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Background: The treatment of radial club hands is difficult and requires staged procedures in specialised centres. Objective: To report the Ivorian experience with this condition. Settings: Yopougon Teaching Hospital, Abidjan and "Don Orione” Centre for the Crippled, Bonoua. Subjects and Methods: The management of 22 club hands in a cohort of 14 patients (nine boys and five girls) aged 14 days - 12 years (mean age, 3.3 years + 4.3) over a 14-year period, was reviewed. Three of the children were neonates, six were aged one month-one year while the rest were older than one year. The lesions were classified according to the method described by Bayne & Klug. Theywere all treated surgically with preoperative physical care in the neonates and infants. Functional and aesthetic results were assessed by using the criteria of Cattaneo etal at a mean follow up period of 2.4 years. Results: Twelve of the children had Bayne type IV deformity, nine type I and one type II. Eleven children with type IV deformity were treated by centralization with ulnar osteotomy and one child with type IV, by centralization alone. Complications included one case of wound infection, two with haematomas and two pin migrations without recurrence of wrist deviation. According to Cattaneo et al's staging score, the hand function was good in 18 cases and average in four; aesthetic result was good in 12 hands, average in six and poor in four. Conclusion: The treatment provided satisfactory results for the children and their families with the result that there has since been an increase in the number of club hands referred to the hospital.

Context: Elastic stable intramedullary nailing has revolutionised the treatment of fractures in children. Aim: To report our experience with this current technique of management of fractures in children. Methods and Materials: A retrospective study of all children with fractures treated by this method from November 2003 to June 2006 at the Paediatric Surgery Department of Yopougon Teaching Hospital, Abidjan, Côte d'Ivoire. Data were recorded from their medical charts regarding demographics, fracture patterns, associated injuries, morbidity, and outcome. Results: A total of 38 children (14 boys; mean age, 11.7 years; range, 9-15 years) with 41 fractures, sited at femur (n=15), humerus (n=8), tibia and fi bula (n=6), forearm (n=7), and radial neck (n=5), associated with other injuries in 7 cases, were enrolled in the study. The mean interval for surgery was 6.8 days. Open reduction was required 5 times (12.1%). The hospital stay was in the range 5-12 days. Minor adverse events were 1 (2.4%) early tibial loss of reduction, 3 (7.3%) skin irritations and 2 (4.8%) transient knee limitations. Complications (17.3%) included 2 axial (4.8%) and 1 rotational (2.4%) femoral malunions below 15°; 3 elbow (7.3%) and 1 knee stiffness (2.4%) in openly reduced cases. Solid consolidation was achieved in all cases, with no disturbance in standard union times. At a mean follow-up period of 16 months (range, 9-28 months), all but 3 patients with opened joints recovered full range of motion, and none showed either limp and gait anomalies or re-fracture after removal of wires. Conclusion: Elastic stable intramedullary nailing in children fractures is easy to perform and has little complications if a proper technique is used. [ABSTRACT FROM AUTHOR]

Background: In most children proximal humeral fractures are treated non-operatively with generally good results. This review discusses the indications of operative treatment and assesses the treatment results. Materials and Methods: The charts of 20 patients (14 girls; mean age: 12.3± 2.8 years; range: 7-16 years) with proximal humeral fractures who were operated on at our institution were reviewed from 1992 to 2002. Results: There were five metaphyseal fractures and 15 physeal injuries which were angulated according to Neer-Horowitz score as grade III in four cases and grade IV in 16 cases with a mean angulation of 47.8±39.1 degrees (range: 6-148 degrees). Associated lesions comprised open fracture and head trauma in two cases each. Patients with associated injuries were operated on primarily and the 16 others by secondary intention. All but one were reduced via an anterior approach with internal fixation. They were assessed for clinical and radiological healing at a mean follow up of 3.6 years ranging from 1.2 to 7.8 years. Conclusion: Based on our study, surgical option is indicated for severely displaced and unstable fractures in older children and adolescents. [ABSTRACT FROM AUTHOR]

Abstract: Inguinal hernias are due to the patent vaginoperitoneal canal; surgical treatment lead to a definitive cure. The aim is to describe the inguinal hernias of male children and report our experience in their management. We conducted a retrospective study of the hernias on male children from 1993 to 2003. We analyzed its prevalence, its clinical characteristics, the associated malformations and the results of the treatment. Inguinal hernias represented 18% of the consultations over the period of study. Diagnosis was delivered within 3.6 months on average with extremes of 1 day and 15 years. It was associated to prematurity in 8% of the cases. They were inguino-scrotal in 54% of the cases and predominantly in the right side in 59% of the cases. They were associated to other genito-urinary abnormalities in 9%. Incarceration was the clinical pattern in 16% of the cases. The cure had been made by the vaginoperitoneal canal ligature, and a prefunicular link of the conjoint tendon and the inguinal ligament in 100% of the cases. The postoperative complications were 2.4% with one recurrence; the mortality was 0.7% due to incarcerations. The inguinal hernia of the male is known as a benign pathology but it can be fatal when not recognized in its incarceration form with late treatment. [Copyright &y& Elsevier]

Aims: To analyze the results of treatment of major renal injuries according imaging data in order to determine their function after follow-up., Patients and Methods: This is a retrospective study of 22 cases of fracture of the kidney (grade V) in two pediatric surgical services that were reviewed over a period of 16 years. After initial conservative treatment in 19 patients (86.5%), a scan and/or Uro-MRI were realized in all patients in monitoring evolving. Three children with vascular injury were treated by interventional radiology. The morphology and functional evolution of the injured kidney were determined., Results: A DMSA scan investigation was performed in 21 patients (95.5%) associated with Uro-MRI in two cases; one patient was only explored with Uro-MRI. A complete restitution of the renal parenchyma was confirmed in 10 children (45.5%), we noted an atrophy of the upper pole in 30%, a lower pole atrophy in 4.5%, two complete renal atrophy in 9%. An urinoma was present in six patients (27%) that required drainage in five cases and declined during the surveillance in one case. Normal function of the injured kidney was noticed in half of grade V (11 of 22 patients) with a mean follow-up of 19 months. None of our patients did present hypertension., Conclusion: Non-operative conservative treatment in severe renal trauma was efficient, morphological and functional sequelae were present in 50% on scintigraphy and/or Uro-MRI., (Copyright © 2011. Published by Elsevier Masson SAS.)

Circumcision is the most common surgical procedure carried out in boys in our countries. It is performed by medical members but also by traditional practitioners. Circumcision is considered as a benign operation but its complications are common, sometimes severe and the treatment delicate. Authors reported 35 cases of circumcision's complications in boys, aged of 2 days to 14 years old who were circumcised by traditional practitioners and by medical members. The most frequent complications were urinary meatus stenosis (17 cases), haemorrhage (5), total glans section (3), urethral fistula (3), and incomplete circumcision (3). These complications were caused by traditional practitioners in 19 cases, paramedical members in 11 cases, and 5 cases by physicians. Among these complications, fistula and amputation had required delicate surgical procedure. All the stenosis were treated by meatal plasty and fistula were sutured with one recurrence. Partial glans section underwent Mathieu's procedure and the total sections were referred to the plastic surgeon. Authors recommend surgical procedure for circumcision which must be performed in medical center or by well trained practitioners.

Objective: To describe epidemiology and to bring back the results of the treatment of the fractures of the forearm fracture., Population and Method: During 3 years and 3 months, we studied the forearm fractures of the children from 0 to 15 years. For each one of them, we studied, the age, the sex, the aetiology and the characteristics of the fracture, the treatment carried out and their evolution., Results: Sixty-nine forearm fractures were listed, the frequency was 23 fractures per years. The sex ratio was 2,63 and the average age was 8 years and 2 months with 13 month and 15 years as extremes. The accidents of play accounted for 93% of the aetiologies. The cutaneous injuries were associated to the fracture in 30 cases (43%). The fractures with displacement was observed in 25 cases (36%), green steak fracture in 21 case (30%), fracture without displacement in 13 case (19%) and other displacements 10 cases (15%). The treatment was orthopaedic (reduction and immobilisation) in 97% of the cases. We observed 3 cases (4%) of secondary displacements under plaster and 6 cases (9%) of the vicious cal., Conclusion: The orthopaedic treatment is usually indicated for the Key words: fractures with anatomical restitution. The failures of the orthopaedic treatment need to be treated surgically.

A retrospective study about 80 cases of exomphalos treated in the digestive unit of the paediatric surgery department in Abidjan teaching hospital--Côte d'Ivoire had been performed to analyse the result of this malformation treatment during 8 years. Prenatal diagnosis was made in two cases on six antenatal ultrasounds. Prematurity involved 7% of newborn and their birth weight ranged from 2500 to 4000 grams in 70% of cases. Treatment began in 64% at birth, conservative treatment with merbromine tannage was systematic on the non disrupted exomphalos. Surgery was indicated in the disrupted exomphalos and in the complicated cases of conservative treatment. Intestinal occlusion was the main fatal complication observed in both treatments but most of the time it occurred with surgical closure. Total lethality reached 30%, influenced by exomphalos super infection and by neonatal resuscitation insufficient means. Authors think exomphalos lethality reduction implies antenatal ultrasonographic for early diagnosis which could indicate a possible caesarian section in case of the voluminous exomphalos in order to prevent disruption and neonatal resuscitation operation.

We conducted a retrospective study on 48 children (with a sex ratio of 22 males to 26 females) who had been operated over the preceding 10 years for typhoid perforation on the viscera ward within the paediatric surgery department of Yopougon teaching hospital in Abidjan, Côte d'Ivoire. The mean age was 9 years 3 months ranging from 3 to 16 years. Typhoid peritonitis was diagnosed on the basis of symptoms, intestinal injuries and only rarely by way of biological examinations. Medical treatment associated three antibiotics: aminosid, metronidazol and the third generation of cephalosporin. Hydroelectrolytical and haematological resuscitation was performed 3 to 6 hours before laparotomy. Excision-suture was made in 81% of cases. Exclusive parenteral nutrition began 48 hours after the laparotomy. Mortality occurred in 6% of patients and morbidity in 46%. Complications were parietal suppurations, digestive fistula, parietal hernia, early occlusive syndromes and necrosed cholecystisis. Rectorragy and leucocytosis were considered as pejorative signs when associated to the classic typhoid peritonitis.