habituellement non paralyse. Au niveau du genou; les auteurs proposent une correction par desinsertion large du quadriceps; intervention plus lourdemais dont les resultats sont meilleurs que la simple plastie d'allongement du tendon quadricipital

[Ocular injuries in children aged 0-15 years: epidemiological and clinical aspects at the Bangui National Teaching Hospital]. / Les traumatismes oculaires chez les enfants âgés de 0 à 15 ans. Aspects épidémiologiques et cliniques au Centre National Hospitalier Universitaire de Bangui.

PURPOSE: Ocular injuries in children are frequent and are an ophthalmological emergency. If not managed sufficiently early, these lesions may cause definitive partial loss of vision or blindness. In this survey, the authors analyze different epidemiological and clinical aspects of ocular injuries at the Bangui National Teaching Hospital in the Central African Republic to increase the awareness of children's parents, guardians, and care-takers. PATIENTS AND METHODS: A prospective study was conducted on 194 cases in the ophthalmology department over a period of 3 years, and included children aged 0-15 years. A total of 197 eyes were examined by the same practitioner, comprising 191 unilateral ocular injuries and three bilateral injuries. RESULTS: Of the children examined, 59% were males and 41% were females, with a sex ratio of 1.3. The age group with the highest exposure (39.3%) was between 5 and 10 years. Punishments (25.9%), accidents during games (19.3%) and fights (18.8%) were the main sources of these ocular injuries. Consultation most often occurred long after the incident. Only 2.0% were seen before the 6th hour and 43.7% between 48 hours and 1 week. The clinical picture was dominated by bruises posing a therapeutic problem: 25 hyphemas (12.7%), 19 conjunctival injuries (9.6%), 19 lens dislocations with or without vitreous loss (9.6%), 18 trauma-induced cataracts (9.4%), and 15 eye lid injuries with or without lachrymal duct ruptures (7.6%). The most serious injuries were cornea injuries with or without hernia of the iris (19.8%) and nine globe dislocations (4.5%). CONCLUSION: The frequency and gravity of the lesions identified, the severity of the injuries and the delay in treating these injuries show that the public authorities, parents and child care-takers need more information in order to reduce the frequency of these accidents.

[An update on severe pediatric malaria in Central Africa hospital units]. / Les aspects actuels du paludisme grave de l'enfant en milieu hospitalier pédiatrique centrafricain.

OBJECTIVE: The authors had for aim, to determine the frequency and the main clinical forms of severe malaria and to evaluate its management. PATIENTS AND METHODS: A cross-sectional investigation was made in the "Complexe Pediatrique" of Bangui, the only children hospital of the CAR capital, from 12 January to 12 September 1998. The survey included children 6 months to 15 years of age presenting on admission with a positive thick drop examination, and at least one of the clinical symptoms of severe malaria as defined by the World Organization of Health (WHO). RESULTS: Four hundred and thirty-two children were included. Those from 6 months to 4 years of age accounted for 89.35% of the studied population. The most frequent clinical forms were neurological 31% and anemic 22.2%; the other forms were combined in 42.8%. Managing patients consisted of an etiologic treatment by quinine (91.7%) or sulfadoxine pyrimethamine (3.2%) and symptomatic treatment in the following proportions: rehydration: 49.3%; blood transfusion: 36.3%; preventing seizure: 72.9%; oxygen therapy: 77.5%; use of antipyretics: 96.7%, and correction of hypoglycemia: 9%. The death rate remained high with 62 deaths (14.35%). It was higher in combined forms (48 deaths out of 62). CONCLUSION: Severe malaria and its various clinical forms remain a major problem for our pediatric intensive care unit. Updated technical means and human resources could improve the management of severe pediatric malaria.

[Acute abdominal pain in children at the Pediatric Hospital in Bangui (Central African Republic). Epidemiological, clinical, paraclinical, therapeutic and evolutive aspects]. / Les douleurs abdominales aiguës chez l'enfant au complexe pédiatrique de Bangui (Centrafrique). Aspects épidémiologiques, cliniques, paracliniques, thérapeutiques et évolutifs.

UNLABELLED: Acute abdominal pains in children in general, and in subsaharian Africa in particular, are among the most frequent causes of consultations. MATERIAL AND METHODS: The authors achieved a two-year retrospective study on acute abdominal pains in children, with the objectives of determining the frequency of acute abdominal pains, precising the epidemiological, clinical, therapeutic and evolutive aspects and different aspects of the treatment. The study concerned 312 cases. RESULTS: A predominance of the ages three to ten years was noted (67% of the cases). Most of the patients were related to low income parents. Half patients were submitted to antiparasitical treatment before arriving at the hospital and they were treated mainly by antihelminthiasis. The diagnosis were appendicitis (32.4%), typhoid perforations (9.9%), digestive forms of acute malaria (5.8%), strangulated herniae (4.8%), acute gastroenteritis (4.8%), acute pneumoniae (3.8%), urinary tract infections (3.5%), amibian liver abscess (1.9%), viral hepatitis (1.6%), Schönlein Henoch purpura (1.3%), occlusive syndrome (1.3%) and other medical causes (2.2%). In 22.8% of the cases, no cause was found. CONCLUSION: The ignorance of the seriousness signals, late recourses to hospitals structures and the limited financial means explain the high rate of mortality (8%), mainly due to appendicitis and typhoid perforations.

[Ewing's tumor in children: report of 31 cases]. / La tumeur d'Ewing de l'enfant: à propos de 31 observations.

A retrospective study, from January 1985 to January 1997 has been realised on 31 children with Ewing's tumor. These children have been treated by conservative way. We haxe pick out different aspects - epidemiologic: about sex, we found 15 boys for 16 girls for the age, the axerage age was 10. - Clinic: the main discovery circumstances were pain and tumor, and initial or eventually second localizations during the extension research was mainly thighhone and fibula then pelvis. - surgical way choosen and results. Then we compared our results with others and conclued that the pronostic of this disease can become better, using a multidisciplinar staff and very important technical means which we can reach with a lot of difficulties in Africa.

[Profile of surgical emergencies in rural areas: the regional Hospital of Bambari in Central Africa as an example]. / Profil des urgences chirurgicales en zone rurale: exemple de l'Hôpital Régional de Bambari en Centrafrique.

The authors has list different surgical emergencies in an hospital in a rural area in Central African Republic, by a retrospective and prospective study. There were 213 cases, distributed among: 88 cases of trauma (41.3%), 78 cases of abdominal emergencies (21.5%), 46 cases of gynaecologic and obstetrical emergencies (21.5%), one case of urologic emergency (0.4%). Those pathologies have been studied through the age and sex of the patients, the different aetiologies and the body areas injured ( for the traumatims). Then they compared their results with those of the others and concluded that an effort must be done in those areas, mainly about the traffic accidents which number are growing.

[Difficulties in the management of supracondylar fractures of the humerus in children living in Central African Republic]. / Difficultes dans la prise en charge des fractures supracondyliennes de l'humerus de l'enfant en Centrafrique.

Like many developing countries, the Central African Republic lacks the technology and skills to perform certain medical procedures. One example of this situation can be found in the Pediatric Surgery Department of Bangui with regard to first intention management of supracondylar fractures of the humerus (SCF). Due to a lack of proper technological facilities (e.g. absence of brightness enhancement) and to insufficient staff training, management of SCF must be limited to orthopedic reduction followed cast application and brachio-anti-brachio-palmar traction such problems. This retrospective study describes management of 119 cases of SCF involving children between the ages of 0 and 15 years. Special emphasis was placed on factors impairing outcome, namely, inadequate staff training, availability of brightness enhancement, and poor awareness on the part of the parents concerning the seriousness of SCF. The quality of reduction was compared according to whether reduction was done with or without brightness enhancement (reduction without brightness enhancement was imperfect in most cases: 78/119) and according to fracture grade (high number of imperfect reductions in grade 3 and 4:69%). Assessment of outcome at one month showed a high incidence of poor results due to severe fracture or imperfect reduction. A prospective study including 35 cases with a follow-up of three years showed poor results for the same reasons. Comparison of these results with those reported by previous authors showed a large gap which must be filled by upgrading technical facilities and training staff.

[Epidemiology of supracondylar fractures of the humerus in children in Bangui, Central African Republic]. / Epidémiologie des fractures supra-condyliennes de l'humerus chez l'enfant à Bangui, Centrafrique.

The purpose of this retrospective study was to evaluate the epidemiological, clinical, and anatomical aspects of supracondylar fractures of the humerus in children treated at the National University Hospital Center (NUHC) of Bangui, Central African Republic. Between January 1992 and March 1995 a total of 119 documented cases involving children between the ages of 0 and 15 years were treated. Most patients were boys (62%) between 3 and 8 years of age. Fracture occurred during play in 74% of cases on the left side (92 cases) more often than the right. The mechanism of fracture was extension in 115 of the 119 cases with only four open fractures. Most fractures (68.1%) were severe (Lagrange Grade 3 and 4). These findings which are comparable to those reported in other countries confirm the high incidence of supracondylar fracture of the humerus and need for appropriate treatment in African orthopedic facilities.

[Focal fibrocartilaginous dysplasia and tibia vara. Apropos of 2 cases. Review of the literature]. / Dysplasie fibrocartilagineuse focale et tibia vara. A propos de 2 cas. Revue de la littérature.

Focal cartilaginous dysplasia is a rare condition associated with unilateral tibia vara in young children. The authors report 2 cases. In one patient spontaneous correction occurred at the age of 18 months. In the other case the patient's deformity persisted, and an osteotomy was performed at the age of 36 months. Through these 2 cases and 26 cases of the literature, the authors discuss the healing process and etiology. The most likely exploration is an abnormal development at the insertion of the pes anserinus inducing epiphysiodese like effect. In most cases, the growth plate of the proximal tibial appears to correct the deformity. Surgical correction is necessary after the age of 36 months, if the angular deformation is up to 30 degrees of varus.