Associated injuries and complications in floating knee management

Objective: This retrospective study set out to explore associated injuries and complications in floating knee management.Design: A retrospective study.Materials and Methods: The investigation lasted ten years from 1st January, 2000 to 31st December, 2009. All the patients admitted in that period with a floating knee were included. Fifty two files with a floating knee were included with 53 floating knees. One of them had a bilateral floating knee. The floating knees were classified according to Fraser’s classification.Results: The average age was 38.37 years with extremes of 18 and 81 years. There were 40 men and 12 women that is a sex-ratio of 3.33. There were polytrauma context in 24 cases. Ninety seven associated injuries (22 head injuries, 6 upper limb fractures, 2 pelvic ring traumas, 2 cervical traumas, 17 knee hemarthrosis, 2 paralysis of fibular nerve associated to a displaced fracture of neck of fibula, 45 cases of open skin injury). Twenty five patients had received orthopaedic treatment. The complications were as follows: 8 knee stiffness, 7 vicious callus, 1 aseptic pseudarthrosis, 2 osseous infection. Twenty seven patients with a total of 28 floating knee had been treated surgically. Nine (33.33%) of them had presented at least one complication. We noted 4 knee stiffness, 3 vicious callus, 2 septic pseudarthrosis, 2 aseptic pseudarthrosis which one occurred on a broken plate, 1 osseous infection and 2 migrations of femoral nail. The afterings at middle follow-up were 2 shortness.Conclusion: Associated injuries and complications of floating knee are frequent in our activities. Based upon findings, the study suggests that a good outcome of floating knee management will depend on early evaluation and treatment of associated injuries.Keywords: Associated injuries, complications, Floating knee, Managemen

Nécrose drépanocytaire de la tête fémorale chez l’enfant et l’adolescent – Résultat du traitement fonctionnel

Objectif: la prise en charge de l’ostéonécrose aseptique de la tête fémorale chez l’enfant atteint de drépanocytose est difficile ; elle impose une hospitalisation de longue durée, avec des résultats cliniques peu satisfaisants. Il était donc nécessaire d’envisager une autre approche thérapeutique. Notre objectif est d’analyser les résultats préliminaires d’une courte série de patients traités de façon ambulatoire. Methode : Il s’agit d’une étude descriptive, prospective et expérimentale réalisée sur 11 jeunes patients atteints de drépanocytose et régulièrement suivis au centre national de référence de la drépanocytose et présentant une ostéonécrose de la tête fémorale. Après un diagnostic collégial entre chirurgien orthopédiste, radiologue et pédiatre, les enfants ont été confiés au spécialiste de médecine physique pour un traitement fonctionnel. Le bilan clinique et radiologique a été repris à la fin de la série de rééducation fonctionnelle. Résultats : Onze patients ont été enrollés dans cette étude. L’atteinte était bilatérale chez 2 d’entre eux ce qui porte l’effectif à 13 hanches. Nous n’avons observé aucun enraidissement, la mobilité articulaire et la force musculaire étaient conservées. Au plan radiologique, les lésions sont restées stables. Par ailleurs il n’y a pas eu d’hospitalisation et tous les enfants ont eu un bon résultat scolaire. Discussion : Les résultats de cette courte série sont prometteurs. La surveillance clinique doit être poursuivie pour augmenter le recul de la série. Déjà, les avantages sociaux de la méthode ambulatoire méritent d’en faire un protocole codifié qui pourrait faire l’objet d’une étude multicentrique régionale Mots clés : Drépanocytose, hanche, enfant, traitement ambulatoire.Objective: The taking care of avascular necrosis of femoral head on sickle cell disease young patients is very difficult. It needs a long period of hospitalization with poor results. Therefore we feel it necessary to look for another solution. Our goal is to analyse the preliminary results of a small group of patients treated by ambulatory procedure. Method: This is a prospective, descriptive and experimental trial witch concern 11 young patients affected by sickle cell disease and regularly followed up at the National referential center for the disease. Those patients presented a femoral head osteonecrosis. Following a collegial diagnosis between orthopeadic surgeon, radiologist and pediatrician the children have been referred to a specialist for physical medicine for a functional treatment. The X-ray and clinical results have been redone after the physiotherapy course. Results: Eleven patients have been followed in this study. The impact was bilateral for two of them and that bring us to 13 hip cases. We haven’t observed any case of stiffness, the articular mobility and muscular strength were preserved. On the X-ray point of view, the lesion stayed stable. None of the children have been hospitalized and they obtained good school results. Discussion: The results of this short serial are encouraging. The clinical survey has to be continued to increase the trial’s hindsight. Already, the social advantages of this ambulatory method deserve to make out of it a codified protocol which could lead to a regional multicentric study.Key words: sickle cell disease, hip, children, ambulatory treatment

Long term results of Intramedullary Nailing in childhood femur fractures

Objective: To evaluate the impact on bone growth of intramedullary nailing of femur using Küntscher technique in childhood.  Methods: 18 patients who had undergone Küntscher  intramedullary nailing were analyzed as they have grown to adulthood. Growth of each lower limb was compared using predefined clinical and radiological parameters. Results: Patient ages at the time of evaluation, ranged from 21 to 30 years and the follow up length 12 to 16 years. Clinical examination noted 10 normal patients and 8 patients with anomalies, among them 6 were less than 12 years old at the time of intervention. Six patients had lengthening; 4 had atrophy of the thigh and 7 patients had coxa valga of operated limb. All patients with coxa valga had undergone the intervention before the age of 12 years. Conclusion: intramedullary nailing using Küntschter nails to treat femoral fractures in children  may have some long terms sequelae. Therefore it is advisable not to use this technique in children less than 12 years old. Key words: intramedullary nailing, children, growth plate, femur

Aspects épidémiologiques et approche thérapeutique des cals vicieux de la cheville au Centre National Hospitalo-Universitaire de Cotonou

Les cals vicieux de la cheville évoluent inéluctablement vers l'arthrose. Le but de ce travail était de décrire leurs aspects  épidémiologiques et les résultats de leur traitement chirurgical au Centre National Hospitalier et Universitaire Hubert Koutoukou MAGA (CNHU-HKM) de Cotonou. Il s'agissait d'une étude observationnelle rétrospective sur 12 ans, réalisée à la Clinique Universitaire de Traumatologie, d'Orthopédie et de Chirurgie Réparatrice (CUTO-CR) du CNHU-HKM de Cotonou de janvier 2003 à décembre 2015. Elle avait concerné 11 patients présentant un cal vicieux de la cheville, opérés et suivis pendant au moins 6 mois. Le diagnostic de cal vicieux  de la cheville avait été retenu grâce à l'examen clinique et complété par les clichés radiographiques de la cheville de face et de profil. Le traitement était chirurgical. Les résultats fonctionnels ont été évalués selon le score de Kitaoka. Onze patients dont 8 hommes et 3 femmes d'âge moyen de 41 ans avec des extrêmes de 16 ans et 63 ans avaient un cal vicieux au niveau de la cheville. Les lésions initiales étaient : la fractures bi-malléolaire (n=6), la fracture tri-malléolaire (n=2), la fractures du pilon tibial (n=2) cas et la fracture du talus (n=1). Le traitement chirurgical consistait en une arthrodèse dans 4 cas et une ostéotomie de correction dans 7 cas. Le résultat fonctionnel était jugé bons dans 4 cas, moyen dans 6 cas et mauvais dans 1 cas. Les cals-vicieux de la cheville sont des lésions rares, polymorphes et graves. Ils sont fréquents chez le sujet jeune de sexe masculin. Le traitement par arthrodèse ou par ostéotomie de correction nous a permis d'obtenir des résultats fonctionnels satisfaisants. Mots clés : cal vicieux, cheville, arthrodèse, ostéotomie.Malunion at the level of the ankle inevitably progresses to osteoarthritis. The aim of this study was to describe the epidemiological  aspects as well as the outcome of the surgical treatment at the Cotonou Hubert Koutoukou MAGA National University Hospital (CNHU-HKM).This was an observational retrospective study over 12 years, carried out at the Traumatology , Orthopedics and Corrective Surgery University Clinic (CUTO-CR) of the Cotonou CNHU-HKM, from January 2003 to December 2015. The study involved 11 patients presenting a malunion at the level of the ankle, who underwent surgery and were followed up during a minimal period of 6 months. The diagnosis of ankle malunion was evocked based on clinical examination and confirmed by an X-ray of ankle with frontal and lateral views. The treatment was surgical. The functional outcome were evaluated by the Kitaoka score. Eleven patients including 8 males and 3 females with a mean age of 41 years,ranging between 16 and 63 years had a malunion at the level of the ankle. The initial lesions were: 6 bimalleolar fracture (n=6), 2 trimalleolar fracture (n=2), tibial pestle fracture (n=2) and talus fracture (n=1). The surgical  treatment consisted of arthrodesis in 4 cases and corrective osteotomy in 7 cases. The functional outcome was evaluated to be good in 4 cases, average in 6 cases and poor in 1 case. Ankle malunion is an uncommon, polymorphous and severe lesion. It is frequent in young male patients. Arthrodesis or corrective osteotomy provided satisfactory functional results in our patients. Keywords: malunion, ankle, arthrodesis, osteotom

Disseminated Mycobacterium ulcerans disease in an HIV-positive patient: a case study [letter]

Not the final published versio

Aetiology of the Lumbar Spinal Stenosis in Black Africans: Intraoperative Observations

Background & Aim: Lumbar spinal stenosis (LSS) is a common condition. This congenital or acquired stenosis has multiple etiologies. The goal of this study was to describe intraoperative pathoanatomic findings of lumbar spinal stenosis observed within a black African population. Methods & Materials/Patients: It was a retrospective and descriptive study performed at Departmental Teaching Hospital of Borgou in Republic of Benin (West Africa) from January 2008 to June 2014. All black African patients who underwent surgery for LSS were included. Intra operative aetiologies were recorded. Patients with extruded lumbar discopathy were excluded. Results: During study period, 199 patients were selected. It was 109 men (54.8%) and 90 women (42.2%). Patients mean age was 53.2 years ± 10.96, mean weight 77.11kg ± 14.37 and mean height 171 cm ± 8.64cm. The LSS was acquired in 157 patients (78.9%), congenital in 29 (14.6%) and in 13 cases (6.5%) it was mixed origin. A hypertrophyof ligamentum flavum was observed in 101 patients (50.8%), zygapophyseal joint hypertrophy in 15 cases (7.2%) and in 74 cases (37.2%) the two factors were associated. A disc bulge were observed in 9 cases (4.5%).  Conclusion: The ligamentum flavum hypertrophy is the main cause of LSS in black Africans. Studies to determine the mechanism of hypertrophy will be useful in order to initiate preventive treatment

Motivations des médecins à se spécialiser en chirurgie à la Faculté des Sciences de la Santé de Cotonou

International audienc