Traitement des fractures du massif trochantérien par vis-plaque dynamique au Centre Hospitalo-Universitaire de Kamenge, Burundi

L’objectif de l’étude était d‘évaluer les résultats radiologique et fonctionnel des patients traités par vis plaque dynamique (DHS) pour fractures dumassif trochantérien. Il s’agit d’une étude propective et descriptive menée au Centre hospitalouniversitaire de janvier à décembre 2016. Etaientinclus dans l’étude tous les patients diagnostiqués de fractures du massif trochantérien. Trente deux patients ont été hospitalisés pour fractures du massif trochantérien et traités par DHS sous contrôle scopique. L’on notait 19 hommes (59,3%) et 13 femmes (40,6%) avec un âge moyen de 71 ans (les extrêmes allant de 32 ans à 98 ans). La chute de sa hauteur était la plus retrouvée parmi les circonstances du traumatisme dans 75% (n=24).Selon la classification AO, les fractures de type 31- A1 étaient de 78,1% et de type 31-A2 de 21,8%. La réduction était bonne dans 90,6%(n=29) et la vis DHS était en bonne position chez 25 patients(78,125%). La durée moyenne d’hospitalisation était de 22,5 jours. Le délai moyen de consolidation était de 15 semaines et avec un recul d’aumoins six mois, la fracture était consolidée dans 81,2% (26 cas). Avec un recul moyen de 6 mois, les résultats fonctionnels selon la cotation de Postel et Merle d’Aubigné étaient excellents dans 46,4% (n=13), bons dans 28,5% (n=8), passables dans 21,4% (n=6) et mauvais dans 3,5% (n=1).Nous avons noté deux décès (6,2%), un balayage du col et de la tête sur la vis DHS chez deux patients (6,2%) et un descellement de la plaque chezun patient (3,1%). Deux patients ont été réopérés (6,2%) après balayage. La vis-plaque dynamique DHS nous a permis d’obtenir de bons résultats radiologique et fonctionnel permettant une reprise des activités quotidiennes dans les meilleurs délais. Elle est apparue comme une solution fiable pour les fractures du massif trochantérien.Mots clés : fractures massif trochantérien, vis plaque dynamique, Kamenge-BurundiThe objective of the study was to analyze the radiologic and functional outcome of patients treated with DHS for trochanteric fractures. It is a  prospective descriptive study conducted at the university hospital of Kamenge from January to December 2016. Included in the study, were all patients diagnosed with trochanteric fractures. Thirty two patients were hospitalized for trochanteric fractures and treated by DHS under image intensifier control. There were 19 men (59.3%) and 13 women (40.6%)with a mean age of 71 years (range, 32 years to 98 years). The main etiology was a fall in 75% (n = 24). According to the AO classification, the 31-A1 type fractures were 78.1% and the 31-A2 type 21.8%.The reduction was anatomic in 90.6% (n = 29) and the screw was well positioned in 25 patients (78.1%). The average duration of hospitalization was 22.5 days .Mean union time was 15 weeks and at least six months of follow-up, the union rate was 81.2% (26 cases). At an average follow-up of 6 months,functional outcomes according to the rating of Postel and Merle d’Aubigné were excellent in 46.4% (n = 13), good in 28.5% (n = 8), fair in 21.4% (n= 6), and poor in 3.5% (n = 1). We noted two deaths (6.2%), a cutout of the screw from the femoral head in two patients (6.2%) and a tearing off the plate in one patient (3.1%). Two patients were reoperated (6.2%) after screw cutout. The dynamic hip screw allowed us to obtain good radiological and functional results enabling a resumption of daily activities as soon as possible. It has emerged as a reliable solution for intertrochanteric  fractures.Key words: trochanteric fractures, dynamic hip screw, Kamenge-Burund

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran