[Knee dislocation at chu Gabriel TOURE : therapeutic and evolutionary aspects]. / Luxations du genou au chu Gabriel TOURE : aspects therapeutiques et evolutifs.

INTRODUCTION: Dislocations of the knee are serious, involving the functional prognosis and sometimes the vital prognosis of the limb concerned. The aim of our work was to assess the functional results of our care. MATERIALS AND METHODS: This were a prospective study concerning patients with dislocation of the knee, treated and followed in the Department of Orthopedics-Traumatology at the CHU Gabriel TOURE from January 2015 to October 2018. RESULTS: We collected 30 patients with knee dislocation. The male sex predominated (60%) with a sex ratio of 1.5. The average age was 32.56 years. AVP was the main etiology with 83.3%. The mechanism was direct in 86.7%. Standard knee X-ray with front and side views was performed in all patients. Posterolateral dislocation was the most common type of pathology (20%). Associated lesions were observed in 56.6%. The response time was less than 6 hours in 100%. The treatment was orthopedic in 93.3%. Complications were dominated by knee laxity with 43%. At the average follow-up of 18.9 months, the functional results were good in 20%. CONCLUSION: Knee dislocations are the prerogative of the young subject. Accidents due to motorcycles are the main circumstances. Associated lesions are frequent. Orthopedic treatment is still relevant but the evolution is still unpredictable despite the early treatment.

INTRODUCTION: Les luxations du genou sont graves mettant en jeu le pronostic fonctionnel et parfois le pronostic vital du membre concerné. Le but de ce travail était de déterminer les aspects épidémiologiques, cliniques et d'évaluer les résultats du traitement. MATÉRIEL ET MÉTHODES: il s'agissait d'une étude retro prospective concernant les patients présentant une luxation du genou , traités et suivis dans le service d'Orthopédie-Traumatologie au CHU Gabriel TOURE de janvier 2015 à octobre 2018. RÉSULTATS: Nous avons colligé 30 patients présentant une luxation du genou. Le sexe masculin a prédominé (60%) avec un sex-ratio de 1,5. L'âge moyen était de 32,56 ans. Les AVP ont été la principale étiologie avec 83,3%. Le mécanisme était direct dans 86,7%. Les radiographies standards du genou de face et profil ont été réalisées dans 100%. La luxation postéro-latérale a été le type anatomopathologique le plus fréquent (20%). Les lésions associées étaient observées dans 56,6%. Le délai de prise en charge a été de moins de 6 heures dans 100%. Le traitement a été orthopédique dans 93,3%. Les complications étaient dominées par la laxité du genou avec 43%. Au recul moyen de 18,9 mois, les résultats fonctionnels ont été bons dans 20%. CONCLUSION: Les lésions associées sont fréquentes. Le traitement orthopédique reste toujours d'actualité, mais l'évolution est toujours imprévisible malgré la précocité de la prise en charge.

[Acetabular Fractures at CHU Gabriel Toure : epidemiology, therapeutic and evolutinaryaspects]. / Les Fractures Acetabulaires au CHU Gabriel Toure : aspects epidemiologiques therapeutiques et evolutifs.

INTRODUCTION: Acetabularfractures involving the functionalprognosis of the hip. The aim of thisworkwas to determine the epidemiological, clinical, and outcome aspects of treatment. MATERIALS AND METHODS: This wasa retro-prospective study of patients withacetabulum fracture treated and followedfromJanuary 2015 to June 2018. RESULTS: Wecollected 49 patients with an acetabulum fracture. Acetabulum fractures made up 8.3% of all pelvic injuries during the studyperiod. The male sexprevailed (87.8%) with a sex ratio of 7.16. The averageagewas 36.14 years (range: 17 years and 77 years). The circumstances of the trauma were accidents on the public highway (69.4%), accidents atwork (14.3%), accidents in the home (10.2%), accidents in sports (4.1%), assaults (2%). The mechanismwas indirect in 87.8%.Pain with total functional impotence wasobservedin 83.7% and with a vicious attitude of the traumatized limbin 89, 8%. The standard radiographywith the incidences of the pelvis face as well as the ¾ wing and ¾ obturatorwasperformed in all patients. The transverse fracture of the acetabulumwas the mostcommonanatomo-radiological type (61.2%). Shock (34.6%) and hip dislocation (24.4%) were the mostcommonearly complications. Treatment was orthopedicin 95.9%. After an averagefollow-up of 23.24 months, the anatomicalresultsweresatisfactoryin 32.7% and the functionalresults good in 51%. Lameness (91.8%), mechanical pain (30.6%) and osteoarthritis (16.3%) were the main complications in the medium term. CONCLUSION: Fractures of the acetabulum are the preserve of the adult, especially of the male. The complications are dominated by mechanical pain, lameness and early hip osteoarthritis. The anatomicalresultsthat condition the functionalresults are less good with the orthopedictreatment.

INTRODUCTION: Les fractures de l'acétabulum mettent en jeu le pronostic fonctionnel de la hanche et leur traitement est difficile. Le but de ce travail était de déterminer les aspects épidémiologiques, cliniques, et d'évaluer les résultats du traitement. MATÉRIEL ET MÉTHODES: il s'agissait d'une étude retro prospective concernant les patients présentant une fracture de l'acétabulum, traités et suivis de janvier 2015 à juin 2018. RÉSULTATS: Nous avons colligé 49 patients présentant une fracture de l'acétabulum. Les fractures de l'acétabulum ont constitué 8, 3% des traumatismes du bassin pendant la période d'étude. Le sexe masculin a prédominé (87,8%) avec un sex-ratio de 7,16. L'âge moyen était de 36,14 ans (extrêmes : 17 ans et 77 ans). Les circonstances du traumatisme ont été les accidents de la voie publique (69,4%), les accidents de travail (14,3%), les accidents de vie domestique (10,2%), les accidents de sport (4,1%), les agressions (2%). Le mécanisme était indirect dans 87,8%. La douleur avec impotence fonctionnelle totale a été observée dans 83,7%, et avec une attitude vicieuse du membre traumatisé dans 89, 8%. La radiographie standard avec les incidences du bassin de face ainsi que les ¾ alaire et ¾ obturateur était réalisée chez tous patients. La fracture transversale de l'acétabulum a été le type anatomoradiologique le plus fréquent (61, 2%). L'état de choc (34,6%) et la luxation coxo-fémorale (24,4%) ont été les complications précoces les plus observées. Le traitement a été orthopédique dans 95,9%. Après un recul moyen de 23,24 mois, les résultats anatomiques ont été satisfaisants dans 32,7% et les résultats fonctionnelsbons dans 51%. La boiterie (91,8%), la douleur mécanique (30, 6%) et l'arthrose (16, 3%) ont été les principales complications à moyen terme. CONCLUSION: les fractures de l'acétabulum touchent fréquemment l'adulte, surtout de sexe masculin. Les complications sont dominées par les douleurs mécaniques, la boiterie et la coxarthrose précoce. Les résultats anatomiques qui conditionnent les résultats fonctionnels sont moins bons avec le traitement orthopédique.

[Profile of cranio-cerebral trauma and spinal cord trauma related road accidents in Guinea]. / Profil des traumatismes crânio-encéphalique et vertébro-médullaire liés aux accidents de la voie publique en Guinée.

OBJECTIVE: To describe the profile of the patient injured in traffic accidents and having a cranio-cerebral trauma (CCT) or spinal cord trauma (SCT). METHOD: Cross-sectional and retrospective survey of records management in 2829 road accident victims with CCT and/or a SCT and admitted to a hospital in Guinea between 1st January and 31st December, 2009. The profile was described by: the sociodemographic data, the circumstances of the accident and the clinical, therapeutic and follow-up data. RESULTS: For an average age of 27.1±12.7 years, the location of the trauma was cranio-cerebral in 82.0% of cases, spinal in 8.9% of cases and mixed in 9.1%. A large proportion of CCT (66.3%) and mixed trauma (63.1%) comes from to two-wheeled vehicles, while the large proportion of SCT (54.2%) is attributable to vehicles with four wheels. The Glasgow Coma average was 13.2±2.6 at admission, 21.7% of the victims are taken in charge beyond the first 12hours after the accident. Only 19.2% of patients underwent a surgical treatment with a hospital mortality ranging from 3.3 % (TVM) to 7.7% (mixed). CONCLUSION: CCT and SCT are characterized by an age under 30 years and male predominance. The support care suffers greatly from the unbalanced distribution of qualified personnel on the national territory and the lack of material means.

[Management of hand burns: clinical and epidemiological aspects and therapy at CHU Gabriel Toure]. / Sequelles de brulure de la main: aspects epidemio-cliniques et therapeutiques au CHU Gabriel Toure.

AIM: Evaluate the care of burn sequel of the hand in the services of orthopaedic trauma and paediatric in the teaching hospital Gabriel Touré. METHODS: It was about a longitudinal and prospective study lasting from Jun 2006 to January 2008 in all the children aged from 0 to 14 years with burn sequel of the hand admitted and treated in the services of orthopaedic- trauma and paediatric surgery of Gabriel Touré. Patients with an incomplete file or lost during the study were not included. RESULTS: In 20 months we brought together 40 cases of burn sequel of hand. The mean age of the patients was 8.5 years. There were 18 boys and 22 girls. The sex-ratio was 1.22 for girls. The causal agent was more frequently thermal (85%) by hot liquid. Burn was caused by domestic accident in 95%. 14 of our patients were seen by a doctor after 24 months of burn and another 14 were after 36 months. A functional deficit was noted to the physical examination in all our patients. The treatment was surgical in 26 patients. Results were judged well in 16 cases, little good in 8 and bad 2 case. A good initial treatment done in a fear condition permit to reduce the number of sequel of the hand and to stay less severe.

[Osteomyelitis in sickle cell anemia patients in the Orthopedic and Trauma Department of the CHU Gabriel Toure]. / Osteomyelite drepanocytaire au Service d'Orthopedie et de Traumatologie du CHU Gabriel Toure.

AIM: Describe the severity of bone lesion and evaluate the results of the treatment of osteomyelitis in patients with sickle cell disease. MATERIAL AND METHODS: It was about a prospective study done from December 2005 to November 2006 in patients with confirmed sickle cell admitted for osteomyelitis. RESULTS: We gather together 62 cases of osteomyelitis in sickle cell disease among 120 cases, which was about 51.7%. The mean age has been 17 years. The diagnosis was made on biology and x rays. 46.78% of our patients were sickle cell homozygote. Bone pain was the 1st reason of consultation with 53.2% of cases. Staphylococcus aureus and salmonella were the most frequent germs, with 43.55% each. Complications were noted in 32.26% because of diagnosis delay (P 0.05). Delay in the management or incorrect treatment can result in a severe and definitive sequel for the functional future of those patients.

Osteomyelite drepanocytaire au service d'orthopedie et de traumatologie du CHU Gabriel Toure

Objectifs : Decrire la gravite de l'atteinte osseuse et evaluer les resultats du traitement de l'osteomyelite drepanocytaire. Materiel et methodes : Il s'agissait d'une etude prospective allant deDecembre 2005 a Novembre 2006 se rapportant sur les malades admis pour osteomyelite pour causede drepanocytose confirmee. Resultat : Nous avons collige 62 cas d'osteomyelite d'originedrepanocytaire sur 120 cas d'osteomyelite; soit 51;7. L'age moyen a ete de 17 ans. Le diagnostic arepose sur la biologie et l'imagerie. 46;78de nos malades etaient drepanocytaires homozygotes. Ladouleur osseuse a ete le premier motif de consultation avec 53;2des cas. Le staphylocoque dore et lesalmonella ont ete les germes les plus frequents; soit 43;55pour chacun. Les complications ont ete notees chez 32;26dues au retard diagnostique (P 0;05). Le retard dans la prise en charge ou un traitement inadapte peut aboutir a des sequelles graves et definitives pour l'avenir fonctionnel de ces malades

Paediatric open tibiofibular fractures following a donkey bite. A report of two cases.

Open tibiofibular fractures resulting from domestic animal bites are exceptional. We report two such cases, in patients of 11 and 13 years of age, and discuss the etiological, pathogenic, anatomic, and clinical aspects of these injuries. These were type III fractures according to the Cauchoix and Duparc classification. The fractures were treated with emergency wound care, wound dressing, and conservative orthopaedic treatment using a long leg cast for immobilization. Preventive parenteral antibiotics were also given. Evolution was favorable in both cases and the patients returned to their normal activities with no substantial disability.

[Study of foot fractures at the orthopedics and traumatology of the Gabriel Toure Hospital over 10 years]. / Etude des fractures du pied dans le service d'orthopedie et de traumatologie de l'hopital Gabriel Toure sur dix ans.

UNLABELLED: The objective of this work was to determine epidemio-clinical and therapeutic aspects of foot bones fractures in Orthopedic and Traumatology service of Gabriel TOURE hospital. PATIENT AND METHODS: The study was retrospective descriptive and carried on 454 patients of January 1996 to December 2005. Have been included the patients admitted and tidy in the service during the period of survey, that had fractures isolated of the foot or associated to other fractures. Have not been included the patients with fractures of the foot that interrupted their treatment in the hospital for no conventional treatment. RESULTS: The masculine sex was predominant (321 men, 133 women, sex-ratio 2.41). The age groups of 21-30 years and 31-40 were the more attacks with respectively 32.38% and 20.48% (Table I). The workers were the more reached with 28.41% (Table II). On the ten years, 2001 recorded the biggest number of case of foot fracture with 12.56% (Table III). The accidents of the public way and the accidents of work were the most frequent etiology with respectively 70.48% and 20.71%. The right foot was the more frequently broken with 55.95%. The metatarsus was the more reached with 50%. Fractures closed of the foot represented 88.33%, the open fractures 11.67%. The treatment of the closed fractures was exclusively orthopedic. In the cases of open fractures the surgical dressing has been done follow-up of the orthopedic contention. The recovery has been gotten in 60.79% of the cases. The complications were of 39.21% among which the vicious calluses predominated with 34.83% (Table IV). The result of the treatment was good in 73.57% of the cases, means in 17.62% of the cases and bad in 8.81% of the cases. CONCLUSION: The fractures of the foot concerned more the men and the working profession. So the most active layer of the society was the more exposed to the accidents of the public way and the work. The osteosynthesis in the complex or complicated shapes could have improved our results.

[Osteitis at the service of orthopedics and traumatology at the Hopital Gabriel Toure in Bamako]. / Les osteites dans le Service d'Orthopedie et de Traumatologie de l'Hopital Gabriel Toure de Bamako.

UNLABELLED: The osteitis is a frequent and dangerous affection in Mali. OBJECTIVE: To describe the epidemio-clinical and therapeutic aspects of the osteitis in the service of Orthopedic and Traumatology of Gabriel TOURE hospital of Bamako. MATERIAL AND METHODS: The study was retrospective and carried on 145 osteitis recovered among 130 patients of January 1994 to December 2003. Have been included the patients affected by osteitis and treaties in the service during the period of study. Have not been included those that presented other bony affections. RESULTS: The set counts 80.77% of men, 19.23% of women, sex ratio 4.2, age middle 21 years 2 months with extremes of 2 and 86 years. The most affected age group was 11-20 years with 48.46%. The pupils--students were the more concerned with 30.77%. Normal haemoglobin AA has been found at 80.77% of the patients; on the other hand 19.23% had a hemoglobinopathy. The etiology post-traumatic has been found in 57.70% of the cases. The germ the more frequently recovered was the staphylococcus aureus: 58.63%. The lower member has been reached more frequently: 79.31%. The most often reached bone was the tibia--48.28%. The hold in initial charge was made by the traditional healer at 57.69% of the patients. Have been treated 74.48% of the osteitis surgically. The sequestrectomy with bony curettage was the surgical technique the more used: 60.18%. The antibiotics have been used in the treatment of the osteitis according to the sensitivity of the germs identified. They have been prescribed alone or in association. The result of the treatment of the osteitis was good in 50.34% of the cases, means in 24.14% and bad in 25.52%. CONCLUSION: The osteitis stays an important problem because a very big number of our populations have recourse in case of illness, to the traditional healer, the impostor or the marabou. The antibiotics certainly revolutionized the treatment of the osteitis but their use must be more discriminatory based on a very precise antibiogramm. The surgery keeps a place of choice again in the treatment of the osteitis.

Les osteites dans le service d'orthopedie et traumatologie de l'hopital Gabriel Toure de Bamako

L'osteite est une affection frequente et redoutable au Mali. Objectif. Decrire les aspects epidemio-cliniques et therapeutiques des osteites dans le service d'Orthopedie et de Traumatologie de l'Hopital Gabriel TOURE de Bamako. Materiels et Methodes. L'etude etait retrospective et portait sur 145 osteites retrouvees chez 130 patients de janvier 1994 a decembre 2003. Ont ete inclus les patients atteints d'osteites et traites dans le service pendant la periode d'etude. N'ont pas ete inclus ceux qui presentaient d'autres affections osseuses. Resultats. La serie compte 80;77d'hommes; 19;23de femmes; sex ratio 4;2; age moyen 21 ans 2 mois avec des extremes de 2 et 86 ans. La tranche d'age la plus affectee a ete 11-20 ans avec 48;46. Les eleves- etudiants ont ete les plus concernes avec 30;77. L'hemoglobine normale AA a ete trouve chez 80;77des patients; par contre 19;23avaient une hemoglobinopathie. L'etiologie posttraumatique a ete trouvee dans 57;70des cas. Le germe le plus frequemment retrouve a ete le staphylocoque dore : 58;63. Le membre inferieur a ete plus frequemment atteint : 79;31. L'os le plus souvent atteint a ete le tibia- 48;28. La prise en charge initiale etait faite par le guerisseur traditionnel chez 57;69des patients. Ont ete traitees chirurgicalement 74;48des osteites. La sequestrectomie avec curetage osseux a ete la technique chirurgicale la plus utilisee : 60;18. Les antibiotiques ont ete utilises dans le traitement des osteites en fonction de la sensibilite des germes identifies. Ils ont ete prescrits seuls ou en association. Le resultat du traitement des osteites a ete bon dans 50;34des cas; moyen dans 24;14et mauvais dans 25;52. Conclusion. Les osteites demeurent un probleme important car un tres grand nombre de nos populations ont recours en cas de maladie; au guerisseur traditionnel; le charlatan ou le marabout. Les antibiotiques ont certes revolutionne le traitement des osteites mais leur utilisation doit etre plus discriminatoire basee sur un antibiogramme bien precis. La chirurgie garde encore une place de choix dans le traitement des osteites

Etude des fractures du pied dans service d'orthopedie et traumatologie de l'hopital Gabriel Toure sur dix ans

L'objectif de ce travail etait de determiner les aspects epidemio-cliniques et therapeutiques des fractures des os du pied dans le service d'Orthopedie et de Traumato- logie de l'Hopital Gabriel Toure. Patients et Methodes : Il s'agit d'une etude retrospective descriptive portant sur 454 patients dans une periode allant de janvier 1996 a decembre 2005. Ont ete inclus les patients admis et soignes dans le service pendant la periode d'etude; qui avaient des fractures isolees du pied ou associees a d'autres fractures. N'ont pas ete inclus les patients avec des fractures du pied qui ont interrompu leur traitement hospitalier pour un traitement non conventionnel. Resultats : Le sexe masculin etait predominant (321 hommes; 133 femmes; sex-ratio 2;41). Les tranches d'age de 21-30 ans et de 31-40 ont ete les plus atteintes avec respectivement 32;38et 20;48(Tableau I). Les ouvriers etaient les plus atteints avec 28;41(Tableau II). Sur les dix ans; 2001 a enregistre le plus grand nombre de cas de fracture de pied avec 12;56(Tableau III). Les accidents de la voie publique et les accidents de travail ont ete les etiologies les plus frequentes avec respectivement 70;48et 20;71. Le pied droit a ete le plus frequemment fracture avec 55;95. Le metatarse a ete le plus atteint avec 50. Les fractures fermees du pied representaient 88;33; les ouvertes 11;67. Le traitement des fractures fermees a ete exclusivement orthopedique. Dans les cas de fractures ouvertes le parage chirurgical a ete effectue suivi de la contention orthopedique. La guerison a ete obtenue dans 60;79des cas. Les complications ont ete de 39;21parmi lesquelles les cals vicieux ont predomine avec 34;83(Tableau IV). Le resultat du traitement a ete bon dans 73;57des cas; moyen dans 17;62des cas et mauvais dans 8;81des cas. Conclusion : Les fractures du pied ont concerne plus les hommes et la profession ouvriere. Ainsi la couche la plus active de la societe a ete la plus exposee aux accidents de la voie publique et de travail. L'osteosynthese dans les formes complexes ou compliquees aurait pu ameliorer le pourcentage de nos resultats

[Contribution of ultrasound in the diagnosis of the complications of intramuscular injection in children]. / Apport de l'echographie dans le diagnostic des complications de l'injection intramusculaire chez l'enfant.

During a prospective study conducted at the rehabilitation Center of the physically handicapped persons and at the mother-child Hospital in Bamako, the authors report 50 cases of neuromuscular complications of the quinine intramuscular injection in the child. The scan revealed muscular calcifications in 37 cases (740%), abscesses, in 7 cases (14%) and muscular inflammations in 6 cases (12%). Xray of the affected limb was not systematic: it has been performed in four children in the case of a subjacent bone involment. It showed calcifications in two cases. If muscular abscess is easily diagnosed by clinical exam it is not the case for calcifications. The scan allows to set up a precise mapping of the muscular lesions, to determine their type and size. It also helps the clinicians in their therapeutic attitude. Medical treatment associated with rehabilitation has been carried out in 40 patients (80%) and surgery in 10 patients (20%).

[The diabetic hand]. / Atteinte de la main chez le diabetique.

The frequent localization of the infection to the hand to ours diabetic patients oppositely to the classic description of diabetic foot leds us to initiate this work, which had the objectif to determine the prevalency and to describe the "diabetic hand" to our patients. For that we have conducted a descriptive retrospective and prospective study in the internal Medecine Service of the National Hospital of Point G (NHPG) and in Traumato Orthopaepics Service of Gabriel Touré Hospital (G.T.H.) in Bamako. In 341 diabetic examined patients 158 infections of soft areas have been listed (46.33%) with a localization on the foot in 87 among them (25.51%) and the hand in 55 (16.13%). The female sex has been the most affected with an average of 52 years old and recent discovered diabetes. The diabetes was of type I in 54.54% of cases and of type II in 45.46%. The reaching of hand was following upon a traumatism (7.28%), a burn (3.63%), an ingrown mail (3.63%); but in 85.46% of cases any front door hasn't been found. The type of damage observed has been the abscess (49.09%), the whitlow (25.46%), the gangrene (21.82%) and the burn (3.63%). We have noticed an ostect in 41.81% of cases. In bacteriologic field, the staphylocoque was the prevailing germ in relating to the negative gram (25%). The curring has required an amputation in almost a third of patients (30.9%) the healing has been gained in 76.3% of cases with sometimes some fonctional important after effects. On death has been noticed in 9.09% of cases.

[Value of computer tomography in the managment of brain injuries]. / Apport de la tomodensitométrie dans la prise en charge des traumatismes cranio-encéphauques: expérience de L'Hopital de Bamako.

The purpose of this prospective study conducted from January 2001 to December 2001 was to ascertain the value of computer tomography for evaluation of brain injuries. Computer tomography was performed using a Toshiba X VID system with contiguous 5 mm axial sections through the posterior fossa and 10 mm contiguous axial sections through the subtentorial region without contrast injection. A total of 107 patients with brain injuries were enrolled over the one-year study period. These patients accounted for 0.8% of all admissions to surgical emergency unit of Gabriel Toure Hospital in Bamako, Mali. The predominant age group for brain injuries was the 20- to 29-year-old group (35 cases). The male-to-female sex ratio was 5:1. Vehicular accident was the most frequent cause of brain injury (76 cases). Trauma was severe in 48 patients with a Glasgow score less than 8. Coma occurred immediately after injury in 90 cases. Ventricular hemorrhage led to coma in 100% of cases whereas brain hemorrhage and hematoma led to coma in 93.3% and 83.3% of cases respectively. Treatment was medical in 99 cases and neurosurgical in 8. The mortality rate was 34% and the morbidity rate (permanent sequels) was 36%. Computer tomography is a valuable tool for therapeutic decision-making in medico-surgical emergencies involving brain injuries.