Orthopedic postoperative infection profile and antibiotic sensitivity of 2038 patients across 24 countries - Call for region and institution specific surgical antimicrobial prophylaxis.

Purpose: Improper utilization of surgical antimicrobial prophylaxis frequently leads to increased risks of morbidity and mortality.This study aims to understand the common causative organism of postoperative orthopedic infection and document the surgical antimicrobial prophylaxis protocol across various institutions in to order to strengthen surgical antimicrobial prophylaxis practice and provide higher-quality surgical care. Methods: This multicentric multinational retrospective study, includes 24 countries from five different regions (Asia Pacific, South Eastern Africa, Western Africa, Latin America, and Middle East). Patients who developed orthopedic surgical site infection between January 2021 and December 2022 were included. Demographic details, bacterial profile of surgical site infection, and antibiotic sensitivity pattern were documented. Results: 2038 patients from 24 countries were included. Among them 69.7 % were male patients and 64.1 % were between 20 and 60 years. 70.3 % patients underwent trauma surgery and instrumentation was used in 93.5 %. Ceftriaxone was the most common preferred in 53.4 %. Early SSI was seen in 55.2 % and deep SSI in 59.7 %. Western Africa (76 %) and Asia-Pacific (52.8 %) reported a higher number of gram-negative infections whereas gram-positive organisms were predominant in other regions. Most common gram positive organism was Staphylococcus aureus (35 %) and gram-negative was Klebsiella (17.2 %). Majority of the organisms showed variable sensitivity to broad-spectrum antibiotics. Conclusion: Our study strongly proves that every institution has to analyse their surgical site infection microbiological profile and antibiotic sensitivity of the organisms and plan their surgical antimicrobial prophylaxis accordingly. This will help to decrease the rate of surgical site infection, prevent the emergence of multidrug resistance and reduce the economic burden of treatment.

Simultaneous bilateral femoral fracture in children.

Introduction: Bilateral femoral fractures in children (BFFC) are an uncommon condition. Only a few cases were reported in the literature. The frequency and outcome in low-setting facilities are unknown. This study aims to describe our experience in managing BFFC. Patients and Methods: A 10-year ongoing study spanning from 2010 to 2020 was held in a level-1 paediatric facility. We included all cases of BFFC on a bone-free disease with at least 10 months of follow-up time. Data were collected and analysed with statistical software. Results: A total of eight patients with ten BFFC were collected. It involved mainly boys (n = 7/8) with median age of 8 years. Mechanism of injury were a road traffic accident (n = 4), a fall from height (n = 3), and been crushed by a falling wall (n = 1). Associated injuries were frequent (n = 6/8). Patients were managed nonoperatively with spica cast (n = 5) and by elastic intramedullary nails (n = 3). After 6.11 years of mean follow-up time, all fractures healed. The outcome was excellent and good in 7 cases. One patient sustained knees stiffness. Conclusion: Non-operative management of BFFC showed satisfactory outcomes. Early surgical care must be developed in our low-income settings to reduce in-hospital stay and encourage early weight-bearing.

Dual mobility total hip replacement: a 15-year experience in Burkina Faso.

To report our 15 years of experience in dual mobility total hip replacement (THR) in Burkina Faso through a Franco-Burkinabé relief organization. A retrospective study spanning from 2004 to 2018 was held in a private facility. All dual mobility THR cases with at least one year of follow-up time were included. The survey used a questionnaire, and data were analyzed with statistical software (Stata® v.13). A total of 145 primary THR in 129 patients were included in disabled young patients. There was 60.46% of males (n=78) with a mean age of 44.57 years (SD=12.43). The mean etiologies were avascular necrosis of the hip (n=84), followed by childhood chronic arthritis sequalae (n=24, 16.55%) and trauma sequalae (n=13, 8.97%). All prostheses were metal-on-polyethylene from Zimmer-Biomet®. It was usually small sizes with 48 mm (females) and 50 mm (males) cups, stem 1 (female) and 3 (males). After 2.70 years (SD=2.66) of mean follow-up times, results were good despite a high rate of revision (n=10, 6.89%) due to infections and implant malposition. THR practice might be encouraged in developing countries. The dual mobility concept is adapted to sociological activities. High duration implants and cost limitation is mandatory for the replacement joints diffusion.

Reduction of Neglected Displaced Fractures of the Distal Femoral Physis.

BACKGROUND: We performed open osteoclasis, soft-tissue release, and fracture fragment reduction and fixation to treat 10 cases of neglected physeal fractures of the distal aspect of the femur with severe deformity. To our knowledge, no specific surgical procedure for this problem has been reported in the literature. DESCRIPTION: The procedure is typically performed through an extensile anterolateral approach. With use of an osteotome, the typically abundant fracture callus is disrupted and partially removed to recreate the original fracture line. Through periosteal dissection, an extensive musculoperiosteal detachment and release is achieved to facilitate fracture reduction while protecting the physis from further injury. ALTERNATIVES: Knee rehabilitation in closed, nondisplaced or minimally displaced fractures1.Open callus osteoclasis in combination with a Z-shaped quadriceps tenoplasty, reduction, and plaster cast immobilization2.Open subperiosteal osteoclasis, reduction, and tibial traction3.Open callus osteoclasis, reduction, and condylar plating4.Sequestrectomy with preservation of a periosteal sleeve to treat osteomyelitis complicating an open fracture1.Transfemoral amputation to treat gas gangrene or vascular injury following severe open injury1,5-7. RATIONALE: This procedure was developed in remote medical facilities where patients are often first seen >21 days after the original injury. By that time, closed reduction or standard open reduction and internal fixation techniques are no longer possible. After 6 months of fracture age, the procedure is inefficient. EXPECTED OUTCOMES: This procedure allows correction of limb malalignment and shortening while preserving the growth plate1. IMPORTANT TIPS: In some cases, hypertrophic fracture callus might be mistaken for the femoral diaphysis.An extensive musculoperiosteal release will facilitate reduction of the fracture fragments.The adequacy of reduction must be assessed in all 3 planes intraoperatively.The adequacy of reduction must be assessed in all 3 planes intraoperatively.The adequacy of reduction must be assessed in all 3 planes intraoperatively.

[Total hip replacements in a country with limited resources: evaluation of medium-term results]. / Arthroplasties totales de hanche dans un pays a ressources limitees : evaluation des resultats a moyen terme.

INTRODUCTION: Total hip arthroplasty (THA) has been regularly performed in the public hospital in Bobo-Dioulasso since 2010. The objective of thisstudywas to assess the medium-termresults of total hip arthroplastyat the Bobo-Dioulasso UniversityHospital. Dioulasso. PATIENTS AND METHODS: This was a non-randomized single-center retrospectivestudydesigned in accordance with the recommendations of the Declaration of Helsinki. Wereviewed the medical files and evaluated 29 patients, i.e. 33 hipsoperated for THA at the Bobo-Dioulasso UniversityHospitalfromJanuary 1st, 2010 to December 31, 2015. RESULTS: ONATF was the indication for ATH in 78.79% of cases (n = 28). THA wascementedin 43% of cases. Complications wereposterior dislocations (n = 4), infection (n = 1) and loosening (n = 2). The meanfollow-up was 78.3 months. At the last follow-up, the mean PMA was 15.13 and the mean Harris score was 84.36. The inclination of the cupswasbetween 45 ° and 50 °. The femoral stems werecenteredin 94% of cases (n = 32). There was one case of peri-prosthetic ossification and one case of acetabularrim. CONCLUSION: Total hip arthroplasty has become a common and well-codified practice in orthopedicsurgerywithreliable and veryencouragingresults.

INTRODUCTION: L'arthroplastie totale de la hanche (ATH) est régulièrement pratiquée dans l'hôpital public à Bobo-Dioulasso depuis 2010. L'objectif de cette étude était d'évaluer les résultats à moyen terme des arthroplasties totales de hanches au CHU de Bobo-Dioulasso. PATIENTS ET MÉTHODES: Il s'agissait d'une étude rétrospective monocentrique non randomisée rédigée conformément aux recommandations de la déclaration d'Helsinki. Nous avons revu les dossiers médicaux et évaluer 29 patients soit 33 hanches opérées pour PTH au CHU de Bobo-Dioulasso du 1er Janvier 2010 au 31 Décembre 2015. RÉSULTATS: L'ONATF était l'indication de l'ATH dans 78,79% des cas (n=28). Les PTH étaient cimentées (n=14) ou non. Les complications étaient les luxations postérieures (n=4), l'infection (n=1) et le descellement (n=2). Le recul moyen était de 78,3 mois. Au dernier recul, le PMA moyen était de 15,13 et le score de Harris moyen de 84,36. L'inclinaison des cupules était comprise entre 45° et 50°. Les tiges fémorales étaient centrées 94% des cas (n=32). Il a été noté un cas d'ossification péri prothétique et un cas de liséré acétabulaire. CONCLUSION: L'arthroplastie totale de hanche est devenue une pratique courante et bien codifiée en chirurgie orthopédique avec des résultats fiables et très encourageants.

Bilateral anterior shoulder dislocations: A review of two cases and the relevant literature.

The bilateral symmetric anterior shoulder dislocations (BSASD) must be suspected in patients with bilaterally flattened shoulders after an uncontrolled muscular contraction like seizure condition. BSASD is best managed acutely and challenging to manage when diagnosed late. Chronic BSASD, after two years in a young patient, can result in fair functions.

Inguinal Lymph Node Dissection for Advanced Stages of Plantar Melanoma in a Low-Income Country.

BACKGROUND: Advanced stages of plantar acral lentiginous melanoma are common in Africa. Inguinal lymph node dissection (ILND) in these cases plays a critical role in disease-free and overall survival. Our study aims to share our experience in ILND for advanced plantar melanomas. Methods and Study Design. Four-year prospective study. Patients. We included all documented cases of advanced stage plantar melanoma with clinically detectable inguinal lymph node metastasis. Twenty-two of 27 patients identified-with mean age 56 years-underwent ILND. Studied Variables. Tumor patterns and stage, surgery, morbidity, oncologic pathology, and evolution were studied. Statistical software assessed the overall survival (OS). RESULTS: Plantar lesions were all excised with a cancer-free margin (3 cm). ILND was performed for 22 patients with visible (n = 11), palpable (n = 7), and ulcerous (n = 4) lymphadenopathies. It was performed through an S-shaped (n = 11) or ellipse-shaped skin incision (n = 11). The tumors were AJCC stage III (n = 18) and IV (n = 2). We found high Breslow index tumor thickness (>3 mm) and an advanced Clark IV stage (n = 20). All operative wounds healed within 46 days (21-90). Wound healing was delayed by suture failure (n = 16), lymphorrhoea (n = 22), and infection (n = 18). After 29 months, three patients had complete remissions, seven had recurrences, and twelve patients had died. The overall survival (OS) at one year was 56%. In two patients with AJCC stage III disease, the OS was better (22 months). CONCLUSION: In low-income countries, ILND in advanced stages of plantar foot melanoma is a valuable surgical treatment option. Alongside ILND adjuvants, treatment must be available and accessible to improve survival.

Darier and Ferrand's dermatofibrosarcoma: A carcinologic and cosmetologic challenge in a low-income country.

INTRODUCTION: Dermatofibrosarcoma (DFS) is a common dermic sarcoma. It is a local malignant tumor occurring in young adults. The recurrence potential justifies an R0-type surgery with a three centimeters margin. We report our experience of the management of locally advanced DFS by resection and reconstructive surgery. METHODS: It is an ongoing descriptive study spanned from June 2005 to December 2018. We included all DFS cases treated by curative resection and reconstruction. A total of eight cases of DFS among 108 soft tissue sarcomas were studied. All patients were males. The mean age was 41.8 years [32-60]. Carcinologic results, cosmetic results, and outcomes were analyzed. RESULTS: R0-type resection was performed in six cases. In two cases, the resection was R1-type and resulted in amputation. In four cases, it was an iterative surgery. Average desease duration was 4 years [1-8]. Reconstructive surgery was needed for wound closure in six cases. Wounds healed in 28 days [18-90]. Outcomes showed hyperchromic keloid scars (N=2) at the trunk localization. CONCLUSION: DFS is a common cancer with a good outcome if managed earliest. Delayed diagnoses and inadequate first-time surgery led to tumor extension and recurrences. Locally advanced tumors management needs extensive resections and reconstructive surgery. In addition to surgery, Imatinib and radiotherapy improve outcomes, but are not available in our context.

Management of neglected distal femur epiphyseal fracture-separation.

INTRODUCTION: Neglected epiphyseal fracture-separations of the distal femur are rare. Still reported in developing countries, they lead to therapeutic issues. The objective of the study is to describe their characteristics and to propose treatment options. MATERIALS AND METHODS: Ten years of ongoing study was held in our orthopedics department. All patients with a neglected epiphyseal fracture-separations of the distal femur after a knee trauma were included in the study. Pre-operative and post-operative data were collected and analyzed. RESULTS: A total of 13 cases of neglected traumatic epiphyseal fracture-separations of the distal femur were found among 8616 in-patients of the department. It was mainly boys (9M/4F) around 16 years that were received 14 weeks after knee trauma. Most of the injuries were an AO-type 33-E/2.1 (Simple Salter-Harris' type II) (n=12) distal femur malunion (n=10). Associated complications were cutaneous opening (n=7), superficial infection (n=4), deep infection (n=4). Fractures were management surgically (n=12) by an open osteoclasis procedure (n=9), debridement (n=7) and a thigh amputation (n=1). The outcome was better if an open osteoclasis procedure was early performed in closed distal femur mal-union with a complementary rehabilitation program. CONCLUSION: Specialized trauma care facilities must be increased, and trauma education programs must be undertaken to avoid neglected epiphyseal fracture-separations of the distal femur in developing countries.

Erecta dislocation of the shoulder joint-A rare injury: About four cases.

A nonresolving axillary nerve injury is a rare associated complication to an inferior dislocation of the shoulder joint. This worsen the midterm outcome of the shoulder. So, neurovascular status must be checked by regular clinical testing and by an electromyography in all cases of inferior dislocation of the shoulder joint.

Trauma related to falls from trees treated in a specialized trauma centre in Burkina-Faso-one hundred and six cases treated in one year.

PURPOSE: Falls from trees related traumas are rarely reported in literature. They are public health problems in developing countries where their frequency is still important. The aim of the study is to describe falls from trees related trauma patterns and to present preventative measures. METHODS: An annual ongoing prospective study was held in our trauma emergency department (ED) about all the patients who sustained an injury after a recent fall from tree. A questionnaire related to the patient and to the trauma was established. The data were encoded and analysed by a statistical software. RESULTS: One hundred six patients who sustained a fall from tree trauma, out of a total of 139, were studied. Most patients were under 15 years old (76.4 %); they were injured in fruits season (33 %) after a fall from a fruit tree (mango trees, Shea trees, Néré, etc.) and were received late (86 %). Injuries were polymorphic from traumatic brain injuries (51.8 %) and spine injuries (13.2 %) to thoraco-abdominal (21.6 %) and limbs injuries (46.2 %). Three housewives were pregnant at the time of the trauma with secondary abortions. Patients were managed medically (33.9 %), surgically (19.8 %) or by casting (34.9 %) with good outcome in 59 cases. Twelve patients refused medical care and two died. CONCLUSION: Education programs must focus on picking fruits and leaves in order to make them safe and prevent injuries related to these traditional or professional activities.