Abcès froid dorsolombaire révélant un mal de Pott

Les abcès froids tuberculeux représentent une forme rare et inhabituelle de tuberculose extra pulmonaire. Nous rapportons un cas d’abcès froid dorsolombaire révélant un mal de Pott sans complications neurologiques chez un patient de 27 ans, présentant depuis 05 mois une tuméfaction dorsolombaire gauche. L’examen du prélèvement à l’issu d’une incision et drainage de l’abcès a permis de confirmer l’origine tuberculeuse. Un traitement antituberculeux de 12 mois permettait une guérison avec une séquelle à type de gibbosité modérée.Mots clés: Abcès froid, mal de Pott, osteoarticulaire, spondylodiscite, tuberculoseEnglish Title: Dorsolumbar cold abscess revealing Pott’s diseaseEnglish AbstractTuberculous cold abscesses are a rare and unusual form of extrapulmonary tuberculosis. We here report the case of a 27-year old patient with a 5-month history of left dorsolumbar swelling presenting with dorsolumbar cold abscess revealing Pott’s disease without neurological complications. Examination of pus sample collected at the time the abscess was incised and drained helped to confirm the diagnosis of cold abscesses of TB origin. The patient underwent 12 months of anti-tuberculosis treatment which lead to a faster recovery; the sequelae was slight gibbosity.Keywords: Cold abscess, Pott’s disease, osteoarticular, spondylodiscitis, tuberculosi

Déformation de Madelung à propos d’un cas et revue de la littérature

La maladie de Madelung est une déformation du poignet due à une atrophie de la partie médiale du cartilage de croissance distal du radius. Il en résulte une subluxation antéro-médiale du carpe,limitant les amplitudes articulaires. Cette dysplasie osseuse est rare et représente 1,7% des anomalies congénitales. Les auteurs rapportent un cas bilatéral chez une fille de 21 ans. L’étude de cette observation nous a permis d’étudier la fréquence, les signes et les moyens de son diagnostic ainsi que les mesures thérapeutiques adéquates afin de pouvoir répondre aux attentes des patientes.Pan African Medical Journal 2016; 2

Locally-developed external fixators and their impact on the stability of long bone diaphyseal fractures after osteosynthesis

Open tibia fractures (OTF) can cause significant morbidity. These injuries justify early antibiotic therapy, adequate debridement, stable osteosynthesis, and early coverage of the fracture. The mostly poor infrastructural conditions concerning the provision of health services in developing countries (DCs) likely render adequate treatment of problematic fractures practically impossible. The hygienic conditions required for surgical treatment involving techniques of internal osteosynthesis may be insufficient; for cost reasons, the necessary devices including image intensifier and implants may be lacking in places where such treatment could indeed be offered. Thus, casting with plaster of Paris (POP) is still the commonly used restraint method due to its availability and low-cost. However, this method may cause many complications. In this context, the external fixator (EF) is still the implant of choice, which is also suitable for precarious areas. The EF has proven its usefulness in the treatment of open fractures. This alternative could be employed to circumvent the difficulties of implementing a classic osteosynthesis. There are many sophisticated external fixators on the market, but they are too expensive, which limits their usefulness in our country. This doctoral thesis investigated the locally-developed external fixator (LDEF) manufactured from available and easily accessible materials for treating shaft fractures of long bones, including the tibia. The first part of this thesis investigated the treatment of open fractures in DCs in sub-Saharan Africa. A prospective clinical study on the management of OTF in a reference health facility in Ivory Coast was carried out, as was a systematic review of literature concerning the treatment of OTF. This was meant to establish an inventory concerning the treatment of open tibia fractures. The second part of this thesis investigated the design and biomechanical aspects of different LDEFs. Design of the LDEF was made from materials locally available in developing country like the Ivory Coast. These fixators are suitable for simple and comminuted pattern fractures. A static biomechanical study revealed a rigidity that was comparable to reference external fixator. After applying 1 million loading cycles, the overall stiffness characteristics of the frame remained unchanged. Based on these test results, the LDEF could be re-used, but certain fixator components had to be inspected and eventually replaced, especially pins. The third part of this thesis sought to evaluate the LDEF effectiveness as definitive treatment for open tibia fractures. A prospective clinical study was conducted, revealing a consolidation rate exceeding 70%, with an 80% functional recovery in LDEF-treated patients.(MED - Sciences médicales) -- UCL, 202

Treatment of open tibia fractures in Sub-Saharan African countries: a systematic review

INTRODUCTION Open tibia fracture (OTF) treatment is well documented in developed countries. Yet, this fracture pattern remains challenging because it is associated with an increased risk of infection and delayed union, particularly in case of Gustilo III B and C open fractures. Since access to healthcare is limited in Sub-Saharan African countries, this paper explores the results of OTF management in this setting. MATERIALS AND METHODS A systematic review of the literature was conducted using current databases such as MEDLINE, Cochrane, EMBASE, PubMed, ScienceDirect, Scopus, and Google Scholar in order to identify prospective studies with cohorts of patients treated for OTF. Studies were included based on predefined inclusion and exclusion criteria. The quality of studies was analyzed by the Coleman Methodology Score (CMS). RESULTS Eight papers met the inclusion criteria and had an average CMS of 70 (range 54–73). The most common treatment was non-operative management of the fracture with cast immobilization (67%). Gustilo Type II and III fractures were associated with a higher risk of complications. The infection rate was 30%. Malunion, chronic osteomyelitis and nonunion were observed in 14.5%, 12.3%, and 7% of the cases, respectively. More complications were observed with non-operative treatment (cast immobilization) than with surgical fixation. CONCLUSIONS Although the surgical environment does not allow for internal fixation, poor results of non-operative management of open fractures should lead to the introduction of trainings on the proper use of external fixators. It is also advisable to support the development of locally produced external devices that utilize local source materials, which would make external fixation available at a reasonable cost

Biomechanical study of a low-cost external fixator for diaphyseal fractures of long bones

BACKGROUND: External fixation improves open fracture management in emerging countries. However, sophisticated models are often expensive and unavailable. We assessed the biomechanical properties of a low-cost external fixation system in comparison with the Hoffmann ® 3 system, as a reference. METHODS : Transversal, oblique, and comminuted fractures were created in the diaphysis of tibia sawbones. Six external fixators were tested in three modes of loading– axial compression, medio-lateral (ML) bending, and torsion – in order to determine construction stiffness. The fixator construct implies two uniplanar (UUEF1, UUEF2) depending the pin-rods fixation system and two biplanar (UBEF1, UBEF2) designs based on different bar to bar connections. The designed low-cost fixators were compared to a Hoffmann ® 3 fixator single rod (H3-SR) and double rod (H3-DR). Twenty-seven constructs were stabilized with UUEF1, UUEF2 and H3-SR (nine construct each). Nine constructs were stabilized with UBEF1, UBEF2 and H3-DR (three construct each). RESULTS : UUEF2 was significantly stiffer than H3-SR (p<0.001) in axial compression for oblique fractures and UUEF1 was significantly stiffer than H3-SR (p=0.009) in ML bending for transversal fractures. Both UUEFs were significantly stiffer than H3-SR in axial compression and torsion (p<0.05), and inferior to H3-SR in ML bending, for comminuted fractures. In the same fracture pattern, UBEFs were significantly stiffer than H3-DR (p=0.001) in axial compression and torsion, while only UBEF1 was significantly stiffer than H3-DR in ML bending (p=0.013). CONCLUSIONS: The results demonstrated that the stiffness of the UUEF and UBEF device compares to the reference fixator and may be helpful in maintaining fracture reduction. Fatigue testing and clinical assessment must be conducted to ensure that the objective of bone healing is achievable with such low-cost devices

La prise en charge des fractures ouvertes de jambe dans une structure hospitalière en Côte d’Ivoire pose-t-elle problème et pourquoi ?

INTRODUCTION : La prise en charge des patients victimes d’une fracture ouverte de jambe en Côte d’Ivoire ne rencontre pas les standards des pays développés en raison des conditions socio-économiques, de l’accessibilité et de l’organisation des soins. L’objectif de cette étude était d’évaluer le taux de complications infectieuses ou mécaniques et ce en fonction en particulier du délai de prise en charge et de la méthode de traitement. Notre hypothèse était que le taux de complications est lié au délai de prise en charge. MATÉRIEL ET MÉTHODES : Cette étude prospective a été menée entre janvier 2018 et mai 2018. Les paramètres étudiés étaient les facteurs liés au patient, à la fracture et aux conditions du traitement. Ils ont été corrélés aux taux de complications par analyse multivariée. RÉSULTATS : La série comptait 30 fractures Gustilo 1 et 2 et 13 fractures Gustilo 3. Le délai opératoire moyen était de 26,6±8,1h. La stabilisation des fractures a été obtenue par plâtre cruro-pédieux, par fixateur externe et par enclouage non verrouillé dans respectivement 27,10 et 6 cas. Les complications ont été 17 cals vicieux, 8 ostéomyélites, 3 pseudarthroses septiques et 1 amputation. Une consolidation sans complication a été observée dans 15 cas et un résultat fonctionnel acceptable dans 16 cas. Une immobilisation plâtrée était significativement associée à un risque de complications (p<0,001) alors que le délai de prise en charge ne l’était pas. Conclusion : La prise en charge des fractures ouvertes en milieu précaire est associée à un taux élevé de complications et un résultat fonctionnel insatisfaisant. L’immobilisation par plâtre est corrélée aux complications. La disponibilité de fixateurs externes contribuerait certainement à une diminution des complications. NIVEAU D’ÉVIDENCE : IV, étude prospective non comparative

Anatomical evidence supporting the revision of classical landmarks for genicular nerve ablation

We would like to thank Tran et al1 for their interest in our paper2. They expressed their concerns about two of the five anatomical landmarks we proposed to target with increased accuracy for genicular nerve ablation: the superior medial (SMGN) and the superior lateral (SLGN) genicular nerves. We would like to respond to the issues raised and to clarify some anatomical and methodological disagreements

Anatomical study of the descending genicular artery and implications for image-guided interventions for knee pain

INTRODUCTION: The descending genicular artery (DGA) has recently been mentioned as accompanying some nerves in the medial aspect of the knee joint. This could be clinically relevant as the arteries could serve as landmarks for accurate nerve capture during ultrasound-guided nerve blockade or ablation. The aim of this cadaveric study was to investigate the anatomical distribution of the DGA, assess the nerves running alongside its branches, and discuss the implications for regional anesthesia and knee pain interventions. METHODS: We dissected the femoral artery (FA) all along its course to identify the origin of the DGA, from which we carefully dissected all branches, in 27 fresh-frozen human specimens. Simultaneously, we systematically dissected the nerves supplying the medial aspect of the knee from proximally to distally and identified those running alongside the branches of the DGA. The surrounding anatomical landmarks were identified and measurements were recorded. RESULTS: The DGA was found in all specimens, arising from the FA 130.5 ± 17.5 mm (mean ± SD) proximally to the knee joint line. Seven distribution patterns of the DGA were observed. We found three consistent branches from the DGA running alongside their corresponding nerves at the level of the medial aspect of the knee: the artery of the superior-medial genicular nerve, the artery of the infrapatellar branch of the saphenous nerve, and the saphenous branch of the DGA. CONCLUSION: The consistent arteries and surrounding landmarks found in this study could help to improve the capture of the targeted nerves during ultrasound-guided interventions

Distribution of sensory nerves supplying the knee joint capsule and implications for genicular blockade and radiofrequency ablation: an anatomical study

BACKGROUND: Despite their emerging therapeutic relevance, there are many discrepancies in anatomical description and terminology of the articular nerves supplying the human knee capsule. This cadaveric study aimed to determine their origin, trajectory, relationship and landmarks for therapeutic purpose. METHODS: We dissected 21 lower limbs from 21 cadavers, to investigate the anatomical distribution of all the articular nerves supplying the knee joint capsule. We identified constant genicular nerves according to their anatomical landmarks at their entering point to knee capsule and inserted Kirschner wires through the nerves in underlying bone at those target points. Measurements were taken, and both antero-posterior and lateral radiographs were obtained. RESULTS: The nerve to vastus medialis, saphenous nerve, anterior branch of obturator nerve and a branch from sciatic nerve provide substantial innervation to the medial knee capsule and retinaculum. The sciatic nerve and the nerve to the vastus lateralis supply sensory innervation to the supero-lateral aspect of the knee joint while the fibular nerve supplies its infero-lateral quadrant. Tibial nerve and posterior branch of obturator nerve supply posterior aspect of knee capsule. According to our findings, five constant genicular nerves with accurate landmarks could be targeted for therapeutic purpose. CONCLUSION: The pattern of distribution of sensitive nerves supplying the knee joint capsule allows accurate and safe targeting of five constant genicular nerves for therapeutic purpose. This study provides robust anatomical foundations for genicular nerve blockade and radiofrequency ablation

A Comparison of Genicular Nerve Blockade With Corticosteroids Using Either Classical Anatomical Targets vs Revised Targets for Pain and Function in Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial.

OBJECTIVE: Compare the effectiveness of genicular nerve blockade (GNB) using classical anatomical targets (CT) versus revised targets (RT) in patients suffering from chronic knee osteoarthritis pain. DESIGN: Double-blinded randomized controlled trial. SETTING: Pain medicine center of a teaching hospital. METHODS: We randomly assigned 55 patients with chronic knee osteoarthritis pain to receive a GNB (using a fluid mixture of 2 mL: lidocaine 1% + 20 mg triamcinolone) with either classical targets (CT-group, n = 28) or revised targets (RT-group, n = 27). Numeric rating pain scale (NRS), Oxford knee score (OKS), Western Ontario and McMaster Universities osteoarthritis index score (WOMAC), Quantitative analgesic questionnaire (QAQ) and global perceived effects were assessed at baseline, and at 1-hour, 24-hours, 1, 4, and 12 weeks post-intervention. RESULTS: The RT-group showed greater reduction in NRS mean score at 1-hour post-intervention (2.4 ± 2.1 vs 0.4 ± 0.9, 95% confidence interval (CI) [.0-.8] vs [1.6-3.2], P < .001). The proportion of patients achieving more than 50% knee pain reduction was higher in the RT-group at each follow up interval, yet these differences were statistically significant only at 1-hour post intervention (82.1% [95% CI = 63.1-93.9] vs 100% [95% CI = 97.2-100] P = .02). Both protocols resulted in significant pain reduction and joint function improvement up to 12 weeks post-intervention. CONCLUSIONS: The revised technique allowed more pain relief as well as greater proportion of successful responders at 1-hour post intervention. The large volume injected during therapeutic GNB could have compensated the lack of precision of the classical anatomical targets, mitigating differences in outcomes between both techniques