[Epidemiology of cervical spine injuries in National teaching hospital Hubert K. Maga of Cotonou]. / Epidemiologie des traumatismes du rachis cervical au centre National hospitalier et universitaire Hubert K. Maga de Cotonou.

INTRODUCTION: Trauma to the cervical spine is a real public health problem. They can cause neurological complications that are sometimes irreversible and mortality remains high. The causes are dominated by traffic and work accidents. We assess their epidemiological and lesional aspects in our work environment. MATERIAL AND METHOD: This was a descriptive retrospective study of any cervical spine trauma patient admitted to the National teaching hospital Hubert Koutoukou Maga of Cotonou between January 2010 and June 2014 for which the clinical file was complete. RESULTS: 57 files were retained. The average age was 38.7 years (19 - 71 years). The predominance was male with a sex ratio of 4.2. The mean admission time was 27.5 days (3 hours - 175 days). As aetiologies, we found: traffic accidents (41 cases or 71.9%), work accidents (13 cases or 22.9%) and domestic accidents (3 cases or 5.3%). From an anatomopathological point of view, there were 16 simple fractures, one compression fracture, 13 dislocation fractures, 15 pure dislocations, 5 sprains, 2 post-traumatic disc herniations and 5 decompensations of cervicarthrosis myelopathy. The lesions involved the upper cervical spine (7%), the lower cervical spine (71.9%), the upper and lower cervical spine (21.1%). Thirty-two patients (56.1%) were quadriplegic and autonomic disorders were present in 7 patients (12.3%). CONCLUSION: Cervical spine trauma is frequent in Cotonou. They are often of interest to the young male subject. The lesions predominate on the lower cervical spine.

INTRODUCTION: Les traumatismes du rachis cervical constituent un véritable problème de santé publique. Ils peuvent engendrer des complications neurologiques parfois irréversibles et la mortalité reste élevée. Les étiologies sont dominées par les accidents de circulation et de travail. Nous étudions leurs aspects épidémiologiques et lésionnels dans notre milieu de travail. MATÉRIEL ET MÉTHODE: Il s'agissait d'une étude rétrospective descriptive portant sur tout traumatisé du rachis cervical admisdans le Centre National Hospitalier et Universitaire Hubert Koutoukou Maga de Cotonou entre janvier 2010 et juin 2014 dont le dossier clinique était complet. RÉSULTATS: 57 dossiers ont été retenus. L'âge moyen était de 38,7 ans (19 - 71 ans). La prédominance était masculine avec un sex-ratio de 4,2. Le délai moyen d'admission était de 27,5 jours (3 heures -175 jours). Comme étiologies, on retrouvait : lesaccidents de circulation (41 cas soit 71,9%), les accidents de travail (13 cas soit 22,9%) et les accidents domestiques (3 cas soit 5,3%). Au plan anatomopathologique, on dénombrait, 16 fractures simples, une fracture tassement, 13 fractures-luxations, 15 luxations pures, 5 entorses, 2 hernies discales post-traumatiques et 5 décompensations d'une myélopathie cervicarthrosique. Les lésions intéressaient le rachis cervical supérieur (7%), le rachis cervical inférieur (71,9%), le rachis cervical supérieur et inférieur (21,1%).Trente-deux patients (56,1%) étaient tétraplégiques et des troubles neurovégétatifs étaient présents chez 7 patients (12,3%). CONCLUSION: Les traumatismes du rachis cervical sont fréquents à Cotonou. Ils intéressent souvent le sujet jeune de sexe masculin. Les lésions prédominent sur le rachis cervical inférieur.

Outcomes of lower limb amputees at Cotonou.

BACKGROUND: Limb amputations are responsible for disability. We studied the outcomes of lower limb amputees in our daily practice. METHODS: This prospective analytical study over 7 years (January 2009-December 2015) included 70 amputees of lower limb. They were mainly male (73%), aged on average of 42.4 ± 18.8 years. The mean time of follow- up was 3.2 ± 1.9 years. We assessed disability on balance, walking, disability in daily life for patients with prosthesis, and the socio-economic impact of the amputation. Statistical analysis was performed with Chi2 and Mann-Whitney tests; a p-value ≤ 0.05 was considered statistically significant. RESULTS: The average Timed Up and Go Test was 18.5 s. Class II of Pohjolainen subjects were the most recovered (37%). The mean Houghton score in the 17 fitted patients was 6.2 ± 2.0. Socially, 90% of the patients no longer practiced leisure activities, and 4/53 patients were no longer in a couple. At the economic level, 87% of patients had a decreased monthly income. Factors that bear direct correlation to functional outcome of patients were the level of amputation, and the prosthesis fitting. CONCLUSION: Lower limbs amputations entail adverse consequences at the functional and socio-economic level. Our country must review its policy on prosthetic fittings for amputees, and vote laws that involve private firms and government in socio-economic reintegration, and empowerment of these subjects.

Ipsilateral proximal and shaft femoral fractures.

PURPOSE: To study the management and evaluate anatomical and functional outcomes of patients with ipsilateral proximal and shaft femoral fractures. METHODS: A retrospective, descriptive and analytic study lasted for ten years and a half ranging from January 1, 2005 to June 30, 2015. The following parameters were studied: epidemiology, fracture characteristics, therapeutic, anatomical and functional outcomes. The correlation between different parameters was analyzed with Fischer test. The significant threshold was defined for p value <0.05. RESULTS: Ten medical files were registered. There were 7 men and 3 women, with a sex ratio of 2.33. The average age was 46 years (range: 29-62 years). It was about traffic road accidents in all cases. Motorcycle-motorcycle and motorcycle-car collision were most frequent. Average admission delay was 7 h (range: 1.5-24 h). Left side was most reached in 8 cases. According to Garden classification, there was type III cervical fracture in 2 cases, type II in 1 case and type IV in 1 case. According to Ender classification, there was type I trochanteric fracture in 3 cases, type VI in 2 cases and type VII in 1 case. According to AO classification, there was type A shaft fracture in 6 cases (A2 in 4 cases and A3 in 2 cases), type B in 2 cases (B1 in 1 case and B2 in 1 case) and type C in 2 cases (C1 in 1 case and C2 in 1 case). Average surgical delay was 28.7 days (range: 11-61 days). For proximal femoral fracture, Moore prosthesis was used in 1 case, blade plate 130° in 2 cases, long Gamma nail in 4 cases, double screwing in 2 cases and dynamic hip screw in 1 case. For shaft femoral fracture, blade plate 95° was used in 3 cases, low compressive plate in 2 cases. Osseous contention was achieved in 4 cases with long Gamma nail and in 1 case with long blade plate 130°. Nonunion of cervical fracture was achieved in 2 cases. The average osseous healing delay was 5.14 months (range: 3-12 months) for proximal femoral fracture and 5 months (range: 3-8 months) for shaft femoral fractures. According to Friedman and Wyman criteria, functional results were good in 4 cases, average in 4 cases and bad in 2 cases. Regarding implants, healing delay showed no statistic difference between one-implant group and two-implant group (p = 0.52), and among the patients with different functional outcomes (p = 0.52). Functional outcomes showed no statistic difference between one-implant group and two-implant group (p = 0.46). CONCLUSION: Ipsilateral proximal and shaft femoral fractures are relatively uncommon in our daily activities. It is difficult to recognize proximal femoral fractures which are unnoticed. Results are generally good if the doctors take the two fractures into account in the management.

The Direct Cost of Treatment of Traumatic Brain Injury in a Sub-Saharan African Country (Benin).

OBJECTIVES: This is the first socioeconomic study on traumatic brain injury (TBI) undertaken to determine the sociodemographic factors implicated in the occurrence of TBI and to assess the value of the direct cost of the management of TBI at the initial phase in the Hubert Koutoukou Maga National Teaching Hospital of Cotonou. METHODS: This was a prospective study with descriptive and analytic aim that took place from January 1 to July 31, 2014. An individual approach of each patient's expenditure was undertaken via the use of a questionnaire on which all expenses were identified systematically. The dependent variable was the global direct cost of care. The independent variables were the type of accident, severity of the TBI, the structures of care, the stay in the resuscitation unit, the duration of hospitalization. RESULTS: There were 297 patients with TBI: 258 men (86.9%) and 39 women (13.1%), with a sex ratio of 6.61. The average age of patients was 34.3 ± 12.39 years. The average direct cost of care for TBI was €285.67 ± 310.15. The average cost for severe TBI was €522.08 ± 439.91 versus €188.19 ± 164.83 for mild TBI (odds ratio 5.52; standard deviation: 0.0527-0.6222). The average cost was increased significantly more when the patients went through a peripheral hospital (odds ratio 3.65; standard deviation: 1.819-7.3245). CONCLUSIONS: The organization of Benin's health system did not allow for the optimum management of TBI. It seems imperative to develop an insurance system that will allow a proper and effective support for victims of traffic accidents.