[The urological complications of pelvic fractures: about 22 cases at the University Hospital, Brazzaville]. / Les complications urologiques des fractures de la ceinture pelvienne : à propos de 22 cas au CHU de Brazzaville.

OBJECTIVE: To analyze the epidemiology, injury mechanisms and therapeutic aspects of urological complications of fractures of the pelvic girdle. PATIENTS AND METHODS: Retrospective study including 22 cases of urological complications of pelvic fractures analyzed between 2003 and 2010 at the University hospital, Brazzaville. Tile classification modified AO was used to understand the mechanisms underlying urological complications. The variables studied were: frequency, age, sex, origin, etiology, type of pelvic fracture, type of urological complications, clinical urological lesions, the therapeutic delay, the therapeutic method, the long-term prognosis. RESULTS: In total, 22 cases (11.40%) of urological complications were collected on 193 pelvic fractures. Men dominated the series with a sex ratio of 4.5, the average age was 33.8 years (12 to 64). Street accidents were the leading cause with 13 cases (59.09%). The urethra was the most affected in 16 cases (72.73%), the membranous portion in 10 cases (45.45%), the bladder in six cases (27.27%). Type A fractures were complicated four bladder lesions, types B, 12 urological lesions (1 bladder and urethra 11) and six type C lesions (1 bladder and urethra 5). Bone lesions were supported functionally in 18 cases (81.82%). Urethral injuries in men were repaired remotely by anastomotic urethroplasty. Urethral injury in females has been repaired urgently delayed. The bladder lesions were repaired by emergency laparotomy and suture of the breach, or urethral catheterization. In monitoring, seven patients had urological sequelae: erectile dysfunction in one case and urethral stenosis in six cases, they have been treated by dilatation (4 cases) and endoscopic internal urethrotomy (2 cases). CONCLUSION: The urological complications of pelvic fractures were rare in our experience, and must be systematically searched. Unstable fractures (types B and C) were the major providers of these complications. Remote processing was possible with good functional results.

[Pathological fracture revealing an osseous histoplasmosis. A case report on a 60-year patient]. / Fracture pathologique révélant une histoplasmose osseuse. A propos d'une observation chez une patiente de 60 ans.

The authors report a new case of African Histoplasmosis in a 60-year-old patient. It was an humeral localization revealing a pathological fracture which grew into an extension of osteolysis and a cutaneous fistulization likely to be a malignant bone tumor. The case has been diagnosed by surgical biopsy and histological analysis. Its antifungal treatment in progress resulted in the drainage of the out-flow that should permit the bone reconstruction by graft. The authors stress on the need to focus on this affection whenever, in a tropical area, one is faced with any chronic bone fistula that cannot positively be cured in spite of sound medical cares.

[Multiple myeloma and HIV/AIDS infection. Three case reports]. / Myelome multiple et infection à VIH/SIDA. A propos de 3 observations.

HIV/AIDS infection rages at the endemic state in Sub Saharan African and especially in our country. We are reporting 3 observations of patients, all of females affected by HIV/AIDS and multiple's myeloma. They are all in-patients in the department of haematology, University hospital of Brazzaville, from 2000 to 2002. In two cases out of three, multiple's myeloma is discovered after the tracking of HIV/AIDS infection. In the other case, the tracking HIV/AIDS seems to be posterior to the multiple's myeloma diagnostisis. HIV/AIDS is symptomatic in the tree cases and under antiviral treatment. Multiple's Myeloma is diagnosed at an advanced stage. It is about IgG myeloma in two cases and IgA myeloma in the other. The rate of the T4 lymphocytes is noted spontaneously to 204 and 486 by mm3, and 390 by mm3 in a patient under antiviral treatment before her hospitalisation. The measure of the viral intensity is not achieved. The poly chemotherapy of type VMCP and VAMCP is driven without major complications and under anti-infectious prophylaxis. The receding is still insufficient to affirm the medium-term evolution and to determine the prognosis of the malign blood disease. The description of these three observations confirms the implication of the human retrovirus and in particular of the VIH/SIDA in the lymphoma genesis.

[Multiple myeloma and HIV infection: report of 3 cases]. / Myélome multiple et infection a VIH/SIDA : a propos de trois observations.

HIV infection rages at the endemic state in Sub Saharan African and especially in Congo Brazzaville. We report the observation of three female patients infected with HIV and developing multiple myeloma. The three patients were treated at the University hospital of Brazzaville between 2000 and 2002. In two cases multiple myeloma was discovered after the diagnosis of HIV infection. In the other case, the diagnosis of HIV infection was posterior to the occurrence of multiple myeloma. HIV infection was symptomatic in two cases who received consequently antiviral treatment. Multiple myeloma was diagnosed at an advanced stage in the three cases. The paraprotein was an IgG in two cases and an IgA in the other one. The CD4 counts before treatment were around 200/mm3 in two cases and within normal limits in the third case. Viral load was not measured. VMCP and VAMCP regimens were administered without major complications and under anti-infectious prophylaxis. The follow-up is still insufficient to assess the medium-term evolution and to determine the prognosis of multiple myeloma. The description of these three cases confirms the involvement of HIV in B cell lymphoma genesis.

[Subacute osteomyelitis in adults. Apropos of 3 cases]. / Ostéomyélites subaiguës de l'adulte. A propos de 3 cas.

We report three cases of subacute osteomyelitis in 25, 31 and 38-year old adults. The clinical presentation was an insidious condition with persistent nondisabling pain. Radiographical signs suggested a bone tumor. Diagnosis was established from the bacteriological and pathology examinations of the surgical biopsy taken when evacuating the abscess. Cure was obtained in all three patients with combination antibiotic regimens. In two cases immobilisation was required because of bone fragility.

[Tibialization of the fibula for a large bone loss. A case report]. / Tibialisation de la fibula pour une grande perte de substance osseuse. A propos d'un cas.

A 10-centimeter tibial bone loss was treated by inter-tibiofibular bone grafting on each part of the pseudarthrosis, resulting in tibialization of the fibula. The patient was reviewed after 10 years; the clinical result was satisfactory and stable. The tibial forces were deviated on the fibula, which expressed radiologically by important thickening of its cortices. This case illustrates the interest of preserving the fibula for tibial bone loss reconstruction.

[Importance of intertibio-peroneal graft in pseudoarthrosis of the leg at risk for sepsis. Apropos of 21 cases]. / Intérêt de la greffe intertibio-péronière dans les pseudarthroses de jambe à risque septique. A propos de 21 cas.

PURPOSE: The purpose of our study was to analyze the use of intertibio-fibular bone grafting (I.T.F.G.) in non-union presenting a septic risk. MATERIAL AND METHODS: Twenty one non-unions of the tibial diaphysis presenting a septic risk were treated by intertibio-fibular bone grafting through a postero-lateral approach, over a seven year period (1988-1995). There were 2 septic non-unions and 19 non-unions following open fractures, all treated initially by external fixation. Seventeen patients were male, four were female. Mean age was 33 years (range 19 to 70 years). RESULTS: Healing was obtained in 20 cases, only one patient had a second bone grafting. Postoperative complications included two infections (one deep and one superficial) without consequences on bone healing. Functional results were good and excellent in 18 cases (85.7 per cent). DISCUSSION-CONCLUSION: Our study showed that among techniques for the treatment of non-union presenting a septic risk, the I.T.F.G. is one of the most reliable, with low morbidity and low cost. The authors recommend this type of surgery particularly in developing countries.

[Open fractures caused by gunshot in civilian practice. Apropos of 31 cases]. / Fractures ouvertes par armes à feu en pratique civile. A propos de 31 cas.

The authors report their experience of the treatment of 31 gunshot open fractures in civilian practice. The fractures, comminuted in two thirds of cases, were produced by various fire-arms. Two vascular injuries were observed. Conservative treatment was performed in 80% of cases. 13 septic complications were observed (6 superficial and 7 deep infections). The were also 7 cases of delayed union, 3 mal unions and 7 cases of joint stiffness. To improve the prognosis of these lesions, the authors emphasize that surgeons must be familiar with ballistic wounds and carry out an early initial and appropriate treatment.

[Results of an open fixation treatment of 131 fractures of the femoral diaphyses in a Congolese hospital setting]. / Résultats du traitement à foyer ouvert de 131 fractures de la diaphyse fémorale en milieu hospitalier Congolais.

From 1987 to 1991, 196 fractures of the femoral diaphysis were treated at the University Hospital Center of Brazzaville. A retrospective perusal of the files of these patients produced 131 analyzable cases, all treated by open osteosynthesis using either screw-attached plates (n = 84) or nails (n = 47). The overall infection rate was 5.4% (7/131). This rate was 5.9% (5/84) using screw-attached plates and 4.2% (2/47) using nails, i.e. only slightly higher than in the literature. Bone fixation was successful in 90% of cases. Mechanical complications (11.4%) were due mainly to technical errors during the initial fixation. With a follow-up of 3 years, analysis according to the criteria of GENESTE showed that open osteosynthesis of fractures of the femoral diaphysis in an African orthopedic department led to 90% of good (32%) and excellent (58%) results. In this African series, the main problem was the initial fixation.

[Reoperations for mechanical complications of femoral osteosynthesis. Analysis of 20 cases]. / Les réinterventions pour complications mécaniques des ostéosyntheses fémorales. Analyse de 20 cas.

Based on a study of 220 femoral osteosynthesis, the results of 20 second surgical operations because of mechanical complications sat in 19 patients. These complications occurred on 15 screwed plates (6 breakings, 6 angulations, 3 dismounting) and 5 nailings (4 proximal migrations, 1 angulation). The critical analysis about the first osteosynthesis showed some technical error in several cases. Pseudarthrosis (9.2 p.c.) was observed in all mechanical complications at the plates A second surgical operations, thanks to a new osteosynthesis associated, in 8 cases, with a cortico-spungoïd osseous graft led to 85 p.c. of good and very good results and 15 p.c. of satisfactory results. No post surgery complication was observed.

[Galeazzi fracture. 9 cases in the orthopedic-traumatology service (Brazzaville-Congo)]. / La fracture de Galeazzi. A propos de 9 cas service orthopédie-traumatologie (Brazzaville-Congo).

The authors give an account of nine cases of Galeazzi fractures, observed on a four-year period (1987-1991). These uncommon and unstable injuries were treated, in all cases, by rigid osteosynthesis of the radius. The treatment of the distal radio-ulnar dislocation, depending on its importance, was K-wire stabilization (4 cases), plaster-cast immobilization in supination (2 cases). There was no peculiar treatment in 3 cases. The results were influenced by operative delays. However we obtained 4 excellent results, 3 good results and 2 fair results.

[Acute osteomyelitis of the patella]. / Ostéomyélite aiguë de la rotule.

The authors report on an observation of acute osteomyelitis of the patella in a non-sickle-anemic 8-year-old child. The literature helps confirm the scarcity of the disease, the difficulties of diagnosis and the good prognosis of the lesion in the child.

[Recent fractures of the humeral shaft in adults. Role of surgical treatment using screwed plates. Apropos of 35 cases surgically treated]. / Fractures récentes de la diaphyse humérale de l'adulte. Place du traitement chirurgical par plaque vissée. A propos de 35 cas opérés.

Thirty five cases of recent fractures of the adult humeral shaft were treated by using A0 plating technics. Most of the results were satisfactory (91 per cent of good and excellent results). A few post-operative complications were observed: two deep infections, one radial nerve palsy, no pseudarthrosis. Once indicated, internal fixation using plating is the best surgical technic for the authors of the present study.

[Infected, diaphyseal pseudoarthroses of limbs. Therapeutic problems in 17 cases. (Orthopedic-traumatology service of the University Hospital Center of Brazzaville-Congo]. / Pseudarthroses infectées diaphysaires des membres. Problèmes thérapeutiques à propos de 17 cas (Service Orthopédie-Traumatologie du Centre Hospitalier Universitaire de Brazzaville-Congo).

Seventeen cases of infected pseudarthrosis have been registered between 1987 and 1991 in the Orthopaedic Ward of the University Hospital of Brazzaville (Congo). They are distributed as follows: eleven cases located in the leg, three in the humerus, and three others in the femur. Their analysis was especially concerned with the etiological aspects of the different cases, and with their specific therapeutic strategies. The authors' conclusion points to the urge to take deterrent steps to ward off the awful complications of the disease.