Les cals vicieux diaphysaires du fémur de l'adulte traités par ostéotomie et ostéosynthèse à ciel ouvert à Bangui (République centrafricaine)

Introduction: Les cals vicieux diaphysaires du fémur sont le plus souvent les complications du traitement traditionnel des fractures. Cette étude avait pour objectifs de préciser les formes anatomo-cliniques des lésions, décrire la technique utilisée, et évaluer les résultats obtenus.Matériel et méthodes. Cette étude prospective incluait tous les cals vicieux diaphysaires du fémur de l'adulte traités entre juin 2011 et mai 2015. Leur gravité de la déformation était classée selon des critères propres. Les résultats du traitement étaient évalués au recul minimum de 12 mois avec les critères de Thorensen.Résultats L'étude incluait 34 patients (28 hommes et 6 femmes) avec un âge moyen de 30 ans (16 et 65). Les patients ont consulté après un délai moyen de 7,6 mois (4 et 24). Les cals vicieux siégeaient au tiers supérieur (n=6), au tiers moyen (n=16) et au tiers inferieur (n=12). Le traitement initial des fractures était traditionnel (n=22), chirurgical (n=8)et orthopédique (n=4). Les motifs de consultation étaient mixtes associant boiterie à la marche et douleurs articulaires (n=17), douleur isolée (n=8), boiterie (n= 8). Un patient a consulté pour raison esthétique (n=1). Le raccourcissement du membre était en moyenne de 2,6 cm (2 à 4). L'angulation moyenne était de 26,7° (4 à 45°). La mobilité du genou était de 90,4° en moyenne (45 à 120°). Le délai moyen de réalisation de l'ostéotomie était de 7 mois (4 et 25) après le traumatisme. L'ostéotomie était faite après décortication ostéo musculaire selon Judet. Un enclouage avec clou de Kuntscher a été faite pour 29 fractures médiodiaphysaires. Une plaque vissée a été utilisée pour 5 fractures proximales et distales. Aucun patient n'a été perdu de vue. Nous n'avons noté ni fracture iatrogène, ni lésion vasculaire et/ou nerveuse. Aucune infection du site opératoire n'était notée. La mobilité moyenne post-opératoire du genou était de 124° (110 et 135). Au recul moyen de 21 mois les résultats selon les critères de Thorensen étaient bon (n=12) et moyen (n=22).Conclusion Les cals vicieux fémoraux avec un raccourcissement maximal de 4 cm et une angulation à 45° peuvent être corrigés à foyer ouvert en un temps opératoire après une décortication ostéomusculaire

Surgical management of fractured neck of femur.

The fractured neck of femur is the classically described fracture in osteoporotic elderly patients. Further, the fracture has a strong predominance in post-menopausal women and, although relatively uncommon in both children and young adults, where present in this age group it is usually the result of significant trauma. In elderly patients, with an already weakened bone, even minimal trauma may be sufficient to cause fracture and as such a fractured neck of femur is often referred to as a fragility fracture.

Tibia fractures. An overview of evaluation and treatment.

The purpose of this article is to increase the reader's knowledge of tibial fractures, which are infrequently life threatening but are often life changing. The focus is on the continuum of care, starting with the mechanism of injury, classification of the tibial fracture and soft tissue involvement, approaches to stabilization and treatment options, postoperative care, potential complications, and considerations to discharge preparation. The parameters of nursing care extend to pain relief and positioning, nerve and vascular assessments, safe mobility, self-care, and prevention of complications.

Broken bones: common pediatric lower extremity fractures--Part III.

Lower extremity injuries and fractures occur frequently in young children and adolescents. Nurses are often one of the first healthcare providers to assess a child with an injury or fracture. Although basic fracture care and principles can be applied, nurses caring for these young patients must have a good understanding of normal bone growth and development as well as common mechanisms of injury and fracture patterns seen in children. Similar to many of the injuries in the upper extremity, fractures in the lower extremity in children often can be treated nonoperatively with closed reduction and casting. However, this article will also review several lower extremity fractures that frequently require surgical intervention to obtain a precise anatomical reduction. Common mechanisms of injury, fracture patterns, and current management techniques will be discussed. Teaching strategies and guidelines that will enable nurses and nurse practitioners to confidently educate parents, families, and other providers caring for these young patients will be reviewed.

Traumatic pelvic fractures.

Pelvic fractures can be a big challenge in caring for the injured patient. Pelvic fractures are important as a cause for morbitidy and mortality. The mortality can be 30% with unstable pelvic ring injuries, and 10-12% of this percentage alone is due to blood loss. Multiple complications can occur during a pelvic fracture. This article will help nurses assess and manage patients with pelvic injuries. Topics covered in the article include basic anatomy of the pelvis, diagnostic tests performed after a pelvic fracture, types of pelvic fractures, management of pelvic fractures, and complications.

Cuidados perioperatorios de Enfermería a paciente sometido a fijación externa / Peri-operative nursing care for the patient undergoing external fixation

La fijación externa es una técnica cada vez más utilizada en nuestros hospitales, dado que se puede emplear como técnica definitiva en la estabilización de fracturas cerradas, o provisional en fracturas abiertas o en las que existen una alteración cutánea. Además su indicación en muy versátil pudiéndose utilizar en el caso de fracturas en las vértebras cervicales, de la mandíbula, en la articulación de la muñeca, de las falanges, del codo, en fracturas de pelvis, de fémur, de la tibia, articulación de la rodilla y tobillo, entre otras. Además proporciona comodidad al paciente, disminuye el dolor, facilita los cuidados de enfermería y el transporte y movilización del mismo. Con todo ello se hace necesaria la realización de un plan de cuidados estandarizado en el perioperatorio de estos pacientes, que facilite el trabajo de las enfermeras, y permita la aplicación y registro de los mismos siguiendo una metodología científica (AU)

El object of this article is to establish the standardized nursing plan in the peri-operative care of patients with external fixation, the purpose of which is to facilitate the work of peri-operative nurses (AU)

Psychosocial issues relating to external fixation of fractures.

The use of external fixation devices has become increasingly popular for the treatment of fractures and for limb reconstruction procedures. This article reviews the nursing literature that examines psychosocial issues in the context of treatment with external fixation. Nearly all the evidence cited is anecdotal. Personal experience should not be ignored, but this review exercise highlights the lack of research-based evidence to back up provision of care in what is a fundamentally important aspect of the patient experience.

Kyphoplasty--minimally invasive vertebral compression fracture repair.

OSTEOPOROSIS is a skeletal disorder that compromises bone strength, predisposing a person to an increased risk of fracture. An estimated 700,000 spinal fragility fractures, such as vertebral compression fractures, directly related to osteoporosis occur annually. KYPHOPLASTY, a minimally invasive fracture reduction procedure, has become a treatment option for osteoporotic fractures. A balloon is used in place of the conventional bone tamp to reduce the fracture and create a void in cancellous spinal bone. Polymethylmethacrylate, a cement-like material, is injected into the void to stabilize the fracture. EARLY DIAGNOSIS AND TREATMENT of vertebral compression fractures with kyphoplasty allows normal anatomy to be restored, ultimately decreasing the risk of patient morbidity.

Hand and wrist fractures.

The upper extremities provide support, protection, and pleasure in the everyday activities of work, fun, sports, driving, and writing. When an upper extremity sustains an injury, it has a dramatic effect on quality-of-life issues. As professional caregivers, it is important to have a comprehensive understanding of the the effects of upper extremity fractures. The assessment of the patient with an upper extremity should consist of the general health of the patient after a traumatic event, determination of the mechanism of injury, assessment of the fracture site, confirmation of the exact injury, identification of potential complications, and assessment of the patient's social and professional statuses to identify potential problems that might affect treatment and rehabilitation

Hand and wrist fractures.

The upper extremities provide support, protection, and pleasure in the everyday activities of work, fun, sports, driving, and writing. When an upper extremity sustains an injury, it has a dramatic effect on quality-of-life issues. As professional caregivers, it is important to have a comprehensive understanding of the effects of upper extremity fractures. The assessment of the patient with an upper extremity should consist of the general health of the patient after a traumatic event, determination of the mechanism of injury, assessment of the fracture site, confirmation of the exact injury, identification of potential complications, and assessment of the patient's social and professional statuses to identify potential problems that might affect treatment and rehabilitation.

Cuidados de enfermería en niños con yeso pelvipedio / Nursing care in children with gypsum

El yeso pelvipedio se indica principalmente en niños con fractura de fémur como tratamiento postoperatorio, luego de realizada la reducción quirúrgica u ortopédica de la lesión. También se usa en niños operados de luxación congénita de caderas. En ambos casos los niños permanecen un período de 20 a 60 días con este tratamiento en su hogar. Este tipo de inmovilización que incluye pelvis, muslo y pierna según el caso, genera una serie de problemas reales o potenciales que requieren cuidados especiales de enfermería con el propósito de ofrecer al niño las mejores condiciones para su recuperación. En este artículo se dan a conocer los más importantes, especialmente para la primera etapa