Traitement chirurgical des fractures-décollements épiphysaires traumatiques récents du fémur distal dans un hôpital de seconde référence. A propos de 32 cas.

Traumatic epiphyseal detachment fractures of the distal end of the femur are a rare lesion whose severity is linked to disabling sequelae such as limb length discrepancy or most often angular deformities. In this report, surgical treatment seeks to allow early mobilization of the knee. Surgery carried out mainly by placement of pins or screws, through an open or closed approach, can be a source of complications including migration of pins, infections, knee stiffness, and growth disorders. The aim of this work was to describe their epidemiological, anatomo-clinical, therapeutic aspects as well as their evolution in the orthopedics and traumatology department of the Ségou regional hospital which is a reference hospital for orthopedic and traumatological pathology in the region. This was an observational, prospective study over 49 months from March 2015 to March 2019. It included 32 patients with traumatic epiphyseal detachment of the distal femur occurring within at most 21 days, on a healthy knee with an active cartilage fertile, who were treated surgically and followed in the department. The diagnosis of traumatic epiphyseal detachment of the distal femur was based on clinical examination and radiographs of the knee in the anterioposterior and lateral views. The functional results were evaluated according to the functional criteria of the Eastern Orthopedic Traumatology Society (SOTEST). To these criteria, we added muscle atrophy. It was measured by comparative values of thigh circumference taken 10 cm above the base of the patella. Thirty-two patients including 24 boys and 8 girls with a mean age of 12 years, ranging from 8 to 16 years. The lesions were classified according to the Salter Harris classification. We noted 22% type I (n = 7), 72% type II (n = 23), 3% type III (n = 1) and 3% type IV (n = 1). The surgical treatment consisted of reduction and bone fixation: fixation was performed by X-shaped Kirschner wires of diameter 22 in 28 cases (type I n = 7, type II n = 21), by cancellous bone screws 6.5 in 2 patients (type II n = 1, Type III n = 1), and by Kirschner wires and cancellous bone screws in 2 cases (type II n = 1, Type IV n = 1). Union was achieved in all patients within averagely 6 weeks with extremes of 4 and 12 weeks. The functional result was considered very good in 85% and good in 15% of cases. Traumatic epiphyseal detachment fractures of the distal end of the femur are a rare lesion whose severity is linked to disabling sequelae such as limb-length discrepancy or most often angular deformities. Surgical treatment aims to reconstruct the anatomy of the distal femur, to avoid secondary displacements and to allow early mobilization of the knee. [ABSTRACT FROM AUTHOR]