[Osteonecrosis of the femoral head complicating prophylactic screw fixation for upper femoral epiphyolysis: case report and literature review]. / Ostéonécrose de la tête fémorale compliquant un vissage préventif d'une épiphysiolyse fémorale supérieure: cas clinique et revue de la littérature.

The therapeutic approach for the treatment of children with radiologically "normal" hip presenting with epiphysiolysis of the contralateral upper femur is controversial. We here report the case of a 12-year-old boy with osteonecrosis of radiologically "normal" and asymptomatic left femoral head prophylactically fixed due to acute femoral epiphysiolysis of the contralateral hip. Eight months after first surgery, the patient developed symptoms of avascular osteonecrosis of the femoral head. Specific criteria to be used in evaluating the most effective treatment between preventive screw or simple close monitoring exist. Despite these criteria, the risk of osteonecrosis in the "healthy" hip is not zero.

Anterior approach in humeral plating osteosynthesis.

CONTEXT: Humeral plating osteosynthesis is controversial, particularly regarding the choice between anterior and lateral approach, data for which in the context of a low-income country are lacking. HYPOTHESIS: The anterior approach is an easy surgical technique, allowing good anatomic reconstruction. We hypothesize that the anterior approach is associated with fewer neurovascular lesions and functional sequelae than the lateral approach. MATERIALS AND METHODS: A retrospective study with assessment update was carried out over a period of 6years 4months from January 2010 to June 2016, with consecutive recruitment in the city of Yaoundé, Cameroon. It consisted in a review of medical records, with physical reassessment on pre-designed and tested data-sheet. Sixty-two osteosyntheses were documented in 60 subjects operated on for humeral fracture or non-union. The following variables were studied: sociodemographic data, fracture profile, clinical profile, and functional shoulder and elbow results. Data analysis used the Statistical Package for Social Sciences (SPSS), version 23.0. Associations between qualitative variables were assessed on Chi square test, or Fisher test when the expected sample size was less than 5, and between quantitative and qualitative variables on Student t-test for comparison of means; p values≤0.05 were considered statistically significant. RESULTS: The anterior approach showed better results. Operative time was shorter, at 102.5min on average, for 262cm3 blood loss, versus 141.6min and 330cm3 on the lateral approach, with a significant correlation between the two variables. The incidence of postoperative radial paralysis was significantly higher with the lateral approach (22.6% versus 3.2%; p=0.02), and there were likewise higher rates of postoperative infection (9.7% versus 6.5%), secondary displacement, implant damage, and malunion. Reduction was more often anatomical with the anterior approach (28.1% versus 11%) and cortical fixation was better (83.9% versus 61.3%). Functional shoulder and elbow recovery was nearly normal with both approaches, with superimposable values and no statistically significant difference in (p=0.4). CONCLUSION: Cameroon being a low-income country, the anterior approach is of therapeutic and prognostic interest, being easy to perform, with a low rate of postoperative complications and good functional outcome.

[Assessment of concomitant floating knees injuries severity]. / Lésions concomitantes aux genoux flottants et gravite.

Floating knee is caused by high-energy trauma, whose genesis is suggestive of extensive locoregional and general damages. Referring to multiple trauma. The aim of our study was to collect data on all concomitant floating knee injuries in our practice environment and to evaluate their severity. We conducted a descriptive and retrospective study over a period of 14 years and 9 months. Our sample consisted of 75 floating knees, the average age was 35 years. Sixty six patients had an ISS≥16 (classified as polytrauma). Head traumas, chest and abdominal injuries associated with floating knee injuries require adequate resuscitation.

Depressed skull fracture by a mass of 3kg in shot putt an adolescent of 13 years. A rare sports injury. A rare fracture of the skull-deflection shot putt.

INTRODUCTION: More and more teenagers indulge in sports at school or in recreational settings. Some of these sports are considered to be purveyors of accidents and should be practiced by putting in place safety rules and regulations. This report is unusual case of a school child of age 13 who suffered from depressed skull fracture due to accidental fall of a mass of 3kg during an athletics meeting. PRESENTATION OF CASE: He was a 13-year-old boy who accidentally received on his head a throwing mass of 3kg thrown by a young athlete at a school athletics meeting. He became unconsciousness for a moment. The radio clinical evaluation showed a parietal depressed fracture without mass effect on the brain parenchyma to the CT scan. Depression was surgically removed in quite favorable manner. DISCUSSION: Karting is known as a particular sporting accident that causes head injuries affecting mostly children. Other sports such as boxing and skiing are also known to cause trauma but wearing helmets has significantly reduced these sports injuries. Throwing sports can also lead to accidents in the absence of strict security as demonstrated by this case. It was a skull depressed fracture that was operated upon because it entailed a risk leading to a compressive callus. CONCLUSION: This accident could have been avoided if basic safety precautions were put in place.