Treatment of obstetrical brachial plexus palsy sequelae: Preliminary results about 18 cases.

Background: Severe obstetrical injuries of the brachial plexus lead to a complete or incomplete paralysis resulting in a significant functional handicap of the limb.This study aimed to assess the preliminary results of our management. Materials and methods: This prospective study involved 18 patients, with an average age of 7.7 years. The choice of the surgical technique depended on the type of palsy. We evaluated our patients using the Mallet, Gilbert-Raimondi, Brachial plexus World Group Heerlen, and Raimondi scores. Results: Patients in groups I and II of Narakas had an anterior shoulder release (n = 2) and transfer of the latissimus dorsi (n = 8). For those in group III, we performed 5 biceps rerouting and 2 radius derotation osteotomies, one of which was associated with a Zancolli I and an arthrodesis of the thumb MCP joint. In the wrist and hand, we performed two tendon transfers from the flexor carpi ulnaris to the extensor tendons of the fingers.After a mean follow-up of 30.52 months, in the first 9 patients, active external rotation of the shoulder increased from a mean value of -22.5°-38.8° and mean active abduction from 78.3° to 141.1°. In Group III, the mean spontaneous supination position of 75.5° was improved to 45° pronation. Regarding the two patients with tendon transfers, active wrist extension increased from 0° to 45° and from -60° to 0°, respectively. Conclusion: Palliative surgery in the treatment obstetrical brachial plexus palsy sequelae retains an important place in the restoration of upper limb function.

Early posttraumatic ankle osteoarthritis following ankle fracture-dislocations in a sub-Saharan African setting.

INTRODUCTION: Ankle fracture-dislocation (AFD) represents a major threat to the joint and a potential source of complication and functional disability. This study was performed to assess the outcome of AFD in a resource-limited setting and factors associated with the posttraumatic ankle osteoarthritis (PTAOA). We hypothesized that conservative treatment after AFD was associated with higher risk of PTAOA compared to surgical treatment. PATIENTS AND METHODS: Data from 52 consecutive patients (mean age 37.2±11.1years, with 57.7% n=30, males) who were treated and followed in a teaching hospital for AFD during a period of six years were collected. Forty-four of these patients were obtained at the time of the study for a retrospective evaluation. Functional outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS), ankle-hindfoot scale, and the patient's global satisfaction index. Radiographs were performed and analyzed for PTAOA. Logistic regression was used to determine factors associated with the presence of PTAOA. RESULTS: PTAOA was found in 19 (43.2%) patients after an average follow-up period of 27.2±18.3months. Anatomic fracture reduction was achieved in 22 (50%) patients, while the talus was centered in the mortise in 30 (68.2%) patients. Despite these poor anatomical results, the clinical outcome was good to excellent in 33 (75%) patients, and 88.6% was satisfied or very satisfied. Factors associated with the presence of PTAOA were the non-anatomical reduction (OR=11.07; p=0.007, 95% CI: 2.096-58.77) and the time elapsed since trauma (OR=1.073; p=0.007, 95% CI: 1.109-1.129). CONCLUSION: This study indicates that AFDs are associated with high rate of early and severe PTAOA. Non-anatomical realignment and a delay since trauma were positive predictors of PTAOA. There was no difference regarding the occurrence of PTAOA after AFD whatever the type of treatment, surgical or conservative. LEVEL OF EVIDENCE: IV; retrospective cohort study.

Economic cost of the treatment of fractures among old people: a preliminary study in dakar teaching hospital.

INTRODUCTION: The aim of this study was to assess the cost of hospital care related to fractures among the elderly patients. MATERIALS AND METHODS: The aim was to conduct a study over a 12-month period involving patients aged 60 and older with at least 1 musculoskeletal fracture. The population under investigation included 314 patients, mainly female, with 319 fractures. Only 25.47% of the patients had access to government financial assistance. The cost of hospital treatment was assessed on the basis of 3 expense items; the standard currency used was the African Financial Community Franc (CFA franc) and 1 CFA franc equals 656 euros.Expense item No. 1: It related to the cost of diagnostic services that included surgical consultation and x-rays.Expense item No. 3: It is related to the duration of the stay at the hospital. RESULTS: The cost of diagnostic services amounted to 5625 euros. The cost of the second item was put at 43 054 euros: CONSERVATIVE TREATMENT: 43 118 euros; SURGICAL TREATMENT: 41 053 euros. Cost of the hospital stay amounted to 2607 euros. Proximal femur fractures accounted for 43.46% of the overall cost of the care provided. DISCUSSION: Our patients' medical history is similar to the data provided in developed countries:female predominance;predominance of proximal femoral fractures. The cost of the care provided was boosted by the surgical treatment and proximal femur fractures, whereas the cost of hospital stay was rather insignificant. Medical care is a problem among our patients, as few of them have access to government financial assistance. CONCLUSION: Among elderly people, fractures will soon become a public health issue in our context.