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Objectives: Although patients suffering from severe traumatic brain injury (sTBI) and severe trauma patients (STP) have been extensively studied separately, there is scarce evidence concerning STP with concomitant sTBI. In particular, there are no guidelines regarding the emergency surgical management of patients presenting a concomitant life-threatening intracranial hematoma (ICH) and a life-threatening non-compressible extra-cranial hemorrhage (NCEH). Materials and Methods: A scoping review was conducted on Medline database from inception to September 2021. Results: The review yielded 138 articles among which 10 were retained in the quantitative analysis for a total of 2086 patients. Seven hundrer and eighty-seven patients presented concomitant sTBI and extra-cranial severe injuries. The mean age was 38.2 years-old and the male to female sex ratio was 2.8/1. Regarding the patients with concomitant cranial and extra-cranial injuries, the mean ISS was 32.1, and the mean AIS per organ were 4.0 for the head, 3.3 for the thorax, 2.9 for the abdomen and 2.7 for extremity. This review highlighted the following concepts: emergency peripheric osteosynthesis can be safely performed in patients with concomitant sTBI (grade C). Invasive intracranial pressure monitoring is mandatory during extra-cranial surgery in patients with sTBI (grade C). The outcome of STP with concomitant sTBI mainly depends on the seriousness of sTBI, independently from the presence of extra-cranial injuries (grade C). After exclusion of early-hospital mortality, the impact of extra-cranial injuries on mortality in patients with concomitant sTBI is uncertain (grade C). There are no recommendations regarding the combined surgical management of patients with concomitant ICH and NCEH (grade D). Conclusion: This review revealed the lack of evidence for the emergency surgical management of patients with concomitant ICH and NCEH. Hence, we introduce the concept of combined cranial and extra-cranial surgery. This damage-control surgical strategy aims to reduce the time spent with intracranial hypertension and to hasten the admission in the intensive care unit. Further studies are required to validate this concept in clinical practice.

Exposure of the coracoid process during arthroscopic stabilization of acute acromioclavicular disjunctions (ACDs) can be achieved either by passing an extra- articular optical portal through the subacromial space or by an intra-articular optical route through the glenohumeral joint with opening of the rotator interval. The objective of our study was to compare the impact on the functional results of these two optical routes. This was a retrospective, multicentre study that included patients operated on for an acute acromioclavicular disjunction arthroscopically. The treatment consisted of surgical stabilization under arthroscopy. The surgical indication was retained for an acromioclavicular disjunction of grade 3, 4 or 5, according to the Rockwood classification. Group 1, which consisted of 10 patients, was operated on with an extra-articular subacromial optical route, and group 2, which consisted of 12 patients, was operated on with an intra-articular optical route with opening of the rotator interval according to the habits of the surgeon. A follow-up of 3 months was performed. The functional results were evaluated for each patient using the Constant score, Quick DASH, and SSV. The delays in returning to professional and sports activities were also noted. A precise postoperative radiological analysis made it possible to analyse the quality of the radiological reduction. No significant difference between the two groups was found between the Constant score (88 vs. 90; p = 0.56), Quick DASH (7 vs. 7; p = 0.58), or SSV (88 vs. 93; p = 0.36). The times to return to work (6.8 weeks vs. 7.0 weeks; p = 0.54) and sports activities (15.6 weeks vs. 19.5 weeks; p = 0.53) were also comparable. The quality of the radiological reduction was satisfactory in the two groups and did not depend on the approach. No clinically or radiologically significant differences between the extra-articular and intra-articular optical portals in the surgical treatment of acute ACDs were found. The optical route can be chosen according to the habits of the surgeon.

Resume Introduction A l’heure des reseaux sociaux, de la mediatisation de plus en plus importante de la chirurgie et des classements « grand public », les criteres de choix d’un chirurgien ou d’une equipe chirurgicale ne sont pas connus avec precision notamment en France. Aussi nous avons mene une etude prospective sur la ligamentoplastie du ligament croise anterieur afin : (1) d’analyser les moyens par lesquels les patients avaient connu leur chirurgien, (2) d’identifier les facteurs ayant pu influencer le choix final du chirurgien. Hypothese Le choix de son chirurgien par le patient est influence par les notes sur les reseaux sociaux et les classements dans la presse. Materiel et methode Une etude prospective a ete menee, incluant de maniere continue l’ensemble des patients operes, sans referentiel de technique, dans trois etablissements differents, prives et publics. Un questionnaire anonyme sur les criteres de choix note de 0 a 10 etait donne sur volontariat le jour de la programmation de l’intervention par le chirurgien. Resultats Cent cinq patients ont ete inclus. Les futurs operes etaient amenes a connaitre leur praticien par le biais d’avis de proches ou du medecin traitant pour plus de 2/3 d’entre eux. Le critere essentiel du choix final du chirurgien etait la clarte de l’information ecrite et orale en consultation (moyenne = 8,09/10 ± 1,83). Etaient notes ensuite les delais avant chirurgie (7,39/10 ± 2,25) et avant la premiere consultation (7,26/10 ± 2,01) ainsi que la reputation du chirurgien (7,42/10 ± 2,43). Conclusion Le « bouche a oreille » et la qualite de l’information apportee en consultation semblent etre la base du choix final du chirurgien, plus que l’influence des reseaux sociaux et des classements des hopitaux rapportes par les journaux. Niveau de preuve IV ; etude prospective observationnelle sans groupe controle.

This study reports on complications following extended tourniquet application in patients with combat extremity injuries treated by the French Military Health Service in the Sahelian strip. A retrospective review was performed in a French forward medical treatment facility deployed in Gao, Mali, between 2015 and 2020. All patients treated for an extremity injury with the application of at least one tourniquet for a minimum of 3 h were included. Prehospital data were injury pattern, associated shock, tourniquet location, and duration. Subsequent complications and surgical procedures performed were analyzed. Eleven patients with a mean age of 27.4 years (range 21–35 years) were included. They represented 39% of all patients in whom a tourniquet was applied. They had gunshot wounds (n = 7) or multiple blast injuries (n = 4) and totaled 14 extremity injuries requiring tourniquet application. The median ISS was 13 (interquartile range: 13). Tourniquets were mostly applied proximally on the limb for a mean duration of 268 min (range 180–360 min). Rhabdomyolysis was present in all cases. The damage control surgeries included debridement, external fixation, vascular repair, and primary amputation. Ten injuries were complicated by compartment syndrome requiring leg or thigh fasciotomy in the field or after repatriation. Two severely injured patients died of their wounds, but the others had a favorable outcome even though secondary amputation was sometimes required. Extended and proximal tourniquet applications led to significant morbidity related to compartment syndrome and rhabdomyolysis. Hemorrhagic shock, mass casualty incident, and tactical constraints often precluded revising the temporary tourniquet applied under fire.

IntroductionThe treatment of osteoarticular infections in Africa is a medical and surgical challenge due to the difficulties in managing antibiotic therapy after the surgical procedure. The objectives of this study were to identify the types of bacteria in osteoarticular lesions in patients treated in Chad and to determine the spectrum of resistance encountered and the efficacy of available antibiotics.Material and methodsThis is a retrospective study of all intraoperative osteoarticular and soft tissue samples taken in a French Role 2 Medical Treatment Facility of N'Djamena during surgery for chronic osteoarticular infections, in Chad, for 1 year.ResultsA total of 160 bacterial strains were identified, with a predominance of Gram-negative bacillus (GNB) and staphylococcus infections. Among staphylococci, 80% were methicillin-sensitive streptococci which were generally multidrug-sensitive. Enterococci were resistant to third-generation cephalosporins, first-generation fluoroquinolones and gentamycin. Among GNB, there was a predominance of enterobacteria compared with non-fermenting GNB, of which 52% were multidrug-resistant and produced extended spectrum beta-lactamases (ESBL).ConclusionStaphylococcus aureusinfections are most often sensitive to available antibiotics and therefore have better prognoses than infections caused by other bacteria. In contrast, in half of the cases of GNB, infections were caused by bacteria producing ESBL, thus posing the problem of multidrug-resistance, the risks of which are increased in precarious situations. Therefore, the type of bacteria appears to be a major prognostic factor in the treatment of osteoarticular infections in a Role 2 in Chad. This criterion will need to be considered before any treatment decisions are made.

Resume Introduction L’enclouage centromedullaire est la technique de reference dans le traitement des fractures des os longs dans les pays developpes du fait de son caractere mini-invasif et de ses qualites biomecaniques. En condition precaire, l’exofixation ou les osteosyntheses a foyer ouvert par plaque sont plus souvent realisees devant le manque de moyens pour realiser un enclouage centromedullaire. Elles peuvent etre responsables de complications infectieuses et de faillites mecaniques. L’objectif de notre d’etude etait d’evaluer les resultats et les complications postoperatoires du traitement par enclouage centromedullaire des fractures fermees des os longs chez des patients operes au sein d’une antenne chirurgicale (role 2+) francaise. Notre hypothese est que l’enclouage centromedullaire reste une technique fiable a faible morbidite pour le traitement initial des fractures des os longs meme en situation precaire. Materiel et methodes Il s’agit d’une serie prospective monocentrique et descriptive de patients operes entre avril 2016 et novembre 2017. Tous les patients presentant une fracture fermee du tibia ou du femur, quel que soit le delai de la fracture, traites par un enclouage centromedullaire etaient eligibles. Le recul minimum etait fixe a 3 mois. Le critere d’evaluation principal etait l’absence de complication infectieuse et le critere secondaire etait la consolidation. Resultats Cinquante-huit patients ont ete revu avec un recul moyen de a 4,7 mois (min–max : 3–15 mois). L’âge moyen etait de 35,2 ans (15–85 ans) avec une majorite (n = 52) d’hommes. Les fractures concernaient le femur dans 74,1 % (n = 43) et le tibia dans 25,9 % (n = 15). Le delai entre la fracture et sa prise en charge chirurgicale etait en moyenne de 122,3 jours (min–max = 7–720 jours) avec une mediane de 60 jours. Dans 74 % des cas (n = 43), la fracture necessitait un abord chirurgical. Les suites etaient considerees comme simples dans 96,6 % des cas (n = 51). Aucun cas d’infection n’etait survenu au dernier recul. La consolidation etait acquise en moyenne en 4 mois dans 70,7 % des cas (n = 41). Il existait 3 cas de pseudarthrose apres 6 mois. Discussion L’enclouage centromedullaire dans des conditions precaires reste une methode fiable et efficace avec un faible risque de complication et un taux de consolidation osseuse eleve pour le traitement des fractures negligees des os longs. C’est un traitement chirurgical adapte aux conditions precaires sur le territoire africain. Niveau de preuve II, prospectif de faible puissance.