Complications after Dynamic Hip Screw Osteosynthesis of Proximal Femoral Fractures at Army Instructional Hospital-Libreville.

The DHS system is an effective means of open reduction and internal fixation of proximal femur fractures. Postoperative complications are little described and deserve to be studied for better preventive and curative treatment. We report the observations of five (5) patients who presented postoperative complications specific to the DHS system at army instructional Hospital-Libreville. These described complications are related to deterioration of internal fixation leading to callus, nonunion, or infection. Those found are the cut out phenomenon, avascular necrosis of the femoral head, and the fracture of the DHS system. All these complications required surgical revision without functional repercussions at the last follow-up. Complications of internal fixation by the DHS system can be avoided by rigorous asepsis, adequate indications for surgery, and rigorous surgical techniques. Good management can restore hip function.

Fracture-avulsion of tibial tubercle apophyseal in two Cameroonian adolescents.

INTRODUCTION: Avulsion-fractures of the tibial tubercle apophysis are a rare lesion of active adolescent. They are relatively uncommon injuries that occur in the active adolescent. We described cases of tibial tubercle apophysis avulsion-fractures in two Cameroonian adolescents. CASES: We observed 2 cases which occurred in boys after contraction of the quadriceps during sports activity (high jump and football). The lesions were classified as Type IV by Ryu and Debenham (case 1) and type IA by Ogden (Case 2). The treatment was surgical by double screwing (case 1) and orthopedic by plaster knee brace (Case 2). The functional result was excellent without complications. DISCUSSION: Non-displaced fracture of the anterior tibial tubercle I type IA Ogden has good prognosis and responding very well to non-surgical treatment. It should be considered as a separate entity. The other cases of displaced fracture generally require surgery which enables an assessment of often associated lesions. Type IV can required supplemental plate fixation to stabilize the proximal tibia. The prognosis of displaced fractures is poor due to the associated lesions and potential complications. Functional results are excellent despite a few cases of previous pain limiting sports activity. CONCLUSION: Avulsion fractures of the anterior tuberosity in adolescents remain rare in Africa and worldwide. The circumstances of the occurrence are stereotypical. If treated properly, the outcome is usually good.