Les Fractures Diaphysaires des os de l’Avant-bras chez l’Adulte: Aspects Lésionnels et Indications Chirurgicales au Centre Hospitalier Universitaire de Kara

Le but de cette étude était de présenter une vue d’ensemble sur la prise en charge chirurgicale des fractures diaphysaires des os de l’avant-bras dans un pays à faible revenu. Patients et méthode : Cette étude rétrospective a été  conduite de janvier 2019 à décembre 2022. Elle a concerné les patients opérés et suivis dans le service pour fracture d’un ou des deux os de l’avant-bras. Etaient exclus les perdus de vue et les écrasements de l’avant-bras. L’évaluation du traitement chirurgical a été faite par le score de fonction de l’avant-bras d’Anderson. Résultats : durant la période d’étude, 36 dossiers de patients ont été retenus. L’âge moyen était de 38,2 ans avec des extrêmes de 17 et de 65 ans. Il y avait 26 hommes et 10 femmes, soit un sex-ratio H/F de 2,6. Il y avait 61% (n=22) de fractures diaphysaires simultanée des deux os de l’avant-bras, 22% (n=8) de fractures de Galeazzi, et 8,33% (n= 3) de fractures de Monteggia. Dans 3 autres cas (8,33%) il y avait une fracture isolée et non déplacée de l’ulna. La fracture siégeait sur le radius dans 30 cas et sur l’ulna dans 28 cas, soit un total de 58 fractures. Le trait de fracture était simple (2R2A et 2U2A) dans 60,34% ; n=35. La fracture était ouverte dans 36% (n=13). Le type II de Gustillo et Anderson était majoritaire (8 cas), suivi du type IIIb (3 cas). Le type I était vu chez 2 patients. La fracture était associée à un polytraumatisme chez 3 patients (2 cas de traumatisme crânien grave et 1 cas de traumatisme du bassin), à une fracture de l’humérus homolatéral (coude flottant) dans un cas, et à une fracture des métacarpiens dans un cas. Pour la fracture diaphysaire simultanée des deux os de l’avant-bras, le montage Plaque-Plaque était le plus réalisé (59%, n=13), suivi d’une ostéosynthèse par embrochage centromédullaire de chaque os (23%, n=5), puis le montage hybride (18%, n=4). Le résultat global, anatomique et fonctionnel était excellent dans 86% (n=31), bon dans 8% (n=3), et moyen dans 6% (n=2). Conclusion : les fractures diaphysaires des os de l’avant –bas sont prise en charge par trois méthodes chirurgicales au CHU Kara avec des résultats satisfaisants.   The aim of this study was to present an overview of the surgical management of diaphyseal forearm bone fractures in a low-income country. Patients and method: This retrospective study was conducted from January 2019 to December 2022. It included patients operated on and followed up in the department for fracture of one or both forearm bones. Lost to follow-up and forearm crushes were excluded. Surgical treatment was assessed using the Anderson forearm function score. Results: During the study period, 36 patient files were retained. The mean age was 38.2 years, with extremes of 17 and 65 years. There were 26 men and 10 women, giving an M/F sex ratio of 2.6. There were 61% (n=22) simultaneous diaphyseal fractures of both forearm bones, 22% (n=8) Galeazzi fractures, and 8.33% (n=3) Monteggia fractures. In 3 other cases (8.33%), there was an isolated, non-displaced ulnar fracture. The fracture was located on the radius in 30 cases and on the ulna in 28 cases, for a total of 58 fractures. The fracture line was simple (2R2A and 2U2A) in 60.34%; n=35. The fracture was open in 36% (n=13). Gustillo and Anderson type II predominated (8 cases), followed by type IIIb (3 cases). type I was seen in 2 patients. The fracture was associated with polytrauma in 3 patients (2 cases of severe head trauma and 1 case of pelvic trauma), with a fracture of the homolateral humerus (floating elbow) in one case, and with a fracture of the metacarpals in one case. For simultaneous diaphyseal fractures of both forearm bones, open reduction and internal fixation by  plate on each bone was the most common (59%, n=13), followed by centromedullary pinning of each bone (23%, n=5), then hybrid fixation (18%, n=4). The overall anatomical and functional outcome was excellent in 86% (n=31), good in 8% (n=3), and fair in 6% (n=2). Conclusion: forearm dyaphyseal fractures are managed by three surgical methods at Kara University Hospital, with satisfactory results

Propionibacterium acnes as a cause of shoulder osteoarthritis after three shoulder arthroscopies: a case report and review of preventive action

We report a case of postoperative osteoarthritis infection caused by P. acnes after shoulder arthroscopy, and review possible preventive action. A right-handed 24-year-old man presented an anterior instability of the left shoulder. The patient underwent an anterior stabilization by the latarjet procedure. Stabilization failed, requiring a second and third surgery. The patient returned 10 months later for suspected septic arthritis of his left shoulder. An arthroscopy lavage with bacteriological and anatomo-pathological sampling was carried out. The bacteriological results revealed a positive P. acnes culture. The patient was treated using antibiotherapy for 12 weeks with a combination of clindamicin and moxifloxacin. C-reactive protein (CRP) was negative two months after the onset of antibiotherapy.  P. acnes is a anaerobic, non-sporulated, gram-positive bacillus. This commensal germ is part of the normal cutaneous flora and causes acne, but has also been recognized as a causative pathogen in osteoarticular infections since the 1990s, as described by Coden. Treatment is achieved via surgical debridement and intravenous antibiotics. We insist on preventive action in the form of a preoperative patient preparation protocol. Previous literature has underlined the important role of chlorhexidine or alcoholic iodinated polyvidone in the prevention of these infections. As P. acnes is a commensal germ of the patient's skin, prophylaxis should be reinforced by the thorough preparation of the surgery and surgical site. Clindamycin antibioprophylaxy specific to this germ should be administered for this surgery. To my knowledge, there is no specific antibioprophylaxy for shoulder surgery to date

PLAIE ACCIDENTELLE DE L’ARTERE RADIALE LORS DE L’ABORD ANTERIEUR DE L’AVANTBRAS : INTERET DU NON USAGE DU GARROT

Authors report one case of radial artery accidental wound in a 37 years old man who has presented malunion at the one third middle of the two forearm bones during radial focal abord by Henry way. The external bord of flexor carpi radialis muscle was not easy to identify because of anatomics connections modifications by malunion itself and amyotrophy. The garrot was not used at the beginning. A longitudinal wound of about one half centimeter of radial artery occurred and was repaired by classic way. Postoperative affects were simples. The tourniquet non use permit to recognize immediately the complication and to treat it quickly

Aspects Cliniques et Indications Chirurgicales des Fractures Diaphysaires des os de l’Avant-Bras chez l’Adulte au Centre Hospitalier Universitaire de Kara

Le but de cette étude était de décrire les aspects cliniques, thérapeutiques et évolutifs des fractures diaphysaires des os de l’avant-bras dans un pays à faible revenu. Méthodologie : Cette étude rétrospective a été  conduite de janvier 2019 à décembre 2022. Elle a concerné les patients opérés et suivis dans le service pour fracture d’un ou des deux os de l’avant-bras. Résultats : durant la période d’étude, 36 dossiers de patients ont été retenus. L’âge moyen était de 38,2 ans avec des extrêmes de 18 et 65. Il y avait 26 hommes et 10 femmes, soit un sex-ratio de 2,6. Il y avait 61% (n=22) de fractures diaphysaires simultanée des deux os de l’avant-bras, 22% (n=8) de fractures de Galeazzi, et 8% (n= 3) de fractures de Monteggia. Dans 3 autres cas (8%) il y avait une fracture isolée et non déplacée de l’ulna. La fracture siégeait sur le radius dans 30 cas et sur l’ulna dans 28 cas, soit un total de 58 fractures. Le trait de fracture était simple (2R2A et 2U2A) dans 35 cas (60%). La fracture était ouverte dans 13 cas (36%). Sur le plan thérapeutique, le montage Plaque-Plaque était le plus réalisé pour les fractures fermées des deux os (13 cas), suivi d’une ostéosynthèse par embrochage centromédullaire de chaque os (5 cas), puis le montage hybride (4 cas). Le résultat global, anatomique et fonctionnel était excellent dans 85% (n=31), bon dans 9% (n=3), et moyen dans 6% (n=2). Conclusion : En dehors des plaques vissées, les broches de Kirchner jouent un rôle important dans le traitement des fractures de l’avant-bras au CHU Kara.   The aim of this study was to describe the clinical, therapeutic and evolutionary aspects of diaphyseal forearm bone fractures in a low-income country. Methods: This retrospective study was conducted from January 2019 to December 2022. It included patients operated on and followed up for fracture of one or both forearm bones. Results: During the study period, 36 patients files were retained. The mean age was 38.2 years, with extremes of 17 and 65. There were 26 men and 10 women, giving an sex ratio of 2.6. There were 61% (n=22) simultaneous diaphyseal fractures of both forearm bones, 22% (n=8) Galeazzi fractures, and 8.33% (n=3) Monteggia fractures. In 3 other cases (8.33%), there was an isolated, non-displaced ulnar fracture. The fracture was located on the radius in 30 cases and on the ulna in 28 cases, for a total of 58 fractures. The fracture line was simple (2R2A and 2U2A) in 60.34%; n=35. The fracture was open in 36% (n=13). For simultaneous diaphyseal fractures of both forearm bones, open reduction and internal fixation by  plate on each bone was the most common (13 cases), followed by centromedullary pinning of each bone (5 cases), then hybrid fixation (4 cases). The overall anatomical and functional outcome was excellent in 85% (n=31), good in 9% (n=3), and fair in 6% (n=2). Conclusion: Apart from plates fixations, Kirchner wires are very important in the treatment of forearm fractures at Kara University Hospital

LES TUMEURS OSSEUSES PRIMITIVES DES MEMBRES AU CHU TOKOIN DE LOME PRIMARY BONE TUMORS OF MEMBERS IN TOKOIN TEACHING HOSPITAL OF LOME

Introduction. The purpose of this work was to analyze the epidemiological, diagnosis and therapy aspects of member’s primary bone tumors of our center to improve the management. Materials and Methods. We retrospectively analyzed the records of 32 patients treated for member’s primary bone tumors in orthopedic and trauma surgery department of Lomé Tokoin teaching hospital from January 1997 to December 2006. We collected and analyzed data on age, sex, clinical features, X-ray results, the results of the biopsy and therapeutic methods. Results. There were 13 men and 19 women. Pain was the most occasional discovery found in 84.38%. Swelling isolated or associated with pain was the second discovery circumstance in 75%. Pathological fracture showed the tumor in 12.5%. The tumor interested knee in 7 patients and leg in eight (8). Of the 21 patients (65,63%) diagnosed with benign tumors, there were 38.10% of osteogenic exostoses, 23.82% of osteoid osteoma and chondroma, the chondroblastoma, giant cell tumors then the aneurysmal cyst shared for each type 09, 52%. Osteosarcoma (5 patients; 45.46%), chondrosarcoma (3 patients; 27.27%) and Ewing's sarcoma, fibrosarcoma then angiosarcoma (1 patient; 09.90% for each histological type) were the malignant bone tumors found. Benign tumors underwent conservative surgery. All 11 patients with malignant tumors were treated by amputation. Conclusion. The primary bone tumors are relatively rare member of the Tokoin teaching hospital of Lomé. Benign tumors are more frequent. The consultation delay does not facilitate the planning of their care. The malignant tumors are treated by member amputation. It is necessary to increase public awareness about the benefit of early consultation at the slightest symptoms suggestive and advocacy with governments to equip our center which is the national reference in adequate infrastructures and resources for tumors care especially primary bone malignancies

Les Fractures Diaphysaires des os de l’Avant-bras chez l’Adulte: Aspects Lésionnels et Indications Chirurgicales au Centre Hospitalier Universitaire de Kara

Le but de cette étude était de présenter une vue d’ensemble sur la prise en charge chirurgicale des fractures diaphysaires des os de l’avant-bras dans un pays à faible revenu. Patients et méthode : Cette étude rétrospective a été  conduite de janvier 2019 à décembre 2022. Elle a concerné les patients opérés et suivis dans le service pour fracture d’un ou des deux os de l’avant-bras. Etaient exclus les perdus de vue et les écrasements de l’avant-bras. L’évaluation du traitement chirurgical a été faite par le score de fonction de l’avant-bras d’Anderson. Résultats : durant la période d’étude, 36 dossiers de patients ont été retenus. L’âge moyen était de 38,2 ans avec des extrêmes de 17 et de 65 ans. Il y avait 26 hommes et 10 femmes, soit un sex-ratio H/F de 2,6. Il y avait 61% (n=22) de fractures diaphysaires simultanée des deux os de l’avant-bras, 22% (n=8) de fractures de Galeazzi, et 8,33% (n= 3) de fractures de Monteggia. Dans 3 autres cas (8,33%) il y avait une fracture isolée et non déplacée de l’ulna. La fracture siégeait sur le radius dans 30 cas et sur l’ulna dans 28 cas, soit un total de 58 fractures. Le trait de fracture était simple (2R2A et 2U2A) dans 60,34% ; n=35. La fracture était ouverte dans 36% (n=13). Le type II de Gustillo et Anderson était majoritaire (8 cas), suivi du type IIIb (3 cas). Le type I était vu chez 2 patients. La fracture était associée à un polytraumatisme chez 3 patients (2 cas de traumatisme crânien grave et 1 cas de traumatisme du bassin), à une fracture de l’humérus homolatéral (coude flottant) dans un cas, et à une fracture des métacarpiens dans un cas. Pour la fracture diaphysaire simultanée des deux os de l’avant-bras, le montage Plaque-Plaque était le plus réalisé (59%, n=13), suivi d’une ostéosynthèse par embrochage centromédullaire de chaque os (23%, n=5), puis le montage hybride (18%, n=4). Le résultat global, anatomique et fonctionnel était excellent dans 86% (n=31), bon dans 8% (n=3), et moyen dans 6% (n=2). Conclusion : les fractures diaphysaires des os de l’avant –bas sont prise en charge par trois méthodes chirurgicales au CHU Kara avec des résultats satisfaisants.   The aim of this study was to present an overview of the surgical management of diaphyseal forearm bone fractures in a low-income country. Patients and method: This retrospective study was conducted from January 2019 to December 2022. It included patients operated on and followed up in the department for fracture of one or both forearm bones. Lost to follow-up and forearm crushes were excluded. Surgical treatment was assessed using the Anderson forearm function score. Results: During the study period, 36 patient files were retained. The mean age was 38.2 years, with extremes of 17 and 65 years. There were 26 men and 10 women, giving an M/F sex ratio of 2.6. There were 61% (n=22) simultaneous diaphyseal fractures of both forearm bones, 22% (n=8) Galeazzi fractures, and 8.33% (n=3) Monteggia fractures. In 3 other cases (8.33%), there was an isolated, non-displaced ulnar fracture. The fracture was located on the radius in 30 cases and on the ulna in 28 cases, for a total of 58 fractures. The fracture line was simple (2R2A and 2U2A) in 60.34%; n=35. The fracture was open in 36% (n=13). Gustillo and Anderson type II predominated (8 cases), followed by type IIIb (3 cases). type I was seen in 2 patients. The fracture was associated with polytrauma in 3 patients (2 cases of severe head trauma and 1 case of pelvic trauma), with a fracture of the homolateral humerus (floating elbow) in one case, and with a fracture of the metacarpals in one case. For simultaneous diaphyseal fractures of both forearm bones, open reduction and internal fixation by  plate on each bone was the most common (59%, n=13), followed by centromedullary pinning of each bone (23%, n=5), then hybrid fixation (18%, n=4). The overall anatomical and functional outcome was excellent in 86% (n=31), good in 8% (n=3), and fair in 6% (n=2). Conclusion: forearm dyaphyseal fractures are managed by three surgical methods at Kara University Hospital, with satisfactory results

PLAIE ACCIDENTELLE DE L’ARTERE RADIALE LORS DE L’ABORD ANTERIEUR DE L’AVANTBRAS : INTERET DU NON USAGE DU GARROT

Authors report one case of radial artery accidental wound in a 37 years old man who has presented malunion at the one third middle of the two forearm bones during radial focal abord by Henry way. The external bord of flexor carpi radialis muscle was not easy to identify because of anatomics connections modifications by malunion itself and amyotrophy. The garrot was not used at the beginning. A longitudinal wound of about one half centimeter of radial artery occurred and was repaired by classic way. Postoperative affects were simples. The tourniquet non use permit to recognize immediately the complication and to treat it quickly

LES TUMEURS OSSEUSES PRIMITIVES DES MEMBRES AU CHU TOKOIN DE LOME PRIMARY BONE TUMORS OF MEMBERS IN TOKOIN TEACHING HOSPITAL OF LOME

Introduction. The purpose of this work was to analyze the epidemiological, diagnosis and therapy aspects of member’s primary bone tumors of our center to improve the management. Materials and Methods. We retrospectively analyzed the records of 32 patients treated for member’s primary bone tumors in orthopedic and trauma surgery department of Lomé Tokoin teaching hospital from January 1997 to December 2006. We collected and analyzed data on age, sex, clinical features, X-ray results, the results of the biopsy and therapeutic methods. Results. There were 13 men and 19 women. Pain was the most occasional discovery found in 84.38%. Swelling isolated or associated with pain was the second discovery circumstance in 75%. Pathological fracture showed the tumor in 12.5%. The tumor interested knee in 7 patients and leg in eight (8). Of the 21 patients (65,63%) diagnosed with benign tumors, there were 38.10% of osteogenic exostoses, 23.82% of osteoid osteoma and chondroma, the chondroblastoma, giant cell tumors then the aneurysmal cyst shared for each type 09, 52%. Osteosarcoma (5 patients; 45.46%), chondrosarcoma (3 patients; 27.27%) and Ewing's sarcoma, fibrosarcoma then angiosarcoma (1 patient; 09.90% for each histological type) were the malignant bone tumors found. Benign tumors underwent conservative surgery. All 11 patients with malignant tumors were treated by amputation. Conclusion. The primary bone tumors are relatively rare member of the Tokoin teaching hospital of Lomé. Benign tumors are more frequent. The consultation delay does not facilitate the planning of their care. The malignant tumors are treated by member amputation. It is necessary to increase public awareness about the benefit of early consultation at the slightest symptoms suggestive and advocacy with governments to equip our center which is the national reference in adequate infrastructures and resources for tumors care especially primary bone malignancies