Induced membrane technique for reconstruction of a 25 cm humerus diaphyseal defect secondary to chronic osteomyelitis in an adolescent.

The surgical treatment of long bone defects in septic environments remains a challenge for any orthopedic surgeon. The two-stage reconstruction technique described by Masquelet AC is a better alternative in our regions where expertise in microsurgical techniques is rare. We report our first experience with this technique through the reconstruction of the humeral diaphyseal bone defect. We presented a 12-year-old boy diagnosed with chronic osteomyelitis of the left humerus with sequestrum, a pathologic fracture with overly joint involvement. The first stage consisted of a sequestrectomy removing the entire humerus shaft (25 cm) with conservation of the humerus paddle followed by the implantation of cement spacer into the bone defect and stabilization with 2 Kirschner wires (22/10th) and a thoraco-brachial cast. Eleven months later, we performed a cancellous autograft associated with a free non-vascularised fibula graft (12 cm). The bone corticalisation was obtained after 11 months. At the 43-month follow-up, despite joint stiffness and unequal length of brachial segments, the patient and his parents were satisfied.

Epidemiological and diagnostic characteristics of scoliosis in children in a single tertiary centre in Abidjan.

Introduction: Scoliosis is the most frequent spine deformity in children. Epidemiological data are available in Western countries due to the systematic screening policies implemented at school. Unfortunately, in our country, there are neither national data nor screening policy for scoliosis. Are the epidemiological and diagnostic characteristics of scoliosis in our practice similar to the data in the literature? Patients and Methods: We retrospectively reviewed 106 medical records of patients under 19 years old between 2010 and 2019 at the 'Vivre Debout' Centre for structural scoliosis confirmed by spine X-ray with a Cobb angle ≥10°. The epidemiological and diagnostic characteristics were noted. The data were treated with Excel 2010. Results: The mean frequency of scoliosis was 10 cases/year. The male-to-female sex ratio was 1:1.3. The mean age at diagnosis was 11.2 ± 2.13 years. There was a family history of scoliosis in two cases (1.8%). Twenty-four girls (39.3%) out of 61 had had menarche at the time of diagnosis. The mean time from noticing deformity to consultation was 17.9 ± 21.9 months. Lateral deviation of the spine (n = 77; 72.6%), hump (n = 12; 11.3%) and pain (n = 3; 2.8%) were the main complaints for consultation. In 14 cases (13.2%), the discovery was fortuitous during a medical examination for another complaint. The curvature was single in 88 cases (83%) and double in 18 (17%). The convexity was right in 69 cases (65.1%) and left in 37 (34.9%). Curvatures were thoracic (n = 57; 53.8%), lumbar (n = 10; 9.4%) and thoracolumbar (n = 39; 36.8%). The average Cobb angle was 35.2° ±10.71° (range: 11°-90°). Curvatures were moderate (20°-40°) in 49 cases (46.2) and severe (>40°) in 18 (17%). The aetiologies were predominated by idiopathic causes (n = 79; 74.5%), followed by congenital (n = 16; 15.1%) and neuromuscular (n = 11; 10.4%) causes. Conclusion: Scoliosis is uncommon in our practice. It is characterised by single curvature. The predominance of moderate and severe curvatures was due to delayed consultation.

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.

Aesthetic, urological, orthopaedic and functional outcomes in complex bladder exstrophy-epispadias's management.

BACKGROUND: Postoperative complications are related to the surgical procedures, of failures of initial bladder closure and influence the urological, aesthetical and orthopaedic outcomes. MATERIALS AND METHODS: We reviewed four patients who underwent complex bladder exstrophy-epispadias repair over a period of 14 years. The outcomes of treatment were assessed using, aesthetic, urological and orthopaedic examination data. Orthopaedic complications were explored by a radiography of the pelvis. RESULTS: Out of four patients who underwent bladder exstrophy surgical management, aesthetic, functional outcomes and complications in the short and long follow-up were achieved in three patients. The first patient is a male and had a good penis aspect. He has a normal erection during micturition with a good jet miction. He has a moderate urinary incontinence, which requires diaper. In the erection, his penis-measures 4 cm long and 3 cm as circumference. The second patient was a female. She had an unsightly appearance of the female external genitalia with bipartite clitoris. Urinary continence could not be assessed; she did not have the age of cleanness yet. The third patient had a significant urinary leakage due to the failure of the epispadias repair. He has a limp, a pelvic obliquity, varus and internal rotation of the femoral head. He has an inequality of limbs length. Pelvis radiograph shows the right osteotomy through the ilium bone, the left osteotomy through the hip joint at the acetabular roof. CONCLUSION: When, the epispadias repair is performed contemporary to initial bladder closure, its success is decisive for urinary continence. In the female, surgical revision is required after the initial bladder closure for an aesthetic appearance to the external genitalia. Innominate osteotomy must be performed with brilliancy amplifier to avoid osteotomy through to the hip joint to prevent inequality in leg length.

Epidemiology of congenital abnormalities in West Africa: Results of a descriptive study in teaching hospitals in Abidjan: Cote d'Ivoire.

BACKGROUND: Congenital abnormalities constitute one of the major causes of infant mortality, particularly in developing countries. The aim of this study was to describe the epidemiology of congenital anomalies in Cote d'Ivoire. MATERIALS AND METHODS: It was a multicentric study of three academic hospitals and the Heart Institute of Abidjan over 10 years. The epidemiologic Data concerned the Parturients, the annual frequency of congenital abnormalities. Distribution of the congenital abnormalities according to the organs, overall mortality and lethality of congenital abnormalities were evaluated. RESULTS: Over 10 years, 1.632 newborns with 1.725 congenital anomalies were recorded. Frequency was 172.5 congenital anomalies per annum. Parturients were less than 35 years in 33% of cases, multigravida in 20%, multiparous in 18% and had a low socio economic status in 96% of cases. Prenatal diagnosis of congenital anomalies was performed in 1.5%. Congenital anomalies were orthopedic in 34%, neurological in 17%, gastrointestinal in 15%, facial in 11.5%, parietal in 13%, urogenital in 9% and cardiac in 0.5% of cases. The overall mortality rate of congenital anomalies was 52% and gastroschisis was the most lethal disease with 100% mortality. CONCLUSION: This descriptive study reveals the low socio economic status of Parturients with congenital anomalies and their poor prenatal diagnosis. These factors explain the very high mortality of congenital anomalies due to a delay management in our country in which medical expenses were borne by parents and where technical platforms remain obsoletes for good resuscitation and neonatal surgery.

Complex bladder-exstrophy-epispadias management: causes of failure of initial bladder closure.

The success of the initial closure of the complex bladder-exstrophy remains a challenge in pediatric surgery. This study describes a personal experience of the causes of failure of the initial closure and operative morbidity during the surgical treatment of bladder-exstrophy complex. From April 2000 to March 2014, four patients aged 16 days to 7 years and 5 months underwent complex exstrophy-epispadias repair with pelvic osteotomies. There were three males and one female. Three of them had posterior pelvic osteotomy, one had anterior innominate osteotomy. Bladder Closure: Bladder closure was performed in three layers. Our first patient had initial bladder closure with polyglactin 4/0 (Vicryl ® 4/0), concerning the last three patients, initial bladder closure was performed with polydioxanone 4/0 (PDS ® 4/0). The bladder was repaired leaving the urethral stent and ureteral stents for full urinary drainage for three patients. In one case, only urethral stent was left, ureteral drainage was not possible, because stents sizes were more important than the ureteral diameter. Out of a total of four patients, initial bladder closure was completely achieved for three patients. At the immediate postoperative follow-up, two patients presented a complete disunion of the abdominal wall and bladder despite an appropriate postoperative care. The absorbable braided silk (polyglactin) used for the bladder closure was considered as the main factor in the failure of the bladder closure. The second cause of failure of the initial bladder closure was the incomplete urine drainage, ureteral catheterisation was not possible because the catheters sizes were too large compared with the diameters of the ureters. The failure of the initial bladder-exstrophy closure may be reduced by a closure with an absorbable monofilament silk and efficient urine drainage via ureteral catheterisation.

Sporadic occurrence of jarcho-levin syndrome in an ivorian newborn.

We report on an isolated chest-wall asymmetry with imaging findings of multiple vertebral and related rib defects in an Ivorian male newborn. He was born of a healthy and young couple without parental lineage, neither family malformative history nor teratogen exposure. This clinical presentation advocates Jarcho-Levin syndrome, a rare sporadic or familial disorder inherited as autosomal dominant or recessive mode and manifested by extensive vertebral segmentation defects with distinctive rib structural and morphological anomalies. According to our belief, this disorder has not been previously traced in the sub-Saharan African area.

Traitement des fractures décollements épiphysaires du radius distal chez l'enfant

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 I35 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 parune 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