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Introduction : Traumatic spinal injuries (TSI) is a global disease burden in low - and middle–income countries (LMIC). The burden of TSI is higher in LMICs than in developed countries. Despite improvements in TSI management, resource-constrained settings have not benefitted from this progress to the same extent as more developed countries. Hypothese : Spinal implants availability and early surgery are associated with improved neurologic function.Material and methods: This is a retrospective and descriptive study from November 2017 to October 2020. We included adult patients who presented with traumatic spine injury and who underwent surgery stabilization.Results: A total of 93 patients were studied. The population was young (35.92 ± 9.68 years old), men (91.4%). Road traffic accidents accounted for 85% of patients. At presentation, 59.1% of patients had an incomplete neurologic deficit (ASIA B-D). The cervical spine was the most common segment injured (57%). The median time from admission to the operating room was 21.06 ± 11.8 days. After surgery, 15.3% improved by at least 1 ASIA grade. Bedsores (14%) and superficial wound infection (10.8%) were the most typical complications in our series after surgery. Discussion : According to the AANS/CNS guideline, available literature has defined « early » surgery inconsistently, ranging from < 8 hours to < 72 hours. In our series, the median time from admission to the operating room was 21.06 ± 11.8 days (range 2-62). That finding could be explained by the fact that most low-income people have to pay out of their pocket because the rate of medical insurance coverage is low. In the study, only 17.2% of patients have public insurance, and 2.2% private insurance. We performed three types of surgery: anterior cervical discectomy and fusion, anterior cervical corporectomy with tricortical iliac crest graft and plate, and posterolateral thoracic/lumbar fusion. Implant availability for posterior cervical fusion was the principal driver of that decision in our limited resources.Type of study and level of proff: level 3, retrospective cohort study.

Background We analysed the clinical and therapeutic profile of the patients who underwent a surgical lower extremity amputation (LEA) in Togo. Methods Retrospective study based on clinical files of the adult patients who underwent a LEA at a single centre (Sylvanus Olympio Teaching Hospital, SOTH) from 1st January 2010 to 31st December 2020. We analysed files with 95% of the studied parameters and excluded those with less than 5%. Data were analysed by CDC Epi Info Version 7 and Microsoft Office Excel 2013 software. Results We included 245 cases. The mean age was 59.62 years (15.22SD) (range 15 to 90 years), the sex ratio, 1.99. The medical history of diabetes mellitus was found in 143/222 (64.41%). Gangrene was diagnosed in 212/245 (86.53%) patients; crush syndrome in 23/245 (9.39%); bone tumour in 5/245 (2.04%); osteomyelitis in 2/245 (0.82%); chronic ulcer in 2/245 (0.82%); necrosis fasciitis in 1/245 (0.40%). A Doppler-ultrasound of the lower limbs was performed in 91/245 (37.14%) cases. The anatomical site of LEA found in 241/245 (98.37%) files was leg in 133/241 (55.19%), knee in 14/241 (5.81%), thigh in 83/241 (34.44%), and foot in 11/241 (4.56%) patients. The mean delay from the indication of amputation to surgery retrieved in 239/245 (97.55%) files was 6.75 (1–78) days (11.59 SD). The immediate postoperative complications have been reported in 242/245 (98.78%) files, and no complication in 234/242 (96.69%). There were early complications in 56/238 (23.53%) patients. The mortality rate after LEA was 17/238 (7.14%). The mean duration of hospitalization marked in 241/245 (98.37%) files was 36.30 (1-278) days (36.20SD). Conclusion Most patients admitted to SOTH (Lomé, Togo) who underwent LEA had diabetes mellitus at the late presentation, which led to challenging complications. This result entails essential information campaigns to prevent diabetes mellitus and cardiovascular diseases.

Introduction l´instabilité patellaire est une affection rare, multifactorielle et dont la prise en charge est complexe. Le but de notre étude était de décrire les cas d´instabilités patellaires, puis d´évaluer les résultats du traitement dans un pays à faible revenu. Méthodes l´étude s´est déroulée de mars 2013 à février 2018. Elle a porté sur huit patients qui avaient un âge supérieur à 15 ans et qui avaient été traités chirurgicalement pour instabilité patellaire objective. La fonction du genou avant et après le traitement chirurgical a été appréciée par le score IKDC. Résultats l´âge moyen lors de la chirurgie était de 28,5 ans et le sexe féminin prédominait avec six cas. La dysplasie de la trochlée a été le principal facteur étiologique retrouvé chez sept patients. Dans quatre cas cette dysplasie était associée à la hauteur de la patella avec l´index de Caton moyen de 1,4. Dans cinq cas, il a été réalisé la section du retinaculum patellaire latéral associée à la transposition de la TTA et à la plastie d´Insall. L´évaluation fonctionnelle du traitement a été satisfaisante, avec un score IKDC moyen de 91,3%. Conclusion les instabilités patellaires sont rares. Leur prise en charge est retardée dans nos pays en voie de développement, mais les résultats sont bons si les protocoles sont adaptés.

Unicondylar fractures of the femur on osteosynthesis equipment are a particular entity in terms of the lesion mechanisms and therapeutic difficulties. We report this case because of its exceptional nature and discuss the mechanism of occurrence. It was a lateral sagittal unicondylar fracture of the femur on a nail of Kuntscher that had been laid for medio-diaphyseal fracture. The causal mechanism was direct. A double screwing on each side of the nail after an open reduction followed by an early rehabilitation was carried out. Consolidation was obtained at 3 months and the nail removed at 18 months with a good functional knee result. Anatomical reduction and fixation allowing early rehabilitation represent a guarantee for a good long-term result.

Amouzou KS, Malonga-Loukoula ELJ, Kouevi-Koko TE, Bakriga B, Abalo A. Foot hexadactyly, social implications and management in the African setting: Case report. Turk J Pediatr 2018; 60: 453-455. Hexadactyly of the foot, an abnormal congenital condition presenting as eight toes, is a rare malformation. We report the case of a ten-year-old girl, admitted to our orthopedic and reconstructive surgery department for a preaxial hexadactyly. The girl was abandoned by her parents at birth and stopped school early due to stigmatization. The goals of the surgical procedure were: social reintegration, gait improvement, ability to wear shoes comfortably, and improved appearance of the foot. The surgery was a medial resection of the supernumerary toes.

Objectives: to determine the epidemiological aspects, the different techniques of surgical fixation of the patella fractures and the results. Patients and methods: this was a retrospective study from January 1, 2013 to December 31, 2017 and included the records of patients aged 15 years and older surgically treated for a patella fracture in our center. Results: The work involved 36 patients including 28 men (77.8%) and 8 women (22.2%) with a mean age of 35.9 years. High way trauma were the first cause of these fractures. Fractures were open in 44.4% of cases. Type II according to Ricard and Moulay classification was the most represented with 58.3% of cases. The majority of the patients, 80.5%, were treated by rigging. Five (5) cases of hematoma, one (1) postoperative infection, and three (3) cases of knee stiffness complicated the short- and medium-term follow-up. With an average follow-up of 2 years 6 months, radiologically, normal consolidation was achieved in 86.1% of cases. Two (2) cases of delayed consolidation and three (3) cases of nonunion have been noted. Three (3) cases of patellofemoral osteoarthritis appeared at two years. From the functional point of view, according to the Bosman score, 27.8% were excellent, 63.9% were good, 8.3% were bad, and the cable rigging seemed to give excellent and good results. Conclusion: the treatment of transverse fractures of the patella must be exclusively surgical. Guying is an osteosynthesis technique of choice. Nevertheless complications including knee stiffness, non-union and patellofemoral osteoarthritis are not uncommon

Introduction: The purpose of this prospective study was to describe the clinic pathological varieties of fracture-dislocations of Lisfranc joint and outcome of treatment. Patients and Methods: This study was conducted on 21 cases of fracture-dislocations of the Lisfranc joint treated in our orthopedics trauma unit from 2010 to 2013. We selected middle foot pure dislocations or associated with Lisfranc joint bone fractures. Classification of Myerson was used to characterize the lesions. The results assessment criteria were clinical and radiological for foot and Massari score. Results: Fourteen (14) patients were male. The average age was 34.7 years. Five (5) clinic pathological forms were met by relying on the classification of Myerson; 4 cases of type A; 5 cases of type B1; B2, 6 cases; 4 cases of type C1 and 2 cases of type C2. There were eight cases of pure dislocation and 13 dislocations were associated with fractures (metatarsal in 11 patients, cuneiform in 5 patients, cuboid bone in 2 patients and enucleation fracture of the medial cuneiform in 2 patients). It was noted 10 cases of skin openings. Treatment consisted on open reduction in all patients and stabilization by pin complemented by a foot plaster for 6 weeks. Four (4) immediately arthrodeses were made. All patients were followed up 7 month to 4 years (mean, 30 month). According to the criteria of Massiri, treatment outcomes were excellent in 19% of cases, good in 28%, fair in 30% and poor in 23%. Conclusion: In our context, these lesions are often open and associated with fractures of Lisfranc joint skeleton and treated after a period more or less long and sometimes, we face lesions totally old. Immediately arthrodesis can be a lasting solution and should not be overlooked.

Elbow dislocation associated with ipsilateral Galeazzi fracture is a rare pattern of injury. Only seven cases were reported in the literature. We reported another case in a 42 years old man. Closed reduction of the dislocated elbow joint was immediately performed under sedation. Because the patient did not want surgery for radius, it was decided to manage the fracture conservatively. The lack of clinical improvement motivated operative treatment for Galeazzi fracture 56 days after injury. We have discussed the treatment option and the result obtained. The prognosis of this associated injury is related to the DRUJ dislocation, which should not be misdiagnosed.

Purpose: Primary malignant musculosqueletal tumors in adult are rare affections group and its treatment is still a real challenge today. The aim of this work was to describe the epidemiologic and treatment aspects of these tumors in the national reference center of our country. Materiel and Methods: It was a retrospective review of primary malignant musculosqueletal tumors treated in orthopedics and trauma unit of Sylvanus Olympio teaching hospital of Lome, Togo from January 2000 to December 2014. Results: During the study period, 28 cases were selected and reviewed. There were 17 men (60.71%) and 11 women (39.29%). The average age was 32.7 years. There were 20 cases (71%) of primary malignant bone tumors (PMBT) and 8 cases (29%) of primary malignant soft tissues tumors (PMSTT). There were 6 (30%) of osteosarcoma. The tumor was located in the bones of the forearm and wrist/hand in 2 (10%) patients for each anatomical site; for the lower limb, around knee in 7 (35%) patients. Eight patients had PMSTT (28, 57%). There were three cases of rhabdomyosarcoma, 2 cases of fibrosarcoma. Tumors were located around knee in 4 cases and around ankle/foot in 3 cases. In the two groups of tumor, tumor resection was performed in 5 patients (17.86%) and limb amputation indicated in 23 patients (82.14%), was performed in 15 (53.57%) and 8 patients (37.78%), rejected it and left hospital against medical advice. Conclusion: Malignant musculoskeletal tumors are relatively rare in Togo. Their treatment is based on radical surgery which is often not supervised by adjuvant therapies. Ignorance, poverty of the population and embryonic state of diagnostic and treatment infrastructures are the obstacles to their care. Education and awareness must be integrated to care and fight against this group of diseases.

Background: The aim of this paper was to report the functional and clinical results of subcutaneous Achilles tendon rupture repairs through two surgical plasty techniques, with a mean follow-up of 2 years. Patients and methods: This study carries out a retrospective analysis of 27 patients presenting a subcutaneous rupture of Achilles tendon who enderwent surgical treatment between January 2012 and December 2016. Surgical treatment was carried out using the Chigot-Lynn technique for 19 patients and the Bosworth-Lynn technique for the remaining 8 patients. Functional and clinical results were evaluated according to McComis criteria and patient satisfaction. Results: Clinical measurement of the of ankle motion range revealed average flexion of 15 ° and an average extension of 40 °. Amyotrophy of the triceps surae muscle was found in all patients, with an average 2 cm. Residual pain was found in four patients. Average sick leave was 4 months. 8 patients had resumed sport at their previous level of training, 3 patients had returned to lower levels of sport, and one patient had abandoned their sporting activity. The results were considered highly satisfactory or satisfactory by 24 patients, good by two patients and poor by one patient.Conclusion: Chronic ruptures of the Achilles tendon remain a therapeutic challenge for the orthopaedic surgeon. Surgery with a reinforcement plasty must be proposed to patients who are active or have sports activities. Surgical repair reduce iterative ruptures and ensure the best functional recovery.

The aim of this study was to analyse war-related and non-war-related extremity injuries in soldiers in the Mali conflict. This prospective study was performed from 1 May 1 to 31 December 2014. It concerned extremity injuries in soldiers treated at Togo Level 2 Hospital. Seventy-nine patients with an average age of 31.19 years were assessed. Among them, 50 were admitted after war injury and 29 from nonwar injury. Most war-related injuries were due to improvised explosive devices (IEDs) (36 %); road traffic accidents (51.72 %) were the main mechanism of non-war injury. A total of 125 injuries were analysed. Limb fractures were identified in 37 patients (29.6 %), and 22 cases (59.46 %) were open fractures. Twenty-six (20.8 %) patients had soft tissue wounds. The other injuries were sprains (18.4 %), muscle contusions (15.2 %), dislocations (8.8 %), traumatic amputations (4 %) and burns (3.2 %). Surgical debridement and external fixator application were the most frequently performed surgical procedures. Thirty-nine per cent of patients were evacuated to a level 3 hospital for better care. The severity of injuries and their rapid treatment require orthopaedic surgeons to have high levels of surgical experience and knowledge pertaining to military or disaster surgical doctrine.

The pneumococcal septic arthritis is uncommon in healthy adults. In most cases, it occurs in patients with immune deficiency. Its exceptional location at the wrist can maintain doubt with rheumatic causes which are more frequent. IgG4 deficiency found in this patient was the only cause that could be impugned. We report the case of a young woman of 46 years without any evident cause of immunodeficiency and any particular risk factor, managed for septic arthritis of the wrist due to Streptococcus pneumoniae. This case without any apparent risk factors demonstrates that pneumococcal infection in a more distant articulation of the ENT is still possible. Scan has been a very significant contribution in confirming the positive diagnosis that leads to surgical drainage. The approach of the systematic search for the gateway must be done. In the study of the patient’s immune status, the realization of the protein profile could be interesting and then guide the practitioner in the decision to vaccinate the patient against Streptococcus pneumoniae if he was not. We recommend looking always for a cause of immunodeficiency including primary Ig defiencies even among adult.

Background: To identify predictors of humerus shaft fractures nonunion in adults whatever the type of treatment performed. Patients and Methods: We conducted a retrospective study among patients who had a fracture of the humeral shaft moving towards healing or nonunion. Patients were treated in the orthopedic trauma unit of Sylvanus Olympio Teaching Hospital and two other private clinics in Lome between January 2008 and June 2012. On the X-ray of each patient, we measured the angulation, the diastasis, and inter fragmentary contact. For each included patient, we looked for: age, sex, medical history, body mass index (BMI), according to the third location of the shaft fracture, the type of fracture according to AO classification and the type of opening according Tscherne classification. Results: During the study period, 184 patients with humeral shaft fracture were identified. Of these 108 were men. The mean age of patients was 37.3 years. The fractures were treated conservatively in 100 patients (54.3%), 78 treated surgically and six (3.3%) have discharged from hospital against medical advice for traditional treatment. The factors that were associated with nonunion of humerus shaft fractures in these patients were: the opening of the fracture (RR = 4.5; 95% CI = [2.9; 7.1]), the presence of immediately radial paralysis (RR = 5.6; 95% CI = [3.7; 8.5]), the existence of other associated lesions or fracture (RR = 1.8; 95% CI = [1.1; 3.1]), energy of the trauma (RR = 2.3; 95% CI = [1.3; 4.4]) and type III classification of Tscherne (RR = 0.3; 95% CI = [0.2; 0.6]). After multivariate analysis, factors that remained significantly associated with the failure of consolidation were: the existence of diastasis > 2 mm (OR = 7.6; 95% CI = [2.2; 25.6)), the Body Mass Index (BMI) > 25 (OR = 1.3; 95% CI = [1.1 - 1.6]) and the existence of other bone lesion (OR = 4.3; 95% CI = [1.4 - 18.9]). Conclusion: BMI greater than 25, the existence of an interfragmentary gap of more than 2 mm and existence of other bone lesions are significant risk factors for nonunion in humerus shaft fractures. The traditional treatment, common singular factor to the African environment, should not be ignored. Control of these predictors is necessary in carrying out the treatment of humerus shaft fractures.

Fifty years after Chen has performed the first forearm replantation, we report our first case of hand replantation in a sub-Saharan African country. The etiology of the amputation was machete due to interpersonal violence. The amputation was trans-carpal, guillotine-type, subtotal non-viable maintained with a small skin bridge. The replantation procedure was successful. At one year follow-up, the functional result according to Chen's criteria was excellent. Through this first experience, we can state that hand replantation can be performed successfully both in survival and function in a non-specialized hospital of a sub-Saharan African country.

The use of Masquelet technique is a serious option to consider for biologic reconstruction of severe bone loss. Here is exposed a continuous and prospective study on bone loss management using that technique. The aims of this study were to assess epidemiology of bone loss due either to trauma or to non-unions and to give preliminary results.It was a prospective study from April 2015 to december 2016 involving patients treated using the induced membrane technique for a diaphyseal bone defect due either to trauma or non-unions. AO plates or Orthofix external fixators were used for osteosynthesis. Bone healing was radiologically assessed and any complications were listed.During the study period, 11 patients were treated using the induced membrane technique. There were 8 males and 3 females. Their mean age was 40.45 years (21-59). The skeletal segments concerned were 2 humerus, 6 femurs and 3 tibias with a mean bone defect length of 4,45 cm (2.5-8). The delay between reconstruction and trauma was 8 months (20 days - 3 years). After a mean follow-up of 6.54 months (3-11) six patients presented a good radiological healing (4 femurs, 2 humerus) whereas in four patients, autograft osteointegration was still ongoing (2 femurs, 2 tibias). A tibia secondary infection was observed in a patient with the graft partial resorption. In another patient, an initial gangrene lead to a leg amputation.The induced membrane technique is an excellent option for bone defect reconstruction compared to other usual bone graft techniques. It helped us to manage large bone loss in various skeletal segments.

In Togo, reconstructive management has been based on local and regional flaps. In some severe cases and in cases of failure, only a cross leg flap (if possible) or an amputation would save the patient. It has become vital to move forward in the reconstructive ladder in our setting. We report our first case of free gracilis muscle flap for the reconstruction of a foot defect in a 21-year-old male patient who was presented with a foot laceration due to a road traffic accident. The plastic surgeon had training in microsurgery. For other members of the operative team, this was the first microsurgery procedure. The gracilis muscle was harvested from the contralateral thigh and inset in the defect by microsurgical vascular anastomosis. The flap’s monitoring was done clinically. The post-operative course was uneventful. The muscle flap was resurfaced on day 5 using a split thickness skin graft. The patient was discharged on day 12. Total healing was seen on day 21. The patient was very satisfied with the procedure. The success of this first case represents an optimal motivation to build up a microsurgery team and the debut of microsurgery procedures for patients with difficult defects in Togo.

Double fracture-dislocations of the thumb are rare. Only a single case report of a simultaneous extra- articular fracture of the base of the first metacarpal and dislocation of the metacarpophalangeal joint has been previously reported. We report the second case report of this injury in a 20-year-old man. The patient had an excellent outcome after treatment.

Resume Evaluer, de facon retrospective, les resultats du traitement par reinsertion transosseuse par voie anterieure des ruptures du tendon distal du M. biceps brachii (BB) dans notre service. Entre l’annee 2000 et 2007, dix patients ont ete traites pour une rupture du tendon distal du BB. Il s’agissait d’hommes âges de 39 ans en moyenne. Les mecanismes des ruptures ont ete globalement une flexion active du coude contrariee soit par une force opposee soit par un objet lourd. Le diagnostic des ruptures a ete essentiellement clinique. Le traitement a ete une reinsertion transosseuse sur la tuberosite bicipitale ( Tuberositas radii [TR]) par voie anterieure. Le delai operatoire a ete inferieur a une semaine dans trois cas, entre un et trois semaines dans cinq cas, et superieur a trois semaines dans deux cas (29 et 40 jours post-traumatique). Tous les patients ont ete revus avec un recul moyen de 48 mois (17–85 mois). L’evaluation a ete subjective et objective par mesure dynamometrique de la flexion et de la supination du coude (les mesures ont ete corrigees en tenant compte du cote dominant selon les travaux de Baker et Bierwagen). Les resultats subjectifs ont ete bons dans sept cas, moyens dans deux cas et mauvais dans un cas. Neuf patients (90 %) ont retrouve un niveau d’activite d’identique a celui precedant l’accident. Aucun patient ne presentait de douleur au dernier controle. Tous les patients presentaient une mobilite complete du coude. Les mesures dynamometriques ont montre que la diminution de la force de flexion etait en moyenne de 14 % en force maximale et de 27 % en moyenne en endurance. La force en supination a diminue de 22 % en moyenne en force maximale et de 32 % en endurance. Nous n’avons pas releve de paralysie du nerf radial ( N. radialis [NR]). Aucune ossification ectopique n’a ete retrouvee, ni de cas de synostose radio-ulnaire. Nous avons identifie deux facteurs qui pourraient expliquer les moins bons resultats : le delai operatoire (plus long) et le niveau de l’operateur (operateur en etant a sa premiere operation de ce type). Ce travail nous a permis de conclure que la reinsertion transosseuse sur la TR des ruptures du BB donne de bons resultats. Les facteurs sur lesquels nous pourrons agir pour ameliorer ces resultats sont le delai operatoire et le niveau de l’operateur.

Objective. To describe the epidemiological and histological aspects of cancers in Togo.Materials and Methods. We made a retrospective review of the epidemiological and pathological features of cancers observed from 1984 to 2008 at the laboratory of pathology of CHU-TOKOIN in Lomé, Togo.Results. During our study period, we found 5251 cases of cancers with an annual average frequency of 210 cases. The sex ratio, male/female, was 0.9 and the average age of occurring was 45.3 years. This average age was 46.9 years for men and 43.8 years for women. The most frequent cancers for men were prostate cancer (12.9%), nonmelanoma skin cancer (10.4%), and gastric cancer (10.3%). For women it was breast cancer (27.1%), cervix cancer (11.2%) and non-Hodgkin lymphoma (6.3%). Histologically, it was carcinomas in 68.1% of the cases, sarcomas in 11% of the cases and non-Hodgkin lymphomas in 12.6% of the cases. Children cancers were primarily Burkitt lymphoma (27.9% of cases) and retinoblastoma (8.5% of cases).Conclusion. This study shows that cancers are frequent in Togo and emphasizes on the necessity of having a cancer register for the prevention and the control of this disease in Togo.

Background: Fractures of the clavicle are relatively frequent and are benign lesions. Their management may be nonoperative or surgical. The objectives of this study were to determine the functional and anatomical outcome of fractures of the adult clavicle after nonoperative treatment. Materials and methods: Two years retrospective study was done. It rolled patients with clavicle fracture treated with either plaster bolero, scarf or clavicular brace with or without rehabilitation, who gave informed consent and who agreed to provide us initial and control radiological pictures. The objective results were evaluated by the Constant score and radiological control images. The subjective results were mainly represented by the impressions of the patients. Results: We recorded 171 cases of clavicle fracture in adults, or 6.2% of fractures in general, including 53 women. The sample studied consisted of 114 cases, including 12 women. In the majority of cases the constant score was either good, 65.8% or excellent, 20.7%. We have not noticed a poor result. Radiologically, the evolution was marked by 90.4% of vicious callus and 2.6% of pseudarthrosis. More than half of the patients, 62.2% were satisfied with the results of the nonoperative treatment received. Conclusion: The evolution of the fractures of the clavicle after nonoperative treatment was therefore favorable on the functional level but marked by vicious callus and pseudarthrosis.

Purpose. To identify risk factors associated with surgical wound infection in patients infected with human immunodeficiency virus (HIV) undergoing surgery for orthopaedic trauma. Methods. Records of 29 male and 7 female HIV-positive patients aged 18 to 47 years who underwent surgery for orthopaedic trauma were reviewed. Data on HIV-specific variables (HIV clinical classification, CD4+ lymphocyte count) and highly active antiretroviral therapy were retrieved, as were data on wound class, fracture type, surgery type, surgical wound infections, and outcomes. Possible risk factors associated with surgical wound infection were analysed. Results. The median follow-up period was 27 (range, 19–41) months. Of the 36 patients, 14 (39%) developed surgical wound infections (4 were deep and 10 superficial). 89% and 67% of them were in HIV clinical category B and in CD4+ T-lymphocyte category 3, respectively. 12 of these infections resolved after debridement and prolonged antibiotic treatment, and 2 developed chronic osteomyelitis. Four of the patients had non-union. Surgical wound infections were associated with HIV clinical category B (pConclusion. Identification of risk factors may help minimise morbidity in HIV-positive patients.

Resume L’objectif etant de determiner l’incidence et les facteurs de risque des infections du site operatoire en chirurgie orthopedique et traumatologique dans le Centre national de reference du Togo. Cette etude prospective a concerne tous les patients operes sur une periode consecutive de quatre mois dans le service de chirurgie orthopedique et traumatologique du CHU Tokoin de Lome. Ils ont ete suivis pendant un delai minimal d’un an. L’incidence des infections du site operatoire a ete notee. Les facteurs de risques de ces infections ont ete egalement rapportes. Sur 125 intervenions realisees, 29 infections du site operatoires (19 superficielles et dix profondes) ont ete observees. L’incidence globale etait de 23,2 %. Huit infections ont ete diagnostiquees apres la sortie des patients. L’incidence etait de 4,1 % pour la classe propre, 26,9 % pour la classe propre contaminee, 50 % pour la classe contaminee et 66,7 % pour la classe sale. Selon l’index NNIS, elle etait de 100 % pour le score 3. Le germe dominant etait les Staphylococcus aureus . Dans l’analyse univariee, un score ASA superieur a 2, les classes chirurgicales contaminee et sale, un delai operatoire de plus de 21 jours, une duree operatoire de plus de deux heures, la chirurgie traumatologique, ont ete des facteurs de risque de ces infections. Dans l’analyse multivariee, un score ASA superieur a 2, un delai operatoire de plus de 21 jours, et les classes chirurgicales contaminee et sale ont ete des facteurs independants de risques de ces infections. L’incidence des infections du site operatoire en chirurgie osseuse rapportee dans notre etude est elevee par rapport aux taux rapportes dans les pays developpes et dans certains pays en voie de developpement. Les facteurs de risques sur lesquels il faut agir dans le cadre de la lutte contre les infections nosocomiales sont soulignes.

The sickle-cell children are particularly affected by osteomyelitis in specific locations. This study was done in order to point out the locations of osteomyelitis in children with sickle-cell disease. This direct clinical examination for a quick diagnosis. This is a retrospective study done by examining files of 43 children (15 girls and 28 boys), aged from 0 to 15 years, treated for osteomyelitis between January 1998 and December 2006. Their phenotypes included 18 SS, 14 SC and 11 AS. Osteomyelitis was acute in 20 cases and chronic in 23 cases. The different localisations are classified according to the type of osteomyelitis and the kind of bones concerned. The 43 children presented 63 locations: 57 on long bones and 6 on short bones. The osteomyelitis was unifocal in 32 cases, and multifocal in 11 cases. The locations on long bones were humeral (18 cases), tibial (12 cases), femoral (9 cases), fibular (7 cases), radial (7 cases) and ulnar (4 cases). The 6 short bones included 3 metacarpus and 3 phalanxes. The 11 multifocal locations concerned 8 SS, 2 AS and 1 SC. In chronic osteomyelitis, 7 patients had sequestrum and 2 had pathological fracture. During examination of sickle-cell children with fever, particular attention must be shown, respectively to the arm, the leg and the thigh, in order to track down quickly, an acute osteomyelitis. Early diagnosis and quick treatment permit to avoid complications and heavy sequela in these children.

Purpose. To retrospectively study the epidemiology and treatment of acute avulsion fractures of the tibial tubercle in 12 patients. Methods. Records of 12 patients aged 11 to 17 (mean, 14) years with avulsion fractures of the tibial tubercle presenting to our hospital from April 1998 to September 2004 were studied. Patient age, gender, involved side, injury mechanism, clinical and radiographic records, treatment, complications, and outcomes were reviewed. Results. Eight patients injured the right side, 3 the left side, and one both sides. They all engaged in sports or active play during the injury. Two fractures were type IA, one type IB, 2 type IIB, 5 type IIIA, 2 type IIIB, and one type IV. Three patients with type-I fractures and one with a type-IIB fracture were treated with closed reduction and cast immobilisation for 3 to 4 (mean, 3.8) weeks. The remaining 9 fractures were treated with open reduction and internal fixation. The mean follow-up period was 39 (range, 23–59) months. No complications were noted. Ten patients had excellent results and 2 had fair results. Conclusion. Closed reduction and cast immobilisation for minimally displaced fractures, and open reduction and internal fixation for displaced fractures resulted in favourable outcomes.

La luxation de hanche dans sa variete obturatrice est rare. Nous rapportons un cas chez un sujet jeune de 30 ans. Le traitement orthopedique a donne de bon resultat. Le bilan radiographique a 20 mois post traumatique ne note pas de signe de necrose aseptique de la tete femorale. Key words : Luxation, hanche, obturatrice, Afrique

Subacute subdural hematomas are a poorly individualized nosological entity, often equated clinically to chronic subdural hematomas. Yet, their neurological deterioration which is usually rapid seems to distinguish them from chronic subdural hematomas. We wanted to show this dangerousness by establishing the clinically evolving profile of the three types of subdural hematomas. This was a prospective and retrospective study of 63 subdural hematoma (18 acute, 13 subacute, and 32 chronic) patients admitted between 2012 and 2014 in the neurosurgery unit of Lome University Hospital. Hematomas were classified according to the elapsed time after head injury and blood density on CT. The main parameter studied was the evolution of the Glasgow Coma Score (GCS) in the 3 months following the trauma, enabling to establish an evolving profile of each type of hematoma. The average age of patients was 58.1 years for chronic subdural hematomas and 47.6 years for subacute subdural hematomas. Disease duration before admission was 13.1 days for chronic against 36.6 h for subacute hematoma. The clinical profile shows acute worsening within hours during the second week for patients with subacute hematoma, while it is progressive for patients with chronic hematoma. We noted two deaths, all victims of a subacute hematoma (one operated, one patient waiting for surgery). Iso-density hematoma on CT, especially in a young person, must be considered as a predictive factor of rapid neurological aggravation suggesting an urgent care or increased monitoring by paramedics.

Le but de notre étude était de déterminer la fréquence des fractures de membres liées à l'exercice de la fonction militaire au sein des Forces de Défense et de Sécurité en milieu africain en vue de ressortir l'impact des différentes circonstances de survenue. Nous avons entrepris une étude rétrospective descriptive allant du 1er janvier 2004 au 31 décembre 2013. Elle a concerné les agents des forces de défense et de sécurité traités pour des fractures de membres au cours de notre période d'étude. Sept cent quatre (704) cas de fractures de membres ont été dénombrées. La moyenne d'âge des patients était de 30,57 ans avec des extrêmes de 19 et 55 ans et une nette prédominance masculine (95,71%). L'Armée de Terre (51,05%) et la Gendarmerie Nationale (38,86%) étaient les plus représentées. Les hommes du rang étaient majoritaires (43,08%), suivis des sous-officiers (32,59%). La fréquence annuelle des fractures de membres en rapport avec la profession militaire était de 63 cas. Les fractures de jambe étaient les lésions les plus recensées (32,96 %). Les Formations et les stages militaires ont été les circonstances de survenue les plus rencontrées (42,60 %), suivies des accidents de la circulation (39,43%). La perte des journées de service liée à ces lésions était estimée à 14009 jours par an. Les fractures de jambes occupent le premier rang des fractures de membres en rapport avec l'exercice de la profession militaire. Les formations-stages militaires et les accidents de la voie publique en sont les deux grandes circonstances de survenue.

We report a case of postoperative osteoarthritis infection caused by P. acnes after shoulder arthroscopy, and review possible preventive action. A right-handed 24-year-old man presented an anterior instability of the left shoulder. The patient underwent an anterior stabilization by the latarjet procedure. Stabilization failed, requiring a second and third surgery. The patient returned 10 months later for suspected septic arthritis of his left shoulder. An arthroscopy lavage with bacteriological and anatomo-pathological sampling was carried out. The bacteriological results revealed a positive P. acnes culture. The patient was treated using antibiotherapy for 12 weeks with a combination of clindamicin and moxifloxacin. C-reactive protein (CRP) was negative two months after the onset of antibiotherapy. P. acnes is a anaerobic, non-sporulated, gram-positive bacillus. This commensal germ is part of the normal cutaneous flora and causes acne, but has also been recognized as a causative pathogen in osteoarticular infections since the 1990s, as described by Coden. Treatment is achieved via surgical debridement and intravenous antibiotics. We insist on preventive action in the form of a preoperative patient preparation protocol. Previous literature has underlined the important role of chlorhexidine or alcoholic iodinated polyvidone in the prevention of these infections. As P. acnes is a commensal germ of the patient's skin, prophylaxis should be reinforced by the thorough preparation of the surgery and surgical site. Clindamycin antibioprophylaxy specific to this germ should be administered for this surgery. To my knowledge, there is no specific antibioprophylaxy for shoulder surgery to date.

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.

Introduction: Floating Knee is the term applied to ipsilateral fractures of the femur and tibia. Management of this complex injury has been variously described in the literature. This retrospective study was designed to present our experience with treatment of this injury, its complications and the functional results of these patients. Material and Methods: Between January 2004 and December 2007, all floating knee injuries that were managed during the study period were included. The patients were divided according to Fraser's classification. Functional assessment and final outcome was measured using the Karlstrom and Olerud's criteria. Results: Our study included 43 patients with 43 floating knee injuries. There were 32 males and 11 females with a mean age of 37 years. All patients had sustained their injuries in motor vehicle accidents. Thirty nine associated injuries were noted in the 43 patients. According to Fraser's classification, there were 21 type I, 10 type IIa, 7 type IIb, and 5 type IIc. Most of the floating knee injuries were treated with antegrade intramedullary nailing for both the femur and tibia. The mean follow up was 24.8 months. All the fractures united within a reasonable time except for three femur and 14 tibias. The complications encountered were one case of fat embolism, eight case of knee stiffness, 10 cases of delayed union, nine cases of infections, and seven cases of nonunion. Assessment by the Karlstrom criteria revealed 12 excellent results, 19 good results, 4 acceptable results, and 8 poor results. Analysis showed that surgical results were significantly associated with Fraser type classification of floating knee injuries (p = 0.003), the severity of soft tissue injury in the leg (grade III opened fracture) (p = 0.008), and associate lesions (p = 0.001). Conclusion: In patients suffering from floating knees, early fixation is recommended since it has several advantages with few systemic complications. We found Floating knee injuries to be a group of complex injuries that needed careful assessment to detect poor prognostic factors. Combination of all these would determine the ultimate outcome of these patients. Key words: Floating knee, Intramedullary fixation, Associate lesions, Surgical treatment.

This study aimed at assessing the effectiveness of open reduction and plate fixation combined with autogenous bone grafting in the treatment of non-united fractures of the humeral shaft. Forty six patients (27 men, 19 women; mean age, 35.6 years; range, 23-53 years) were operated on for non-union of a diaphyseal fracture of the humerus. Sixteen patients had surgical treatments and 30 patients had non-surgical treatments prior to operation. They were operated on average 7.8 months (6-17) following their initial treatment. None of the nonunions were infected. Radial nerve deficit was present in no patient. Treatment included open reduction and plate fixation combined with autogenous bone grafting. The mean follow-up period was 26 months (range: 13-41). No patient was lost to follow-up. The operative time averaged 91 minutes (range: 68-123). Union was achieved in all patients in a mean of 6.1 months (range: 5-13). There were nine postoperative complications (superficial infection in 5 and radial nerve palsy in 4). The infections resolved after local treatment. The radial nerve palsies recovered spontaneously. On clinical evaluation, shoulder range of motion was excellent in 41 patients (89.1%), and moderate in five patients (10.9%). Elbow range of motion was excellent in 30 patients (65.2%), moderate in 14 patients (30.4%) and poor in 2 patients (4.4%). Functional results were excellent in 24 patients (522%), good in 14 patients (30.4%), fair in 6 patients and poor in 2 patients (04.4%). In this study, plate fixation combined with autogenous bone grafting appeared as a safe and effective option in non-infected non-union of the humeral shaft.

No Abstract.

Objectifs : Déterminer l’incidence et les caractéristiques anatomopathologiques du fémur prise en charge dans le service de traumatologie orthopédie du CHU Tokoin de Lomé.Patients et Méthode : Il s’est agi d’une étude rétrospective fait sur les patients hospitalisés au service de traumatologie orthopédique du CHU-Tokoin pour fractures du fémur. Etude faite du 1er Janvier 2005 au 31 Décembre 2008. Le diagnostique est à la fois clinique et radiologique.Résultats : Les fractures du fémur ont représenté 13,12% des patients reçus en consultation pour fracture de membre. Nous avons une prédominance masculine de sex-ratio de 1,31 L’incidence est de 3 cas pour 100.000 personnes. L’âge le plus touché était compris entre 18 et 35 ans. La moyenne d’âge est de 27 ans avec extrême 18 à 90 ans. Les sans emplois ont été plus touchées suivies de professions libérales (21%). Les tumeurs étaient les facteurs favorisants (60,60%). Les accidents de circulation étaient les principales causes de la genèse des fractures du fémur (68,18%). Ils sont suivis des accidents domestiques (11,70%), les accidents de travail (7,57%), les accidents de sport (2,65%) et autres (10,22%). Au niveau de l’extrémité supérieure, les fractures du col (40,90%) étaient plus représentées. Ils sont suivis des fractures de la tête fémorale (9,30%), les fractures des massifs trochantériens (9,11%). Les fractures de la diaphyse fémorale étaient de 50%, avec une prédilection au tiers moyen. Les fractures de l’extrémité inférieure ont représenté (9,10%) avec une prédominance des fractures supra condyliennes.Conclusion : La majorité des fractures du fémur prises en charge au CHU Tokoin sont des fractures déplacées, à trait simple, et sont secondaires à un accident de la voie publique.Mots clés : Fracture ; fémur ; accident de la circulation ; Afrique.Objectives: To determine the incidence and pathological characteristics of the fractures of femur treated in Trauma Orthopaedic department of Tokoin teaching University of Lome.Patients and Method: This was a retrospective study done on patients hospitalized in the orthopedic unit of CHU-Tokoin for fractures of the femur. The study was made from January 2005 to December 31st, 2008. The diagnosis is both clinically and radiologically.Results: Fractures of the femur represented 13.12% of patients seen in consultation for a member fracture. We have a male-dominated sex ratio of 1.31. The incidence is 3 cases per 100,000 people. The most affected age was between 18 and 35. The average age is 27 years with extreme from 18 to 90 years. The unemployed were most affected followed by professionals (21%). The tumors were contributing factors (60.60%). Traffic accidents were the leading causes of the genesis of femoral fractures (68.18%). They are followed by domestic accidents (11.70%), work accidents (7.57%), sports accidents (2.65%) and others (10.22%). At the upper end, the neck fractures (40.90%) were more represented. They are followed by fractures of the femoral head (9.30%), fractures of the trochanter (9.11%). Fractures of the femoral shaft were 50%, with a predilection in the middle third. Fractures of the lower end represented (9.10%) with a predominance of supra condylar fractures.Conclusion : The majority of fractures of the femur supported CHU Tokoin fractures are displaced, single-line, and are secondary to an accident from the public highway.Key words : Fracture femur; traffic accident; Africa.

Background: Pin tract infection is a complication when using external fixation. The objective of this study was to estimate the incidence, rate and risk factors for pin tract infections after external fixation in the orthopedics wards in a major teaching hospital in Togo (West Africa). Methods: A one year prospective cohort study was conducted at the Tokoin Teaching Hospital in Lomé. All trauma patients treated by external fixation during this period were included in the study. There were 50 patients with 52 fractures who underwent external fixation. Their mean age was 33.9 years. The number of pins used was 257. Patients were interviewed and daily observed during their hospitalisation. Surveillance was continued if the patients were discharged before the removal of the external fixator. Care of the pin site was performed in accordance with a standard protocol for all patients. The scoring system for pin-tract infection described by Checketts was applied to each pin site with the same assessor scoring all pins. To estimate the risk factors of the pin tract infection, statistical analyses were performed. The level of statistical significance was set at p

Purpose.To evaluate surgical outcomes of ipsilateral femoral neck and shaft fractures.Methods.Between April 1997 and September 2004, 29 men and 8 women (mean age, 37 years) underwent fixation of femoral neck and shaft fractures using a dynamic compression plate plus a dynamic hip screw or screws. There were 30 femoral neck and 7 pertrochanteric fractures. Functional results were assessed according to the Friedman and Wyman classification.Results.The mean follow-up period was 49 months. Of the femoral neck fractures, 34 united in a mean of 4 months; 33 of them healed anatomically and one with a 6° varus angulation. No osteonecrosis of the femoral head was noted. Of the femoral shaft fractures, 32 united in a mean of 6 months, 5 were non-unions (2 persisted even after revision surgery). Seven patients developed infections (5 superficial and 2 deep), which resolved with debridement and antibiotic treatment. Functional results were good in 29 patients, fair in 5, and poor in 3.Conclusion.The use of dynamic hip screws and compression plates for ipsilateral femoral neck and shaft fractures is reliable in achieving bone union with few complications.