Preliminary results of the induced membrane in upper limb. About 6 cases.

The aim of this study was to describe the preliminary results after reconstruction of segmental bone defects (SBDs) in the upper limb of six patients. This retrospective study included three men and three women with an average age of 35years (range 18-62years), who had four primary and two secondary SBDs. The average length of the SBD was 4.5 cm (2-10cm). According to the SOFCOT classification, type I (1 case), type II (4 cases) and type III (1 case) defects were identified. The reconstruction involved the humerus in two cases and the forearm bones in four cases. A posterior plaster cast was applied in all patients during the first stage of treatment. Internal fixation was used during the second phrase (five plates, one K-wire). The mean time elapsed between the first and the second stages of treatment was 3 months (2-4 months). At the final follow-up, bone union was obtained in five patients after an average of 4.6 months (4-6 months). The progression was favorable after the first stage of the induced membrane technique. However, two cases of sepsis were observed after the second stage of treatment, one evolving to osteitis that caused graft resorption. The induced membrane technique is a sequential technique used for treating SBDs. It is an alternative method of bone reconstruction in the upper limb.

Reconstruction par la technique de la membrane induite des pertes de substance osseuse du membre inferieur: résultats préliminaires

Introduction: La reconstruction des pertes de substance osseuse étendue du membre inférieur fait appel à plusieurs techniques. L'objectif de cette étude était d'évaluer les résultats préliminaires de la technique de la membrane induite. Matériels et méthodes: Cette étude rétrospective a concerné 20 patients qui avaient une perte de substance osseuse primaire (n=5) et une perte de substance osseuse secondaire (n=15). La longueur moyenne du défect était de 7,6 cm (2-13cm). Selon la classification de la SOFCOT, les lésions étaient de type 1 (n=5), type 3 (n=3), et type4 (n=2). La reconstruction concernait le tibia (n=14) et le fémur (n=6). Lors du premier temps, la contention a été assurée par une attelle plâtrée postérieure (n=2), le fixateur externe (n=14) et les broches (n=4). Le délai moyen entre le premier et le deuxième temps était de 5,23 semaines (4- 44 semaines). Des greffons iliaques cortico-spongieux ont été utilisés. L'évaluation des patients revus au contrôle a été réalisée selon les critères de l'ASAMI. Résultats: Avec un recul moyen de 2 ans (8mois-4 ans). La consolidation a été obtenue chez 15 patients dans un délai moyen de 9 mois (4 - 24 mois) au prix d'une seule intervention de greffe osseuse. Le résultat anatomique était excellent (n=10), bon (n= 3), moyen (n= 3)cas et mauvais (n=3). Le résultat fonctionnel était excellent(n=10 ), bon (n= 3), moyen (n= 3) cas et mauvais (n=3). Conclusion: La technique de reconstruction par membrane induite représente une méthode de choix dans l'arsenal thérapeutique des reconstructions osseuses malgré un délai assez long de consolidation en partie lié au retard de la réalisation du premier temps

[The recovery process after orthopedic surgeries in CHU of Treichville, Abidjan]. / Les reprises precoces en orthopedie traumatologie au CHU de Treichville--Abidjan.

OBJECTIVES: Determine the frequency of early chirurgical recaptures, their causes and therapeutic indications in order to prevent them. INTRODUCTION: The early chirurgical recaptures have been proposed to prevent early post operative infections. This repeat intervention must stop post operative sepsis and the evolutive process. The therapeutic indications have been opened to different complications as mechanic and technical complications. This study permitted to determine the causes of this treatment and its interest in our daily hospital practice. TOOLS AND METHODS: This retrospective study covered a period of 5 years between January 2000 and December 2005. During this period, 2562 operations have been realised in our service, and 68 cases (2.65%) concerned early chirurgical recaptures. Only 46 patients were concerned by the study according to our criteria which was that the early intervention would be realised before 4 weeks after the first operation. RESULTS: The average age of patients was 37.6 does not equal 13.3 years with a frequency of ages from 20 to 39 years about 47.8%. The initial injuries were varied and dominated by open fractures (12 cases) and foot diabetic gangrenes (08 cases). The deadline of the help and technical short comings has equally formed etiologic factors. CONCLUSION: The indications of early recaptures in orthopaedic traumatology are various. The knowledge of these indications is necessary for the prevention of certain post-operation difficulties.

[Aneurismal bone cyst of clavicle: A case report]. / Kyste anévrismal de la clavicule: à propos d'un cas.

Aneurismal bone cyst is a rare tumour. The authors report an exceptional case in its clavicle localization. They review the diagnosis circumstances and treatment modalities of this pathology. The occurrence of the cyst is linked to vascular homodynamic disturbance and its discovery in a post-traumatic context has been assessed by the histology exam. Although numerous therapeutic trials, radical removal versus conservatory methods avoid relapse. Finally, resection of the clavicle leading to few functional consequences should be recommended for the cure of evoluted aneurismal bone cyst.

Osteonecrosis of the hip in sickle-cell disease associated with tuberculous arthritis. A review of 15 cases.

We report a study of 15 cases of tuberculous hips with sickle-cell disease who presented during 1991-1993. Although the osteonecrosis was long-standing, biopsy was nearly always required to reveal the more recent tuberculous infection. Management consisted of 6 months of anti-tuberculous chemotherapy with appropriate palliative surgery 5-8 weeks after the start of drug treatment. The operative techniques which we used are described. The results were good both post-operatively, and in 12 patients followed-up at an average of 3 years. We recommend this combined management for the treatment of secondary tuberculous infections of hips previously damaged by sickle-cell disease.