La Plaque Console Du Radius : Une Alternative Dans L’ostéosynthèse Des Fractures De L’extrémité Supérieure De L’humérus ?

The aim of this study was to report the results of our experience in the treatment of proximal fractures with distal radius plate. This prospective study was conducted between January 2010 and December 2014. It took into account patients with a body mass index (BMI) not more than 25 kg/m2 in which the indication of conservative surgical treatment was decided and who did not have enough financial means to fulfill the required implants. The Neer classification was used to characterize fracture. To assess treatment outcomes, we used UCLA (University of California in Los Angeles) slightly modified score. There were 17 patients including 10 men and 7 women with a mean age of 32 years. According to Neer classification, six patients (35,29%) had stage I lesions, 5 others (29,42%) stage II and 6 patients (35,29%), stage III. There was no open fracture. There were three cases (17, 66%) of fracture-dislocations with one posterior variety. The average time of care was 13, 7 days (with a range of 2 to 29 days). The average time of healing was 117, 4 days with extremes of 81 days and 4 months 10 days. All patients were consolidated. The results at a mean of 15.31 months revealed excellent results in 29.41% and 29.41% poor results. In young patients whose treatment should be as conservative as possible, the distal radius plate could be an alternative if patient BMI does not exceed 25 kg/m2 and the epiphyseal screws are not too long. In case of comminuted fracture, it seems more desirable to postpone the osteosynthesis of weeks. However, only other subsequent studies on larger samples and longer followup, may lead to some conclusions about the usefulness of the distal radius plate in these lesions

DEVENIR DES MACRO-AMPUTES TRAUMATIQUES DU MEMBRE THORACIQUE : CAS D’UN PAYS EN DEVELOPPEMENT

Major upper limb trauma are rare lesions that management should be done in a specialized center. Faced with complex trauma of the upper limb, the orthopedist wonders if everything must be done to maintain a sometimes very functional upper limb amputated. We report the case of three male patients aged 18, 26 and 30 years of crash victims of upper limb accidents from the public road and work. The dominant member was diagnosed in a patient. Two patients underwent arm amputation stump and regularization forearm was performed in the third. Infection of amputation stump with surgery to stabilize, was recorded in a patient. One had a prosthesis made on the spot with his socio-professional reintegration, other patients are waiting

The Asp1 pyrophosphatase from S. pombe hosts a [2Fe-2S]2+ cluster in vivo

AbstractThe Schizosaccharomyces pombe Asp1 protein is a bifunctional kinase/pyrophosphatase that belongs to the highly conserved eukaryotic diphosphoinositol pentakisphosphate kinase PPIP5K/Vip1 family. The N-terminal Asp1 kinase domain generates specific high-energy inositol pyrophosphate (IPP) molecules, which are hydrolyzed by the C-terminal Asp1 pyrophosphatase domain (Asp1365−920). Thus, Asp1 activities regulate the intracellular level of a specific class of IPP molecules, which control a wide number of biological processes ranging from cell morphogenesis to chromosome transmission. Recently, it was shown that chemical reconstitution of Asp1371−920 leads to the formation of a [2Fe-2S] cluster; however, the biological relevance of the cofactor remained under debate. In this study, we provide evidence for the presence of the Fe–S cluster in Asp1365−920 inside the cell. However, we show that the Fe–S cluster does not influence Asp1 pyrophosphatase activity in vitro or in vivo. Characterization of the as-isolated protein by electronic absorption spectroscopy, mass spectrometry, and X-ray absorption spectroscopy is consistent with the presence of a [2Fe-2S]2+ cluster in the enzyme. Furthermore, we have identified the cysteine ligands of the cluster. Overall, our work reveals that Asp1 contains an Fe–S cluster in vivo that is not involved in its pyrophosphatase activity.</jats:p

The clinical and genetic spectrum of autosomal-recessive TOR1A-related disorders.

In the field of rare diseases, progress in molecular diagnostics led to the recognition that variants linked to autosomal-dominant neurodegenerative diseases of later onset can, in the context of biallelic inheritance, cause devastating neurodevelopmental disorders and infantile or childhood-onset neurodegeneration. TOR1A-associated arthrogryposis multiplex congenita 5 (AMC5) is a rare neurodevelopmental disorder arising from biallelic variants in TOR1A, a gene that in the heterozygous state is associated to torsion dystonia-1 (DYT1 or DYT-TOR1A), an early-onset dystonia with reduced penetrance. While 15 individuals with TOR1A-AMC5 have been reported (less than 10 in detail), a systematic investigation of the full disease-associated spectrum has not been conducted. Here, we assess the clinical, radiological and molecular characteristics of 57 individuals from 40 families with biallelic variants in TOR1A. Median age at last follow-up was 3 years (0-24 years). Most individuals presented with severe congenital flexion contractures (95%) and variable developmental delay (79%). Motor symptoms were reported in 79% and included lower limb spasticity and pyramidal signs, as well as gait disturbances. Facial dysmorphism was an integral part of the phenotype, with key features being a broad/full nasal tip, narrowing of the forehead and full cheeks. Analysis of disease-associated manifestations delineated a phenotypic spectrum ranging from normal cognition and mild gait disturbance to congenital arthrogryposis, global developmental delay, intellectual disability, absent speech and inability to walk. In a subset, the presentation was consistent with fetal akinesia deformation sequence with severe intrauterine abnormalities. Survival was 71% with higher mortality in males. Death occurred at a median age of 1.2 months (1 week - 9 years) due to respiratory failure, cardiac arrest, or sepsis. Analysis of brain MRI studies identified non-specific neuroimaging features, including a hypoplastic corpus callosum (72%), foci of signal abnormality in the subcortical and periventricular white matter (55%), diffuse white matter volume loss (45%), mega cisterna magna (36%) and arachnoid cysts (27%). The molecular spectrum included 22 distinct variants, defining a mutational hotspot in the C-terminal domain of the Torsin-1A protein. Genotype-phenotype analysis revealed an association of missense variants in the 3-helix bundle domain to an attenuated phenotype, while missense variants near the Walker A/B motif as well as biallelic truncating variants were linked to early death. In summary, this systematic cross-sectional analysis of a large cohort of individuals with biallelic TOR1A variants across a wide age-range delineates the clinical and genetic spectrum of TOR1A-related autosomal-recessive disease and highlights potential predictors for disease severity and survival

Traitement chirurgical des fractures diaphisaires de l’humerus chez l’adulte

Les auteurs rapportent les résultats du traitement chirurgical d’une série de 23 fractures de la diaphyse humérale. 18 femmes et 5 hommes. 14 cas étaient des fractures anciennes et 3 fractures récentes non encore traitées. L’ostéosynthèse par plaque a été la plus utilisée (18 cas) 86,3% de très bons résultats ont été obtenus après un temps de recul post opératoire de 18 mois. La chirurgie ne devrait plus être considérée comme un recours après l’échec du traitement orthopédique mais de plus en plus comme un traitement de première intension. We reported the results of the surgical treatment of a series of 23 cases of diaphyseal fractures of humerus. There were 18 women and 5 men. Fourteen cases were old fractures. Osteosynthesis by plate was used in 18 cases. The results were very good in 86.3%, and poor in 4.7%. We proposed that surgery should not be any more regarded a recourse after the failure of the orthopaedic treatment but more and more as a treatment of first intension

Fractures Des Plateaux Tibiaux : Aspects Epidemiologiques Et Therapeutiques

Objectif : Déterminer les aspects épidémiologiques et thérapeutiques des fractures des plateaux tibiaux prises en charges dans le département de chirurgie orthopédique et traumatologique du CHU-TOKOIN de Lomé.Matériels et Méthodes : Il s’agissait d’une étude rétrospective qui s’est étendue sur une période de 5ans et a concerné 75 cas de fractures des plateaux tibiaux.Résultats : Les fractures des plateaux tibiaux ont représenté 2,5% des traumatismes et 8,5% des fractures du membre inférieur. L’age moyen était de 42,7ans avec une sex-ratio de 2,9 en faveur des hommes. Les accidents de la voie publique ont été les principales circonstances de survenue (84,0%). Le membre inférieur gauche a été concerné dans 39 cas, le droit dans 35 cas. Le plateau tibial latéral a été atteint dans 43 cas, le médial dans 12 cas et les deux plateaux dans 20 cas. La majorité des lésions élémentaires étaient des fractures enfoncement-séparation. Selon la classification de Duparc et Ficat, nous avons noté 29 cas de fractures uni-tubérositaires, 22 cas de fractures spino-tubérositaires et 24 cas de fractures bitubérositaires. Plusieurs modalités thérapeutiques ont été utilisées. Le traitement chirurgical a été réalisé dans 28 cas. Le recul moyen a été de 13 mois. La consolidation a été acquise dans 71 cas dans un délai moyen de 5,3 mois. Nous avons noté une dégradation de la qualité de la réduction (26 cas de très bonne et bonne qualité de la réduction). Le déficit de l’extension a été en moyenne de 8° avec un maximum de 24° chez deux patients. Le score moyen de Rasmussen a été de 19.Conclusion : Les fractures des plateaux tibiaux constituent un traumatisme peu fréquent (2,5%) avec une prédominance masculine. Le traitement non chirurgical a été d’indication fréquente. Mais ces résultats ont été décevants. Nous proposons donc un changement d’attitude dans la prise de ces fractures.Mots clés : Fracture, plateau tibial, épidémiologie, arthrose, chirurgie.ABSTRACTObjective: To determine the epidemiologic and therapeutic aspects of tibial plateau fractures treated in the department of orthopaedic surgery of Tokoin teaching hospital of Lome. Materials and Methods: It was a retrospective study which extended over a period of 5 years. Results: There were 75 cases of tibial plateau fracture. They represented 2.5% of the traumatisms and 8.5% of the fractures of the lower extremity. The Middle Age was of 42.7ans with a sex-ratio of 2.9 in favour of the men. The road traffic was the principal circumstances of occurred (84.0%). The left lower extremity was concerned in 39 cases, the right in 35 cases. The lateral plateau was reached in 43 cases, the medial in 12 cases and the two tibial plateaus in 20 cases. The majority of the elementary lesions were fractures depression-separation. According to the classification of Duparc and Ficat, we have noted 29 uni-tubérositaires fractures, 22 cases of fractures spino-tubérositaires and 24 cases of fractures Bi-tubérositaires. Several therapeutic methods were used. The surgical treatment was carried out in 28 cases. The follow-up was 13 month. The consolidation was acquired in 71 cases within 5.3 average month. We noted a deterioration of the quality of the reduction (26 cases of very good and good quality of the reduction). The deficit of the extension was on average 8° with a maximum of 24° among two patients. The average score of Rasmussen was of 19. Conclusion: Tibial plateau fractures are a frequent lesion (2.5%) with a male prevalence. The non surgical treatment was of frequent indication. But these results were disappointing. Therefore, we propose a change of attitude in the treatment of theses fractures.Key words: Tibial plateau, fracture, epidemiology, osteoarthritis, surgery

Les Infections Osseuses Chroniques de l’adute : Aspects Epidemiologiques et Therapeutiques au Chu Tokoin de Lome

Introduction : Les infections osseuses en g&eacute;n&eacute;rale, mais surtout les formes chroniques posent surtout un probl&egrave;me th&eacute;rapeutique. Nous rapportons les aspects &eacute;pid&eacute;miologiques et les r&eacute;sultats du traitement chirurgical de 119 infections osseuses de l&rsquo;adulte re&ccedil;ues et trait&eacute;es dans les services chirurgicaux du CHU Tokoin de Lom&eacute;.Mat&eacute;riels et M&eacute;thodes : Il s&rsquo;agit d&rsquo;une &eacute;tude r&eacute;trospective qui a port&eacute; sur la p&eacute;riode comprise entre janvier 1994 et janvier 2004.R&eacute;sultats : La s&eacute;rie comportait 80 cas d&rsquo;ost&eacute;omy&eacute;lites chroniques et 39 cas d&rsquo;ost&eacute;ites chroniques. Tous les cas d&rsquo;ost&eacute;ites chroniques &eacute;taient des complications des fractures ouvertes. Il y avait 89 hommes et 30 femmes. 68% de la s&eacute;rie concernaient des patients &acirc;g&eacute;s de moins de 20 ans, 28% des patients &acirc;g&eacute;s de 20 &agrave; 31 ans et 4 % des patients &acirc;g&eacute;s de plus de 31 ans lors de leur premi&egrave;re hospitalisation dans les services chirurgicaux. Les localisations sur le squelette ont &eacute;t&eacute; les suivantes : f&eacute;mur 42 cas ; hum&eacute;rus 19 cas ; radius 30 cas ; tibia 18 cas ; cubitus huit cas et calcan&eacute;um deux cas. Un staphylocoque pathog&egrave;ne fut mis en &eacute;vidence dans 81 % des pr&eacute;l&egrave;vements et un autre germe dans 9%. Dans 84% des cas, le traitement chirurgical fut un traitement osseux &eacute;radicateur conservateur. Dans 16% des cas, aucun geste osseux ne fut pratiqu&eacute;. La r&eacute;section osseuse n&rsquo;a &eacute;t&eacute; r&eacute;alis&eacute;e dans aucun cas. Tous les patients op&eacute;r&eacute;s ont re&ccedil;u une antibioth&eacute;rapie postop&eacute;ratoire. Le r&eacute;sultat du traitement chirurgical, apr&egrave;s la 1ere intervention, est donc le suivant : taux d'ass&egrave;chement (65.6 %), taux d'&eacute;checs et de r&eacute;cidives : (34.4%).Conclusion : Il serait n&eacute;cessaire d&rsquo;am&eacute;liorer la qualit&eacute; et la dur&eacute;e de l'antibioth&eacute;rapie post-op&eacute;ratoire. Nous pensons qu&rsquo;elle serait la seule fa&ccedil;on d'am&eacute;liorer le pourcentage d'ass&egrave;chement &agrave; long terme.Mots cl&eacute;s : Infections osseuses ; Ost&eacute;ites ; Ost&eacute;omy&eacute;lite ; Epid&eacute;miologie ; TraitementIntroduction: Chronic bone infection poses specially a therapeutic problem. We report the epidemiologic aspects and the results of the surgical treatment of 119 chronic bone infection of the adult received and treated in the surgical department of the Tokoin Medical University Hospital of Lom&eacute;.Materials and Methods: It was a retrospective study which related to the period ranging between January 1994 and January 2004.Results: There were 80 chronic osteomyelitis and 39 osteitis. There were 89 men and 30 female. 68% of the series concerned old patients of less than 20 years, 28% of the old patients from 20 to 31 years and 4 % of the old patients of more than 31 years at the time of the first hospitalization in the surgical services. The localizations on the skeleton were as follows: femur 42 cases; humerus 19 case; radius 30 cases; tibia 18 cases; ulna eight case and calcaneum two cases. Cultures of Staphylococcus were positive in 81% and another germ in 9%. In 84% of the cases, the Surgical procedure was classical : bone window opening, sequestrectomy and saucerisation. In 16% of the cases, no osseous gesture was practised. There were no cases of osseous resection. All the patients operated received a post-operative antibiotherapy. The result of the surgical treatment of these patients, after the first intervention, is the following: rate of draining (65.6 %), rate of failures and repetitions: (34.4%). Conclusion: There is a need for improving quality and the duration of the post-operative antibiotherapy which appears to us, the only way of improving the percentage of long-term draining.Key words: Chronic Bone infection, Osteitis, osteomyelitis; Epidemiology; Treatment