Introduction: Neglected ankle fractures are common in our regions. Patients first consult traditional healers and it is when the signs persist that they consult the surgeon for a swollen and painful ankle. Initially w...Introduction: Neglected ankle fractures are common in our regions. Patients first consult traditional healers and it is when the signs persist that they consult the surgeon for a swollen and painful ankle. Initially we always performed anatomical repairs with osteosynthesis, but the majority of patients still complained of pain and disability. We wondered whether a primary arthrodesis would not be indicated in old ankle fractures to avoid disabling pain for patients. We therefore performed a series of arthrodesis on neglected post-traumatic ankles. The objective of our study was to describe the results of arthrodesis on an old post-traumatic ankle and to propose a therapeutic indication in the face of any neglected ankle fracture. Material and Method: This was a prospective study over 8 years between December 2012 and November 2020, involving 36 cases of neglected ankle fractures treated by arthrodesis using Meary’s technique. We used AOFAS (American Orthopedic Foot and Ankle Score) preoperatively and postoperatively for an objective assessment. Results: The average follow-up was 4.2 years and our results were satisfactory (94.4%) with an average AOFAS score ranging from 27.8 preoperatively to 76.7 postoperatively. The fusion rate was 97.2%. Discussion: Arthrodesis appears here as an important alternative in the treatment of neglected ankle fractures with significant trophic disorders.展开更多
Introduction: Neglected elbow dislocations are much more common in developing and underdeveloped countries. The main reason for the delay in diagnosis is that patients initially seek treatment from traditional healers...Introduction: Neglected elbow dislocations are much more common in developing and underdeveloped countries. The main reason for the delay in diagnosis is that patients initially seek treatment from traditional healers. These will immobilize the elbow in extension, which will lead to the retraction of the triceps muscle and collateral ligaments. Patients and Method: We carried out a prospective study over five years (2014-2019). The study involved patients with unreduced elbow dislocation older than 21 days. All patients with a dislocated fracture and those whose x-ray showed joint fusion were not included in the study. We collected 26 patients, 20 men and 6 women with an average age of 27.5 years (17 and 45 years). The average consultation time was 8.9 months (3 - 13). The approach was posterior about 8 cm above the olecranon and 2 cm below the olecranon, the ulnar nerve was identified and isolated. The triceps tendon was cut in a Z from its myotendin junction to the beak of the olecranon, and then lengthened. Results: The patients were reviewed after a mean follow-up of 24 months (12 - 36). The Mayo Clinic’s average elbow performance index was 77.1 (60 - 85), with 19 good and 6 average results. The mean flexion was 114°(100°- 135°) and the mean extension deficit was 31.15°(10°- 55°). The average range of motion was 82.5°(60°- 120°). We did not find a correlation between the duration of the lesion and functional recovery (p > 0.05). The Wilcoxon test showed that surgery significantly improved the overall range of motion of the elbow (p = 0.001). Discussion: Based on this study, open reduction with tendon lengthening should remain a treatment option regardless of the age and chronicity of the dislocation.展开更多
Introduction: Musculoskeletal injuries are common in children but rarely severe. Their treatment varies according to the type of injury observed. The aim was to describe the epidemiological and therapeutic aspects of ...Introduction: Musculoskeletal injuries are common in children but rarely severe. Their treatment varies according to the type of injury observed. The aim was to describe the epidemiological and therapeutic aspects of severe musculoskeletal injuries in children during play. Patients and Methods: This was a retrospective descriptive study conducted in the Orthopaedic-Traumatology Department and the Paediatric Surgery Unit of the University Hospital of Bouaké between January 2018 and December 2020. It concerned patients less than 16 years of age hospitalised for more than 24 hours for a musculoskeletal trauma following a gambling accident. The variables studied were epidemiological and therapeutic. Results: A total of 53 patients were collected. The frequency was 2.9%. The mean age was 9 ± 3.99 years. There were 38 (71.7%) boys and 15 (28.3%) girls. The sex ratio was 2.5. The patients were attending school in 79.3% (n = 42). The circumstances of occurrence were dominated by falls during play accidents (n = 35;66%). Football was observed in 93.5% (n = 49). The thoracic limb (n = 35;66%) was the preferred site of these injuries. The injuries were closed (86.7%) with a predominance of forearm fractures (n = 22;41.6%). The average hospital stay was 2.8 ± 1.4 days. Most of the patients were treated orthopedically (n = 37;69.9%). The evolution was favourable without complications. Conclusion: Musculoskeletal injuries during play were infrequent (2.9%). The circumstances were dominated by falls during play. The injuries were mainly closed fractures, most of which were treated orthopedically.展开更多
Knee dislocation is a serious and rare injury. Its rarity and the variety of injuries that result from it mean that there is no adequate management that is universally accepted. The aim of this study was to evaluate o...Knee dislocation is a serious and rare injury. Its rarity and the variety of injuries that result from it mean that there is no adequate management that is universally accepted. The aim of this study was to evaluate our emergency care strategy for these injuries. Materials and methodology: This was a retrospective study conducted from January 1992 to December 2004 on nine cases of knee dislocation. It consisted of six men and three women. The average age of these subjects was 35, ranging from 15 to 50 years. The causes for these injuries included: public road accidents (n = 4), household accidents (n = 3), a sporting accident and a dislocation that occurred following a fight. The dislocations were anteromedial (n = 4), posterolateral (n = 2), posterior (n = 2) and anterior (n = 1). Associated injuries were sore joint (n = 2), contusion of the common peroneal nerve (n = 1) and vascular injury (n = 1). An angiography was performed on one patient for a vascular injury and an Elecmyography (EMG) for a common peroneal nerve injury. Closed reduction was used for eight patients and open reduction for one patient. Results: Five knees were stable with normal range of motion and some residual pain. Four patients had knee instability;two anterior, one anteroposterior and one lateral. In three of these patients, the CT arthrography/arthro-scan confirmed central pivot damage, with meniscal damage in two of them. The four patients were referred to a knee surgeon in a private practice. The post-operational effects were minimal in vascular injury. The EMG performed for the common peroneal nerve detected a nerve contusion. Conclusion: Our emergency care strategy remains closed reduction. This therapeutic management is consistent, at least in the first 15 days, with the literature.展开更多
文摘Introduction: Neglected ankle fractures are common in our regions. Patients first consult traditional healers and it is when the signs persist that they consult the surgeon for a swollen and painful ankle. Initially we always performed anatomical repairs with osteosynthesis, but the majority of patients still complained of pain and disability. We wondered whether a primary arthrodesis would not be indicated in old ankle fractures to avoid disabling pain for patients. We therefore performed a series of arthrodesis on neglected post-traumatic ankles. The objective of our study was to describe the results of arthrodesis on an old post-traumatic ankle and to propose a therapeutic indication in the face of any neglected ankle fracture. Material and Method: This was a prospective study over 8 years between December 2012 and November 2020, involving 36 cases of neglected ankle fractures treated by arthrodesis using Meary’s technique. We used AOFAS (American Orthopedic Foot and Ankle Score) preoperatively and postoperatively for an objective assessment. Results: The average follow-up was 4.2 years and our results were satisfactory (94.4%) with an average AOFAS score ranging from 27.8 preoperatively to 76.7 postoperatively. The fusion rate was 97.2%. Discussion: Arthrodesis appears here as an important alternative in the treatment of neglected ankle fractures with significant trophic disorders.
文摘Introduction: Neglected elbow dislocations are much more common in developing and underdeveloped countries. The main reason for the delay in diagnosis is that patients initially seek treatment from traditional healers. These will immobilize the elbow in extension, which will lead to the retraction of the triceps muscle and collateral ligaments. Patients and Method: We carried out a prospective study over five years (2014-2019). The study involved patients with unreduced elbow dislocation older than 21 days. All patients with a dislocated fracture and those whose x-ray showed joint fusion were not included in the study. We collected 26 patients, 20 men and 6 women with an average age of 27.5 years (17 and 45 years). The average consultation time was 8.9 months (3 - 13). The approach was posterior about 8 cm above the olecranon and 2 cm below the olecranon, the ulnar nerve was identified and isolated. The triceps tendon was cut in a Z from its myotendin junction to the beak of the olecranon, and then lengthened. Results: The patients were reviewed after a mean follow-up of 24 months (12 - 36). The Mayo Clinic’s average elbow performance index was 77.1 (60 - 85), with 19 good and 6 average results. The mean flexion was 114°(100°- 135°) and the mean extension deficit was 31.15°(10°- 55°). The average range of motion was 82.5°(60°- 120°). We did not find a correlation between the duration of the lesion and functional recovery (p > 0.05). The Wilcoxon test showed that surgery significantly improved the overall range of motion of the elbow (p = 0.001). Discussion: Based on this study, open reduction with tendon lengthening should remain a treatment option regardless of the age and chronicity of the dislocation.
文摘Introduction: Musculoskeletal injuries are common in children but rarely severe. Their treatment varies according to the type of injury observed. The aim was to describe the epidemiological and therapeutic aspects of severe musculoskeletal injuries in children during play. Patients and Methods: This was a retrospective descriptive study conducted in the Orthopaedic-Traumatology Department and the Paediatric Surgery Unit of the University Hospital of Bouaké between January 2018 and December 2020. It concerned patients less than 16 years of age hospitalised for more than 24 hours for a musculoskeletal trauma following a gambling accident. The variables studied were epidemiological and therapeutic. Results: A total of 53 patients were collected. The frequency was 2.9%. The mean age was 9 ± 3.99 years. There were 38 (71.7%) boys and 15 (28.3%) girls. The sex ratio was 2.5. The patients were attending school in 79.3% (n = 42). The circumstances of occurrence were dominated by falls during play accidents (n = 35;66%). Football was observed in 93.5% (n = 49). The thoracic limb (n = 35;66%) was the preferred site of these injuries. The injuries were closed (86.7%) with a predominance of forearm fractures (n = 22;41.6%). The average hospital stay was 2.8 ± 1.4 days. Most of the patients were treated orthopedically (n = 37;69.9%). The evolution was favourable without complications. Conclusion: Musculoskeletal injuries during play were infrequent (2.9%). The circumstances were dominated by falls during play. The injuries were mainly closed fractures, most of which were treated orthopedically.
文摘Knee dislocation is a serious and rare injury. Its rarity and the variety of injuries that result from it mean that there is no adequate management that is universally accepted. The aim of this study was to evaluate our emergency care strategy for these injuries. Materials and methodology: This was a retrospective study conducted from January 1992 to December 2004 on nine cases of knee dislocation. It consisted of six men and three women. The average age of these subjects was 35, ranging from 15 to 50 years. The causes for these injuries included: public road accidents (n = 4), household accidents (n = 3), a sporting accident and a dislocation that occurred following a fight. The dislocations were anteromedial (n = 4), posterolateral (n = 2), posterior (n = 2) and anterior (n = 1). Associated injuries were sore joint (n = 2), contusion of the common peroneal nerve (n = 1) and vascular injury (n = 1). An angiography was performed on one patient for a vascular injury and an Elecmyography (EMG) for a common peroneal nerve injury. Closed reduction was used for eight patients and open reduction for one patient. Results: Five knees were stable with normal range of motion and some residual pain. Four patients had knee instability;two anterior, one anteroposterior and one lateral. In three of these patients, the CT arthrography/arthro-scan confirmed central pivot damage, with meniscal damage in two of them. The four patients were referred to a knee surgeon in a private practice. The post-operational effects were minimal in vascular injury. The EMG performed for the common peroneal nerve detected a nerve contusion. Conclusion: Our emergency care strategy remains closed reduction. This therapeutic management is consistent, at least in the first 15 days, with the literature.
