Treatment of long bone fractures in children by elastic stable intramedullary nailing: Outcome and challenges in a unit with restricted technical platform.

Introduction: Elastic stable intramedullary nailing (ESIN), developed by the Nancy school in France, is the gold standard for surgical treatment of long bone fractures in children. In Africa, few works have been devoted specifically to this technique. Objective: This study aimed to describe the outcome and to present the challenges with this technique in the treatment of long bone fractures in children. Patients and Methods: This was a prospective and descriptive study over 4 years including patients aged 0-15 years old operated using ESIN. Results: Sixty-two patients underwent ESIN, of whom 44 patients (70.96%) were for femur fractures, nine patients (14.52%) for tibia and fibula fractures and nine patients (14.52%) for humerus fractures. The majority of the patients treated with ESIN were children older than 6 years. Nine patients (14.51%) and 13 patients (20.98%) underwent ESIN following polytrauma and multiple fractures, respectively. Seven patients (11.29%) were operated on through-closed ESIN method. The unavailability of image intensifier (38.71%) and the presence of bone callus (40.32%) were the major reasons for using the open ESIN method. Thirty-three patients (53.23%) had minor or major complications. The majority of patients had satisfactory therapeutic outcomes. Conclusion: ESIN gives good results, even when the fracture site is approached.

Hutchinson-Gilford Progeria syndrome: Report of the first Togolese case.

The aim of this article is to describe the first case of Hutchinson-Gilford Progeria Syndrome (HGPS) in Togo and review all Africans cases. Our patient was a 12.8-year-old Togolese boy followed in our unit till he was 15-year-old for HGPS. He was the only child of non-consanguineous parents. The phenotypic findings were craniofacial dysmorphy, dwarfism, lipodystrophy, diffusely scattered hyperpigmented foci, pyriform thorax, nail dystrophy, decreased joint mobility, and camptodactyly. He had characteristic facies with prominent forehead, prominent eyes, absent ear lobule, thin nasal skin, convex nasal profile, micrognathia, and crowded teeth. Radiologicals findings were bilateral coxa valga, pyriform thorax, and acro-osteolysis. We sequenced the entire coding region of LMNA gene, and mutation analysis revealed a heterozygous mutation c.1824C>T (p.Gly608Gly). Our patient is therefore the fifth African and the fourth with classical mutation, first of Western Africa, and second of (sub-Saharan) African black race. The recurrence of HGPS is low like the cause is neomutation or germinal mosaicism.

Congenital giant epulis obstructing oral cavity: newborn emergency.

The congenital epulis is a benign congenital granular cell tumor arising most often of the alveolar ridge of the jawbone. When giant, it is source of digestive discomfort disabling feeding. We report the case of a newborn female, vaginal delivery, presented with a giant intraoral tumor. Tumor obstructing the mouth of the newborn and prevent the attachment and feeding. The treatment consisted of excision of the tumor under general anesthesia. The histology of the tumor was revealed that it was an epulis.

Cardiac injury in child managed successfully in underprivileged hospital of Africa.

Cardiac injuries are rare and the associated mortality is high. Their prognosis can be ameliorated by early diagnosis and management in a specialized hospital with appropriate resuscitation care. This report describes a case of cardiac penetrating injury in a child managed successfully in an underprivileged hospital of Africa.

Acute cholecystitis from typhic origin in children.

BACKGROUND: To evaluate the particularities of typhoid cholecystitis in children. MATERIALS AND METHODS: This was a 5-year prospective study of typhoid cholecystitis in children under 15 years old at Djougou and Sylvanus Olympio teaching hospital. The diagnosis of typhoid cholecystitis was based on clinical and investigation findings, confirmed by operative findings at cholecystectomy. RESULTS: Six children with typhoid acalculous cholecystitis were treated over a five-year period (4 males and 2 females). Their ages ranged from five to 13 years (median 8.8 years). The mean duration of symptoms was six to 21 days. The clinical signs were fever, abdominal pain, which predominated at the right upper abdominal quadrant, and type II Hackett splenomegaly. The diagnosis was confirmed by a positive Widal's test and Salmonella typhi isolation from the culture in all patients; four patients had ultrasound evidence of acalculous cholecystitis. Open cholecystectomy was successful in the six cases. The operative findings were gangrene (3), perforation (2) and empyema (1). All the patients made an uneventful recovery, and have remained symptom free one and three months on follow-up. CONCLUSION: Typhoid acalculous cholecystitis is a frequent complication in children. Late presentation and diagnosis is associated with complications. Cholecystectomy in association with antibiotic is the treatment of choice.

Emergency treatment of a ruptured huge omphalocele by simple suture of its membrane.

BACKGROUND: The rupture of a huge omphalocele is an emergency that threatens the newborn baby's life. It constitutes a therapeutical concern in the absence of prosthesis especially in developing countries. METHODS: We are reporting herein the case of a newborn baby that we managed in emergency successfully thanks to a simple treatment. RESULTS: It was a huge omphalocele, ruptured during delivery, in a male newborn baby. We conducted a simple and conservative surgical treatment without prosthesis, which consisted of reconstruction of the omphalocele's membrane by closing it with absorbable suture materials. The suture of the omphalocele's membrane was followed by treatment with the Grob's method. This treatment saved the newborn baby's life. The total skinning was obtained after 3 months. CONCLUSIONS: In case of rupture of huge omphalocele in absence of prosthesis, it is better to suture the membrane, and continue the treatment according to the Grob's method; the residual disembowelment can be repaired later.

[Epiphyseal growth fractures: epidemiology and treatment. Retrospective report of 44 cases]. / Les traumatismes du cartilage de croissance chez l'enfant: aspects epidemiologiques, lesionnels et therapeutiques a propos de 44 cas.

OBJECTIVE: To value the frequency of epiphyseal growth fracture and to take out the therapeutic aspects of the epiphyseal growth fracture and to value the results for un good management. PATIENTS AND METHOD: It is about a retrospective study carrying on 44 children aged of less than 15 years hospitalized and treated in the pediatric surgery department or the Tokoin teaching hospital (Lome) from 1st January 2002 to 31st December 2006. RESULTS: The prevalence of epiphyseal growth fracture was of 3.6% with a masculine predominance(59.1%). The middle age was of 9.8 }3.2 years.The type 2 lesions of Salter and Harris classification represented 44%. The accidents of game were the main suppliers (41 %) with affluence in April and August. The orthopedic treatment was applied in 64.4% of case. With a middle receding of 2 years, 4 patients had presented some afterrnaths. CONCLUSION: Epiphyseal growth fracture has a relatively frequency. The diagnostic trap of the epiphyseal growth fracture is numerous and is sometimes the origin of the therapeutic mistake. Their treatment must be well codified to avoid some long-term afterrnaths.

Les traumatismes du cartilage de croissance chez l'enfant : aspects épidémiologiques, lésionnels et thérapeutiques à propos de 44 cas

Objectif : Evaluer la fréquence des traumatismes du cartilage de croissance, faire ressortir les aspects thérapeutiques des traumatismes du cartilage de croissance chez l'enfant et en évaluer les résultats afin d'améliorer leur prise en charge. Patients et méthode : Il s'agit dune étude rétrospective portant sur 44 dossiers d'enfants âgés de moins de 15 ans allant de la période du 1er janvier 2002 au 31 décembre 2006, hospitalisés et traités dans le service de chirurgie pédiatrique du CHU Tokoin de Lomé pour traumatisme du cartilage de croissance. Résultats : La prévalence des traumatismes du cartilage de croissance était de 3,6% avec une prédominance masculine (59,1 %). L'âge moyen était de 9.8± 3,2 ans. Les lésions de type 2 de Salter et Harris avaient représenté 44% des cas. Les accidents de jeu en étaient les principaux pourvoyeurs (41 %) avec une affluence dans les mois d'avril et d'août. L'atteinte de l'extrémité inférieure du fémur avait représenté 28,9% des cas. Le traitement orthopédique était appliqué dans 64 4% des cas. Avec un recul moyen de 2 ans, 4 patients avaient présenté des séquelles. Conclusion : Les traumatismes du cartilage de croissance ont une fréquence relativement faible. Les pièges diagnostiques des traumatismes du cartilage de croissance sont nombreux et sont parfois à l'origine d'erreurs thérapeutiques. Leur prise en charge doit être bien codifiée pour éviter des séquelles à long terme

Locations of osteomyelitis in children with sickle-cell disease at Tokoin teaching hospital (Togo).

BACKGROUND: The sickle-cell children are particularly affected by osteomyelitis in specific locations. This study was done in order to point out the locations of osteomyelitis in children with sickle-cell disease. This direct clinical examination for a quick diagnosis. MATERIALS AND METHODS: This is a retrospective study done by examining files of 43 children (15 girls and 28 boys), aged from 0 to 15 years, treated for osteomyelitis between January 1998 and December 2006. Their phenotypes included 18 SS, 14 SC and 11 AS. Osteomyelitis was acute in 20 cases and chronic in 23 cases. The different localisations are classified according to the type of osteomyelitis and the kind of bones concerned. RESULTS: The 43 children presented 63 locations: 57 on long bones and 6 on short bones. The osteomyelitis was unifocal in 32 cases, and multifocal in 11 cases. The locations on long bones were humeral (18 cases), tibial (12 cases), femoral (9 cases), fibular (7 cases), radial (7 cases) and ulnar (4 cases). The 6 short bones included 3 metacarpus and 3 phalanxes. The 11 multifocal locations concerned 8 SS, 2 AS and 1 SC. In chronic osteomyelitis, 7 patients had sequestrum and 2 had pathological fracture. CONCLUSION: During examination of sickle-cell children with fever, particular attention must be shown, respectively to the arm, the leg and the thigh, in order to track down quickly, an acute osteomyelitis. Early diagnosis and quick treatment permit to avoid complications and heavy sequela in these children.

[Current bacterial causes of osteomyelitis in children with sickle cell disease]. / Bactériologie des ostéomyélites de l'enfant drépanocytaire au CHU de Tokoin (Togo) : tentative d'évaluation et thérapeutiques.

INTRODUCTION: Osteomyelitis in children with sickle cell disease has been caused mainly by salmonella species, but in recent years, greater variation has resulted in other bacteria sometimes heading this list. We conducted this survey to determine the present distribution of causative bacteria, to improve initial probabilistic antibiotic therapy. MATERIAL AND METHODS: This retrospective survey reviewed files of children hospitalised during the 8-year period from 1998 to 2005 for osteomyelitis who had haemoglobinopathy SS or SC. In all, we identified 32 patients (mean age: 6.5 years) - 22 boys and 10 girls, 18 with SS and 14 SC. Eleven children with haemoglobinopathy AS were not included. Thirteen children had acute osteomyelitis and 19 chronic osteomyelitis. Bacteriological research included blood cultures, needle aspiration or biopsy, and cytobacteriological examination of pus. RESULTS: Of 4 blood cultures, one was positive. Only one needle aspiration was performed, and it was positive. Pus was examined in 19 cases and positive in 16 (84%). No bacteriological research was performed in 8 of the cases (25%) of acute osteomyelitis. Staphylococcus accounted for 22% of the bacteria identified, salmonella for 19% and Pseudomonas aeruginosa for 6%. CONCLUSION: Initial probabilistic antibiotic therapy for osteomyelitis in children with sickle cell disease must target staphylococcus and salmonella, preferably by combining a third-generation cephalosporin and aminoglycoside. Systematic bacteriological testing will provide a more reliable selection and improve initial treatment.

[Aseptic osteonecrosis of the femoral head in children with sickle-cell disease]. / Les ostéonécroses aseptiques de la tête fémorale chez l'enfant drépanocytaire.

PURPOSE: To identify the epidemiological, clinical and therapeutic aspects of hip-joint disorders in children with sickle cell disease, to point out the diagnostic problems, and to stress the necessity of early diagnosis for optimal outcome. MATERIAL AND METHODS: This retrospective study, conducted from January 1987 through December 2006, included children with at least one haemoglobin S gene and hospitalised for osteonecrosis of the femoral head. Ficat staging was used. RESULTS: The study included 14 children (12 boys and 2 girls) with a mean age of 14 years, all hospitalised and treated for osteonecrosis of the femoral head during the study period 8 SS and 6 SC. Osteonecrosis of the femoral head was diagnosed at Ficat stage 3 in 8 cases and at stage 4 in 6. Ten children (8 at stage 3 and 2 at stage 4) had orthopaedic treatment (continuous traction for 30 days and then a Thomas's splint for a mean 14 months). Outcome was good for 6 of the stage-3 cases (mean follow-up period 9 years) and poor for the other patients with purely orthopaedic treatment (mean follow-up period 11 years). Four children at stage 4 underwent surgery (varus osteotomy, immobilization in a cast for 8 weeks, and then Thomas's splint for a mean 12 months) with good results (mean follow-up period 10 years). CONCLUSION: Early diagnosis, assisted by computed tomography, magnetic resonance imaging or scintigraphy, makes it possible to provide better treatment and preserve hip function.

[Meckel's diverticulum in children: eleven cases]. / Les diverticules de Meckel chez l'enfant: à propos de 11 cas.

We report 11 cases of Meckel's diverticulum in children admitted to the department of Paediatrics Surgery of Lomé (Togo). None of the cases was identified before surgery. A systematic search during appendectomy identified 3 cases. It was fortuitously discovered four times, and due to complications in four cases. There was one complication related death. Segmental intestinal resection was the only technique used.

[Prophylactic splenectomy to prevent complications of splenomegaly in children with sickle cell anemia?]. / Peut-on envisager une splénectomie préventive des complications des splénomagalies chez l'enfant drépanocytaire?

OBJECTIVE: To assess the effects of splenectomy in children with sickle cell anemia and to propose a therapeutic approach to splenomegaly in sickle cell anemia. MATERIAL AND METHOD: This retrospective study, conducted in the pediatric surgery department of the Tokoin Teaching Hospital in Lomé, included 8 children followed for sickle cell anemia (hetero- and homozygous) and who were admitted from January 1987 through December 2004 for splenic rupture or referred for prophylactic splenectomy. RESULTS: The patients' mean age at splenectomy was 9 years 6 months. Five were homozygous and three heterozygous; on Hackett's scale, spleen size was 4 for four patients and 5 for the other four. All had episodes of pain of the left hypochondrium before surgery and were averaging one blood transfusion a year. Five splenectomies were for traumatic rupture of splenomegaly and three for other splenic complications. Splenectomy made it possible to decrease the frequency of blood transfusions. Pre- and postoperative prophylaxis against infection included penicillin and vaccinations. CONCLUSION: The review of literature shows a frequent loss of immune function in the enlarged spleens of children with sickle cell anemia. The authors propose prophylactic splenectomy in children with splenomegaly, to prevent the risk of splenic rupture and other complications. Preventive measures after the splenectomy are necessary to control infections.