[The reasons for refusal and abandonment of treatment in the emergency surgery at the University Hospital Center of Bouake, Ivory Coast]. / Les raisons du refus et abandon de soins aux urgences chirurgicales du Centre Hospitalier et Universitaire de Bouaké, Côte d'Ivoire.

The refusal and abandonment of treatment is a behavior frequently observed in our daily practice. The purpose of this study was to describe the epidemiology and to identify the reasons for refusals and abandonment of treatment. We conducted a prospective study in the emergency surgery at the University Hospital Center of Bouake from 1st January 2018 to 31st December 2018. It involved all patients admitted with traumatic lesions who had refused or abandoned treatment. Data from 106 cases (16%) of refusal and abandonment of treatment out of 662 cases admitted with limb traumas were examined over this period. The average age of patients was 37 years. The study enrolled 77 men (72.6%). Tertiary sector workers accounted for 56.6% (n= 60) of cases. Lesions were dominated by closed fractures (82.1%; n= 87) and pelvic limbs were the most achieved (78.3%; n=83). Treatment was based on surgery (n=85; 80.2% ) and orthopaedic treatment (n=21; 19.8%). The cost of orthopedic treatment was estimated at 26 500 CFA francs (40 euros) while at 250 000 FCFA (380 euros) for surgical treatment. These costs varied as a function of implant prescribed and its location. Refusal of tratment was expressed by patients (n=30; 28.3%) and by parents (n=76; 71.7%). Reported reasons were dominated by financial problems (n=62; 58.5%), trust in traditional medicine (n=42; 39.6%), religious belief (n=2; 1.9%). The average time of refusal was 22 hours. Eighty eight point seven percent (n=94) of patients signed discharge while 11.3% (n=12) escaped. Refusal of care is a recurrent theme in our context and is due to inadequate health care management of people with limited financial resources.

[Fractures of the pelvis causing vaginal wound]. / Fractures du bassin occasionnant une plaie du vagin.

Pelvic fractures occur most often in people experiencing a traumatic event. Although they are due to high-velocity injuries, these lesions are rarely associated with vaginal wounds, and data on patients' evolution are scarce. The purpose of our study was to describe anatomoclinic lesions, treatment and progression of these lesions. The study involved five female patients who had had vaginal wounds due to pelvic fracture over the past decade. The patients had a mean age of 23,6 years. Vaginal wounds were mainly due to road accidents. Two patients had linear wounds and three had lacerated wounds. Vaginal suture was performed in all patients. After a mean follow-up period of 2 years, patients' evolution was favorable with healing of vaginal wound and bone. Genital and obstetric functions were not compromised. Although vaginal wounds most often go unnoticed, they should be suspected in female patients with pelvic fracture.

Résultats de la fixation centromédullaire par broche de Kirschner des fractures de la clavicule de l'adulte

Introduction : Dans les pays à ressources limitées, la broche de Kirschner est un implant de choix dans le traitement des fractures de la clavicule. L'objectif de cette étude rétrospective était de décrire les résultats de la fixation centromédullaire par broche de Kirschner des fractures de la clavicule de l'adulte. Patients et Méthode : Cette étude a concerné 21 patients (22 fractures). L'âge moyen était de 32 ans. Les fractures étaient fermées (n=19) et ouvertes (n=3). L'ostéosynthèse a été réalisée dans un délai de13 jours à foyer ouvert de manière rétrograde sans amplificateur de brillance. Une broche de Kirschner de 2 à 3 mm de diamètre a été utilisée par foyer de fracture. L'évaluation des résultats a concerné la réduction de la fracture, la cicatrisation de la plaie opératoire, la consolidation, les complications selon Millet, et les résultats définitifs selon Constant. Résultats : La réduction était satisfaisante (n=20). Il persistait une comminution initiale (n=2). La cicatrisation a été obtenue chez tous les patients dans un délai moyen de 3 semaines (2-4). La consolidation a été obtenue chez tous les patients avec un délai moyen de 3 mois (2-5). L'ablation de la broche a été réalisé à 2 mois chez tous les patients sous anesthésie locale en ambulatoire. Les complications notées étaient mineures. Au recul moyen de 2 ans (1-4), 15 patients (16 épaules) ont été revus. Le résultat fonctionnel final moyen selon le score de Constant était de 90 (88- 96). Conclusion : Cette étude suggère que la fixation centromédullaire par broche de Kirchner à foyer ouvert de manière rétrograde des fractures de la clavicule de l'adulte donne de bons résultats anatomiques et fonctionnels. Cette technique est simple. Elle n'est pas onéreuse

[Secondary amputation of the limb after primary surgery of open fractures of the lower limb]. / Amputations secondaires du membre après une chirurgie primaire des fractures ouvertes du membre inferieur.

This study reports the complications occurred during the management of open fractures of the lower limbs, resulting in secondary amputations, observed in clinicians' practice in recent years as well as different risk factors and possible deficiencies in management at the origin of these complications. We conducted a retrospective study over a period of 06 years (January 2006 - January 2012). It included patients with open fracture of the lower limb initially treated in our institution and whose complications resulted in amputation. All patient undergoing emergency amputation after examination at the Emergency Department were excluded. All patient treated in another hospital before being referred to us were excluded by the study, even if secondary amputation had been performed in our institution. We collected data by analyzing the records of patients (clinical and complementary examinations, surgical reports). We evaluated our management of open fractures of the lower limb according to the guidelines and recommendations found in the literature. These complications were observed in 9 out of 306 open fractures of the lower limb treated in the same period (January 2006 - January 2012), reflecting a rate of 2.9%. The average age was 42.6(26-57) years, all patients were male. We recorded 1 case of fracture of the femur, 7 cases of fracture of 2 leg bones and 1 case of foot crushing. These were open fractures including 1 case of type 1 fracture, 3 cases of type II fracture and 5 cases of type III fracture, according to Gustilo and Anderson classification. We performed 5 amputations of the thigh and 4 amputation of the upper third of the leg. Various complications motivated these amputations, including bone infections or soft-tissue gangrenes of ischemic or infectious origin. The patients had no morbidities such as diabete and were not chronic smokers. No patient died. Open fractures deserve special attention of the surgeon on immediade complications both from a diagnostic and therapeutic point of view in order to reduce the amputation rates after primary surgery giving patients the impression that they had an incorrect procedure performed on them. Particular attention should be paid to the degree of initial contamination and to the presence of a virulent germ at the site of trauma which may motivate particular attitudes during primary management.