Ventral partial diphallia associated with hypospadias: A case report.

Diphallia, or penile duplication, is a rare congenital urological malformation. It may be associated with other congenital malformations. The objective of present paper is to report the case of a two-year boy with ventral duplication of the penis associated with proximal hypospadias. The ventral penis was amputated, and Duckett urethroplasty was done. There were no reported postoperative complications in the follow-up.

Compared outcomes of femoral shaft fracture treatment in school-age children in Sub-Saharan Africa: Primary open reduction and intramedullary K-wire fixation versus traction followed by spica cast.

BACKGROUND: Elastic stable intramedullary nailing has become the treatment of choice for femur shaft fractures in school-age children in developed world. However, in the sub-Saharan Africa, this management is still challenging because of the lack of fluoroscopy in more hospitals. We performed either primary open reduction and intramedullary K-wire fixation (PORIKF) or conservative treatment. The aim of this study was to compare the clinical and functional outcomes of these two procedures employed. PATIENTS AND METHODS: This retrospective study included 62 children with 64 fractures (10 years on an average; range: 6-15 years) treating for femoral shaft fractures either by PORIKF (n = 21; 23 fractures) or skin traction followed by spica cast (n = 41) between 2008 and 2017. Outcomes were assessed using Flynn criteria. Comparisons were made by Fisher and Student's t-test with a significant P < 5%. RESULTS: Outcomes were satisfactory in 21 cases (91%) in the PORIKF group compared with 32 (78%) in the conservative group (P = 0.3012). The average hospital stay was 18.6 days in the PORIKF group, whereas it was 20 in the conservative group (P = 0.0601). The mean time for bone union was 13.9 weeks in the PORIKF group and 13.2 weeks in the conservative group, (P = 0.4346). There was a statistically significant difference between the two groups in terms of major complications (P = 0.0177). One patient had osteomyelitis in the PORIKF group. Unacceptable shortening >2 cm was observed only in the conservative group. The average time to return to daily activities was 30 days shorter in the PORIKF group when compared to conservative group (P < 0.05). CONCLUSION: PORIKF provides better results than conservative treatment. Open reduction did not increase the rate of infectious complication.

Management of femoral neck fractures in children: Experience of a short series in a developing country.

BACKGROUND: Fractures of the femoral neck are rare injuries in children but can have many devastating complications. Their treatment is not standardized, but the objectives are early anatomic reduction to minimize the risk for complications. The aim of this study was to assess outcomes of a short series of femoral neck fractures managed in a resource-limited setting. MATERIALS AND METHODS: The medical charts of 11 children who were managed in our institution for femoral neck fractures between January 2000 and December 2015 were assessed retrospectively. There were two cases (n = 2) of Delbet type I, 5 (n = 5) type II, and 4 (n = 4) type III fractures. Patients were treated either surgically by open reduction and internal fixation (n = 4) or conservatively by traction followed by spica cast (n = 7). Outcomes were assessed using Ratliff system. RESULTS: Femoral neck fracture incidence was one case per year. Of the 11 patients, there were 7 boys and 4 girls, with a mean age 9.4 ± 3.28 years. At the mean follow-up of 3.64 ± 1.97 years (range, 2-8.8 years), outcome was fair to good in 8 (72.7%) and poor in 3 (27.3%) cases. Average union time was 13.5 ± 1.77 weeks. Complication rate was 72.7%. Avascular necrosis occurred in three cases (27.3%). Six patients (54.5%) developed coxa vara, with a mean neck-shaft angle of 102.16° ±12.07° (range, 90°-118°). Five patients (45.5%) had leg length discrepancy with a mean 18 mm (range, 7-35 mm). DISCUSSION: local conditions negatively influenced the management of femoral neck fractures. Conservative treatment led to many complications which increase the cost of management.

[Treatment of epiphyseal fractures of the distal radial in children]. / Traitement des fractures decollements epiphysaires du radius distal chez l'enfant.

OBJECTIVE: To assess the results of treatment on epiphyseal fractures of the distal radius. MATERIAL AND METHODS: A retrospective study of 53 patients treated in the pediatric surgery department on children was conducted between 2002 and 2012 for a distal radius epiphyseal fracture. The mean age of 12.5 years. According to Salter-Harris classification, fractures were classified of type I in 35 patients (66%) and types II 18 (34%) cases. The average treatment time was 1.42 days. Firstly, closed reduction followed by an anti-brachial brachiocephalic palmar cast was performed on patients. Failure of the orthopedic treatment led to open reduction and pin fixation. Post-care results were evaluated on the functional and morphological study of the upper limb. RESULTS: Postoperative complications occurred in 7 patients. Failures of closed reduction were caused by irreducibility due to periosteum interposition in 5 patients with type II fractures and by a redisplacement in 2 patients with type I fracture. In these patients, treatment consisted of a fixation pin by open reduction. Positive results occurred in 49 cases (92.5%) and sequelae occurred in 4 (7.5%) patients. Sequelae were represented by a stiff wrist in 3 cases (5.6%), and limitation of prono-supination in 1 case (1.8%). CONCLUSION: The results of treatment of epiphyseal fractures of the distal radius in children are accompanied by a low rate of complications. But a long-term follow up is required because growth disturbances predominated among the complications.

L'objectif de ce travail était d'évaluer les résultats du traitement des fractures décollements épiphysaires du radius distal chez l'enfant. MATÉRIEL ET MÉTHODES: Etude rétrospective portant sur 53 patients traités dans le service de chirurgie pédiatrique entre 2002 et 2012 pour une fracture décollement épiphysaire du radius distal. L'âge moyen était de 12,5 ans. Les lésions étaient reparties selon la classification de Salter et Harris: type I 35 cas (66%), type II 18 cas (34%). Le délai thérapeutique moyen était de 1,42 jour. En première intention, une réduction par manœuvre externe était réalisée, suivie d'un plâtre brachial anti brachio palmaire. Les échecs du traitement orthopédique ont imposé une réduction chirurgicale par brochage à ciel ouvert. L'évaluation des résultats s'est basée sur l'étude fonctionnelle et morphologique du membre supérieur. RÉSULTATS: Des complications post thérapeutiques ont été observées chez 7 patients. Il s'agissait de 5 cas d'irréductibilité par interposition périostée dans le type II et 2 cas de déplacement secondaire dans le type I. Chez ces patients, le traitement a consisté à une ostéosynthèse par brochage à ciel ouvert. Une consolidation sans séquelle a été observée chez 49 patients (92,5%) et 4 patients (7,5%) ont présenté des séquelles. Les séquelles étaient représentées par une raideur du poignet dans 3 cas (5,6%), une limitation de la prono-suppination dans 1 cas (1,8%). CONCLUSION: Le traitement des fractures décollements épiphysaires du radius distal chez l'enfant s'accompagne d'un faible taux de complications. Il convient d'insister sur l'intérêt d'une surveillance prolongée en raison de la nature évolutive et du caractère imprévisible de trouble de croissance.

[Native psoas abcess in children. Case study at paediatric surgery department of university teaching hospital of Yopougon, Félix Houphouet Boigny university Côte d'Ivoire (Abidjan)]. / Abces primitif du psoas chez l'enfant. a propos d'un cas dans le service de chirurgie pédiatrique au CHU de Yopougon Université félix Houphouët Boigny de Cote d'Ivoire (Abidjan).

The authors report on a psoas abscess case whose diagnostic has been facilitated by the use of abdominal echography. The result has been successful due to the combination of antibiotherapy and echo-guided puncture.

Les auteurs rapportent un cas d'abcès primitif du psoas dont le diagnostic a été facilité par l'apport de l'échographie abdominale. L'évolution a été favorable grâce à l'association de l'antibiothérapie et de la ponction écho-guidée.