[Evaluation of the quality-of-life of patients with pacemakers : experience of Burkina Faso about 120 patients paired with the collaboration of doctors from AUVERGNE (France)]. / Évaluation de la qualité de vie des patients porteurs d'un stimulateur cardiaque (pacemaker) : expérience du Burkina Faso à propos de 120 patients appareillés avec la collaboration des médecins d'Auvergne (France).

INTRODUCTION: In Burkina Faso, cardiac stimulation was introduced in October 2000 has grown over time.In orderto evaluate the effectiveness of stimulation on life, we proposed to evaluate the quality of life of patients with a pacemaker. GENERAL OBJECTIVE: to study the effect of the pacemaker on the quality of life of patients PATIENTS AND METHODS: This was a cross-sectional study aimed at describingthe wearers of a pacemaker for at least six months at the Yalgado OUEDRAOGO University Hospital and the Schiphramedical center.The AQUAREL questionnaire has been adapted to our context to establish a quality-of-life score. RESULTS: The mean age of the study population was 68 years with a female predominance (53.3%). Complete atrioventricular block was the main indication of stimulation in 55%. The average duration of implantation was 41.6 months with extremes of 8 and 128 months. The primo implantation was found in 79.1 % of patients against 18.3 % for a first change of case and2.5 % for a second change of housing. Double chamber stimulation was performed in 65% of cases. DDD mode was the most used followed by VVIR. The average quality of life score was 90.12. Negative predictors of quality of life were age and female.A correlation between quality-of-life score and age, hypertension and dyslipidemia was found (p< 0.05). On the other hand, no correlation between the number of implantation, the duration of implantation and the mode of stimulation was found (p> 0.05). CONCLUSION: patients with a pacemaker have a good quality of life. However, quality-of-life is not correlated with the number of pacemakers, nor the duration and mode of stimulation.

[Five years assessment of cardiac stimulation in two public hospitals in Burkina Faso: An experiment of collaboration with two hospitals in Auvergne]. / Bilan de cinq ans de stimulation cardiaque dans deux structures hospitalières publiques du Burkina Faso : expérience d'une collaboration avec deux centres hospitaliers d'Auvergne.

OBJECTIVES: Cardiac stimulation becomes a reality in Burkina Faso. The aim of our study was to evaluate this activity over five years and to appreciate the impact of collaboration with French hospitals of Auvergne area in its development. MATERIALS AND METHODS: Prospective study including consecutively patients who underwent pacemaker implantation since June 2011. Data collected included indications, time to care, type of stimulation, complications, cost of treatment, and education and quality of life of the patient. RESULTS: Sixty-nine patients received definitive pacemaker from June 2011 to June 2016, of whom 45.5% were women. The mean age was 69 years (extremes 35 to 89s). Almost all patients (94%) were symptomatic (54% syncope and 30% dizziness and lipothymias). The main indication for definitive cardiac pacing was complete atrioventricular block of degenerative origin (83%). The mean time between indication and surgery was 8.2 days, and only 4% of patients received temporary stimulation. The lack of financial support was the main reason for the delay in taking charge. During the study period, the two health centers received support in the form of stimulation equipment, a technical platform, and regular training and practical training. This collaboration made it possible to overcome the lack of material, human and financial resources. We recorded as complications a case of case exteriorization, two cases of benign local hematoma and two cases of probe displacement. The quality of life of the patients improved markedly, none of patients undergoing surgery remained symptomatic. CONCLUSION: The organization of cardiac stimulation in Burkina Faso is a reality. Efforts must be made to sustain the activity and strengthen collaboration with hospitals in the north.

Treatment of nonunion in neglected long bone shaft fractures by osteoperiosteal decortication.

UNLABELLED: In emerging countries, nonunion in the shaft of fractured long bones is common. PATIENTS AND METHODS: In a 3-year long prospective study, 50 patients (38 men, 12 women) with an average age of 40.9 years (range 17-60) were treated for neglected diaphyseal nonunion an average of 11 months (range 6-48) after the fracture event. The femur was involved 14 times, tibia 22 times, humerus eight times and forearm bones six times. All of these patients had consulted initially with a traditional bone setter at the time of fracture. The surgical procedure consisted of osteoperiosteal decortication followed by repermeabilization of the medullary canal and then internal fixation. Compression plating was used for the humerus, radius and ulna. Nonunion of the middle-third of the femur and tibia was treated by intramedullary nailing and nonunion of the proximal third of the femur with an inverted DCS screw-plate. Patients were reviewed clinically and with X-rays on postoperative days 21, 45, 90 and 120. RESULTS: Bone union was obtained in under 90 days in the upper limb and under 120 days in the lower limb. No additional grafting was needed. There were only two cases of leg length differences. DISCUSSION: Osteoperiosteal decortication is a reliable technique that leads to predictable, satisfactory results, given the limited materials required to treat long bone nonunion in emerging countries.

Femur malunion treated with open osteotomy and intramedullary nailing in developing countries.

INTRODUCTION: In developing countries, malunion, after diaphyseal femur fractures initially untreated by internal fixation, is not rare. Their difficult management contrasts with the deficiency of the technical operating room facilities. PATIENTS AND METHODS: Our prospective study, conducted over a 1-year period, reports 16 open osteotomies fixed using Küntscher intramedullary nailing in patients who presented malunion of the femoral diaphysis. Twelve males and four females (mean age, 34.5 years; range, 18-67 years) were managed with a mean time to surgery of 8 months (range, 4-14 months). All had initially consulted a bonesetter. The mean length inequality was 3 cm (range, 2-6 cm); the mean knee flexion limitation was 90° (range, 10°-120°). Locking of the rotation was obtained by the obliquity of the osteotomy line. No bone filling was added but reaming and decortications were systematic. The patients were clinically and radiographically assessed at D21, D45, D90, and D120, based on the evaluation of the length inequality, mobility, and bone union. Rotational malunion or deformity were not analyzed. RESULTS: Fifteen patients had achieved union in 90 days. In one case, secondary incurvation of the nail led to changing the nail, allowing union with no axis deformity at D120. The mean postoperative knee flexion was 120° (range, 45°-130°). The mean gain in length was 2 cm (range, 1.5-4 cm). DISCUSSION: This open technique using non-interlocking material allowed us to obtain bone union while improving joint mobility and length inequality. LEVEL OF EVIDENCE: Level IV. Retrospective study.