RESUMO
AIMS: The object of this work is the study of especially ancient clinical forms of the effusion of Morel-Lavallée, to discuss the place of deep fascial fenestration by Ronceray and to propose criteria of therapeutic indication. PATIENTS AND METHOD: Our study concerns a continuous retrospective series over 20 years from 1989 till 2009. Eleven men and eight women, 36.7 year-old on average were treated for an effusion of Morel-Lavallée. The dominant etiology was represented by the accidents of the public highway. The collection was discovered after 41.4 days on average (extremes of 1-180 days). The volume of the collection was on average of 1237cm(3) (extremes 60cm(3)-12L). RESULTS: The conservative treatment concerned all patients who had a recent collection lower than three weeks and three others who had an ancient collection. The surgical treatment was established after all 10 times among which four in first intention and six times after failure of the previous treatment. The cure was obtained in 91% of the patients who had a recent collection by the only conservative method and among four patients by the method of Ronceray. To the three others, it was obtained after iterative unbridlings and talcage treatment. CONCLUSION: The authors insist on certain rare forms met in Africa in particular the "virtual form", the ancient forms and the too plentiful forms (12L). They plead for use deep fascial fenestrations by Ronceray for these last ones.
Assuntos
Pele/lesões , Tela Subcutânea/lesões , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Estudos Retrospectivos , Ferimentos e Lesões/terapia , Adulto JovemRESUMO
Long regarded as a disease exclusively found amongst Northern Europeans, Dupuytren's disease was seldom studied amongst Black Africans. Thus, we sought to study the impact of Dupuytren's disease, its etiological, clinical and evolutionary peculiarities on a segment of the Senegalese population. This study analyzed data derived from clinical observations carried out between January 2006 and December 2018. It involved Senegalese subjects with Dupuytren's disease, the patients' history, profession, habitus, clinical findings, therapeutic modalities and disease staging. The population included 20 men and 6 women averaging 63.5 years of age (range 45-77). None of the patients reported a family of Dupuytren's disease. Twelve patients had diabetes, 11 were smokers and 22 were engaged exclusively in manual labor. The condition was bilateral in 14 cases. Tubiana stages N, I, II, III and IV were found in 31, 15, 9, 5 and 6 rays, respectively. Conservative treatment was done in 11 patients. Surgical treatment was carried out in the other 15 patients: needle fasciotomy (N=10) including two bilateral involvement and open fasciectomy (N=7). Functional outcomes were satisfactory. Lesions were all stable in the short and medium term. Two patients had progressive lesions on a longer-term basis. Dupuytren's disease is real among Afro-descendants from Senegal even though it is seldom studied. Based on the patients' recollection of Dupuytren's disease in their families, heredity is not yet a proven factor. The early forms are more common, and the lesions remain stable for a long time.
Assuntos
População Negra , Contratura de Dupuytren/etnologia , Contratura de Dupuytren/terapia , Idoso , Tratamento Conservador , Contratura de Dupuytren/classificação , Fasciotomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Agulhas , Senegal/epidemiologiaRESUMO
Entrapment of the median nerve is a rare complication following dislocation of the elbow. The authors report a case of incarceration of the median nerve in a neglected dislocation of the elbow in an 18-year-old right-handed boy. The patient sustained a closed injury of the right elbow during a game. The initial treatment was performed by a traditional bonesetter and consisted of attempts at reduction followed by immobilization in extension. There was persistent pain and limitation of movement in the elbow and paraesthesiae in the long finger. This led the patient to consult us at 45 days postinjury. Radiographs showed a posterolateral dislocation of the elbow. Surgical reduction was carried out 6 months posttrauma. After opening of the capsule, we discovered the median nerve blocking the olecranon fossa, passing at the level of the groove of the trochlea where it was wedged between the latter anteriorly and the olecranon posteriorly before resuming its normal course. Reduction was obtained and the nerve replaced in its normal position. The postoperative course was uneventful with disappearance of the paresthesiae and restoration of a good range of movement of the elbow. The authors discuss the mechanism, the clinical forms and propose a new type according to the classification of Fourrier.
Assuntos
Lesões no Cotovelo , Luxações Articulares/complicações , Neuropatia Mediana/etiologia , Adolescente , Articulação do Cotovelo/cirurgia , Humanos , Luxações Articulares/cirurgia , Masculino , Neuropatia Mediana/cirurgia , Amplitude de Movimento Articular , ContençõesRESUMO
The treatment of fungal mycetoma is essentially surgical. This carcinological-like surgery consists of amputation in case of bone involvement. The recurrences after amputation are rare and address the problem of the operative indication. We report 5 cases of recurrence of fungal black-grain mycetoma after amputation of leg or thigh. Case 1: a 52-year-old patient with a mycetoma of the knee evolving for 8 years. There is no history of surgery. A thigh amputation with ganglion dissection is performed. One year after the surgical procedure, the patient presents a recurrence on the amputation stump and on the lymph node dissection site. An indication of hip disarticulation is made and performed 17 months after amputation. Case 2: a 25-year-old patient who has a black-grain mycetoma of the foot with osteitis evolving since 10 years. A leg amputation was performed. The patient had a recurrence at the popliteal level at 15 months postoperatively. An indication of amputation of the thigh is posed and refused by the patient. Case 3: a30-year-old woman with black-grain mycetoma of the knee with bone involvement for more than 10 years. A thigh amputation was performed and at nine months postoperativeshe presented a recurrence in the amputation stump. She was lost of sight despite the decision of surgical revision. Case 4: a 43-year-old patient operated on his foot and leg mycetoma at least 5 timesbefore amputation in 2000. The recurrence occurred one year after amputation. 18 years after amputation, a new surgical procedure was difficult due to extension of the lesions in the pelvis. Case 5: a 50-year-old female patient operated in Mauritania in 2012 (thigh amputation for mycetoma of the knee). She presented a recurrence on the amputation stump in 2018. An indication of disarticulation of the hip was posed and refused by the patient. These recurrences were testified by to the persistence of grains on the preserved segment. They pose the problem of the level of amputation and therefore of preoperative planning. Good preoperative planning allows optimization of the surgical procedure and avoids certain recurrences.
La chirurgie constitue le temps essentiel du traitement des mycétomes fongiques. Elle consiste en une amputation en cas d'atteinte osseuse. Nous avons observé 5 cas de récidives après amputation pour mycétome. Il s'agit dans tous les cas de patients présentant des mycétomes à grain noir avec atteintes osseuses. Les récidives sont survenues à moins de 18 mois de l'amputation faisant parler de reprise évolutive et posant le problème du niveau de l'amputation.
Assuntos
Amputação Cirúrgica , Doenças Ósseas Infecciosas/cirurgia , Extremidade Inferior/cirurgia , Micetoma/cirurgia , Adulto , Cotos de Amputação/microbiologia , Doenças Ósseas Infecciosas/microbiologia , Feminino , Pé , Humanos , Joelho , Perna (Membro) , Extremidade Inferior/microbiologia , Mauritânia , Pessoa de Meia-Idade , Recidiva , SenegalRESUMO
Mycetoma is transmitted by thorns infected. The commonest site for mycetoma is the foot. The primary pulmonary are rare and usually secondary to other primary site. We report a case of pulmonary fungal mycetoma secondary to primary site in the knee. We do a review of the literature and we discuss the way of dissemination.
Le mycétome se transmet principalement par piqures d'épines d'arbustes infectés. Les localisations primitives au niveau du pied sont les plus fréquentes. Les localisations pulmonaires sont exceptionnelles et secondaires à des localisations périphériques primitives. Nous rapportons un cas de localisation pulmonaire d'un mycétome fongique secondaire à une localisation au niveau du genou, puis nous faisons une revue de la littérature et nous discutons de la voie de dissémination.
Assuntos
Infecções Fúngicas Invasivas/diagnóstico , Traumatismos do Joelho/microbiologia , Pneumopatias Fúngicas/diagnóstico , Micetoma/etiologia , Ferimentos Penetrantes/complicações , Humanos , Infecções Fúngicas Invasivas/etiologia , Infecções Fúngicas Invasivas/microbiologia , Infecções Fúngicas Invasivas/patologia , Traumatismos do Joelho/complicações , Traumatismos do Joelho/diagnóstico , Pneumopatias Fúngicas/etiologia , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/patologia , Micetoma/diagnóstico , Senegal , Ferimentos Penetrantes/microbiologiaRESUMO
Black-grain mycetomas are fungal and cannot be healed by antifungals only.We conducted this study to determine the interest of carcinologic surgery only in the management of those black-grain mycetomas.We led a retrospective study concerning 44 patients over a period of 52 months. The mean age of patients was 32.5 years. The main location of mycetomas was the foot (21 cases), the ankle (10 cases), the knee (8 cases), the leg (3 cases), the chest, the back and the pulp of the fourth finger once each. The bone was affected in 21 cases. The surgery consisted in a carcinologic excision or amputation depending on the extension of the lesion and the degree of bony infringement, with ganglionic cleaning out in case of lymphadenopathy. In the average retrospect of 25.5 months, we noted 8 cases of recurrences among which 2 on the amputated patients and 6 on the patients treated by carcinologic excision. The surgery constitutes the main therapeutic issue of the fungal mycetomas.
Assuntos
Micetoma/cirurgia , Adolescente , Adulto , Idoso , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Micetoma/epidemiologia , Estudos Retrospectivos , Senegal/epidemiologia , Adulto JovemRESUMO
Anterior transolecranon fracture-dislocations of the elbow are rare in children and the literature is poor in recommendations for the management of these lesions. We report a new case with a type of lesion that has not been described previously and discuss this pathology. Based on a literature review, we propose a classification into four types of anterior transolecranon fracture-dislocations of the elbow in children, thereby guiding surgical indications. We recommend reduction and synthesis using a figure-eight tension-band wire in avulsions and transverse type I and II fractures. The bone plate is the best indication in type III oblique fractures in older children.
Assuntos
Lesões no Cotovelo , Fraturas Ósseas , Olécrano/lesões , Criança , Fraturas Ósseas/complicações , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares/complicações , Luxações Articulares/cirurgia , MasculinoRESUMO
INTRODUCTION: Neglected elbow dislocations often result in contracture and functional impairment. Surgical treatment is challenging because of the accompanying triceps retraction. We wanted to share our experience in treating these neglected dislocations using the posterior approach. PATIENTS AND METHODS: This was a consecutive, prospective study over a 4.5-year period (January 2003 to June 2007) that included all the patients who presented with a neglected elbow dislocation that was older than 21 days. We treated 22 patients (17 men, five women) with an average age of 22.8±8.2 years (range 14 to 46 years). The dislocations were 8.5±4.2 months old on average (range 2 to 17 months). Average elbow flexion was 46.0°±25.9° (10° to 90°) and the extension deficit was 19.5°±18.4° (0° to 60°) before the surgery. A paratricipital approach was used in all patients. In 14 patients, the dislocation was reduced without triceps lengthening. In eight patients, a V-Y plasty of the triceps muscle was required. RESULTS: The average follow-up was 21 months (range 12 to 30 months). The improvement in the overall range of motion was statistically significant. Average elbow flexion was 112.7°±13.3° (60° to 130°) and the extension deficit was 26.6°±17.0° (0° to 60°). The average Mayo Clinic Elbow Performance Index score was 86 (range 50 to 100), with 14 excellent, four good, two average and two poor results. Complications included three cases of ulnar nerve paresis, which subsided within three months, and one case of superficial infection. DISCUSSION: Although surgical treatment is challenging, the functional improvement in neglected elbow dislocations is outstanding. The best functional results can be expected when the triceps splitting approach to the elbow is not used. LEVEL OF EVIDENCE: IV.
Assuntos
Articulação do Cotovelo/cirurgia , Luxações Articulares/cirurgia , Doenças Negligenciadas/cirurgia , Procedimentos Ortopédicos/métodos , Adolescente , Adulto , Idoso , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/fisiopatologia , Feminino , Seguimentos , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia , Amplitude de Movimento Articular , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIFS: Consensual treatment of the Galeazzi's fracture is a plate osteosynthesis of the radius more or less associated to the confection of a plaster cast in distal radio-ulnar joint (DRUJ) dislocation. The authors are reporting in this study the clinical and functionnal results of the intra-medullary pinning of the radius in this type of fracture in adult. METHODS: During a prospective study from January 2003 to December 2006, 23 patients (20 men and three women), average-aged of 32 years (16-70 years) presenting with a Galeazzi's fracture were treated by an intra-medullary pinning of the radius. The DRUJ dislocations were locked 17 times by a brachio-ante-brachio-palmar plaster cast in the supination position, and six times by an ulno-radial pinning. Only the 16 over-aged patients presenting with closed recent fractures were included in this study. The DRUJ dislocation was ranked according to Mansat, the radial fracture according to Müller (AO). The assessment of the treatment results used Mestdagh's criteria. In this study, each pseudarthrosis of the radius was considered as a failure. RESULTS: The DRUJ dislocation was reparted into six sprains, eight subdislocations, and three Galeazzi's fracture equivalents. The radius fractures were simple (n=20) or wedge fractures (n=3). These fractures were located at the proximal third (n=13), middle third (n=7) and distal third (n=3). The average consolidation delay was 10 weeks (8 to16 weeks). Two pseudarthrosis have been observed and then treated by a plate osteosynthesis. At the mean follow up of 37 months (18 to 41 months), the mean score according to Mestdagh was 7.8 points, with 20 satisfying results. Nineteen patients were satisfied by their treatment; the reasons were: the esthetic care of their scar, and the good functionnal resumption, as well as before the fracture. CONCLUSION: The intra-medullary pinning of radius in Galeazzi's fractures, in contrary to the previous studies, give good results compared to a plate osteosynthesis treatment. The systematic complementary lock by brachio-ante-brachio-palmar plaster cast during 3 to 4 weeks has balanced the stability defect that Mikic was reproaching to it. Moreover, it confers the benefits of elastic closed osteosynthesis. That less simple and less expensive method represents an alternative to a plate osteosynthesis in Galeazzi's fractures in adult, if it is well standardized.
Assuntos
Fixação Intramedular de Fraturas , Fraturas do Rádio/cirurgia , Adolescente , Adulto , Idoso , Moldes Cirúrgicos , Feminino , Humanos , Luxações Articulares/cirurgia , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Articulação do Punho/cirurgia , Adulto JovemRESUMO
AIMS: Evaluate the technique of Bristow-Latarjet in the treatment of the recurrent dislocation of the shoulder. PATIENTS AND METHODS: It was a continuous retrospective study on 46 cases selected in the CHU of Dakar over 11 years. From our criteria of inclusion, 41 patients were retained. There were 37 men for 4 women, whose average age at the time of the intervention was 29 years (extreme: 20 - 44 years). The management of the first episode was unsuited in 25 times. The average time of the first repetition was 10 months and its number varied between 5 and 36 episodes. The treatment of the recurrences was also misfit in 23 times. All our patients were treated according to the technique of Bristow-Latarjet. A standard immobilization Mayo clinic during 3 weeks was made with a systematic rehabilitation. The evaluation was done according to the scale of Constant with 45,6 months an average retreat. RESULTS: We found: 7 excellent cases (17%); 14 very good cases (34%); 9 good cases (22%); 6 average cases (15%); 5 bad cases (12%). Five cases of omarthrosis (3 types II and 2 types III of Samilson-Prieto) were found like two surface cases of sepsis. There was neither post-operative recurrence nor iatrogenic nervous attack. CONCLUSION: The recurrent anterior dislocation of the shoulder represents a frequent complication of primary dislocations of the shoulder touching especially young subjects. Stabilization by the anterior coracoid abutment according to the technique of Bristow-Latarjet led well represents one of the best techniques for its treatment.
Assuntos
Instabilidade Articular/cirurgia , Procedimentos Ortopédicos , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia , Adulto , Feminino , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Luxação do Ombro/prevenção & controle , Adulto JovemRESUMO
Il s'agit d'une étude faisant ressortir les aspects épidémiologiques, cliniques et thérapeutiques des séquelles de brûlures du membre inférieur chez l'enfant, à propos de 42 cas colligés au service de chirurgie infantile de l'Hôpital Aristide Le Dantec (Sénégal). L'âge moyen retrouvé est de 5 ans et 3 mois, et le sex-ratio garçons/filles de 1,8/1. La brûlure thermique est causée par une flamme dans 33% des cas, par un liquide chaud dans 21% des cas, et par des braises dans 21% des cas. Les cicatrices rétractiles intéressent le genou et le creux poplité dans 47% des cas et le pied dans 45% des cas. Elles sont bilatérales dans 21% des cas, et concernent une autre localisation associée dans 21% des cas. Quant aux brides, 21% ont bénéficié d'une chirurgie, avec un délai moyen de 3 ans et 2 mois après la brûlure. Cette procédure chirurgicale consiste en une plastie en Z dans 91% des cas, à laquelle est associée une greffe de peau dans 54% des cas. Une rééducation fonctionnelle est pratiquée chez 54% des opérés. Parallèlement aux données de la littérature, nos résultats montrent que l'optimisation de la prise en charge passe par une meilleure prévention des accidents domestiques et une bonne codification thérapeutique.
RESUMO
The authors report a case of apophysial fracture of the odontoid process in association with paresis of the upper extremities in a 5-year-old child. The fracture was treated by gradual guided self-reduction without anaesthesia, followed by a Minerva jacket cast immobilisation. Reduction was anatomical, and the neurological problems regressed within 48 hours.
Assuntos
Moldes Cirúrgicos , Manipulação Ortopédica/métodos , Processo Odontoide/lesões , Fraturas da Coluna Vertebral/terapia , Fatores Etários , Vértebras Cervicais/lesões , Pré-Escolar , Seguimentos , Consolidação da Fratura/fisiologia , Humanos , Imobilização/métodos , Masculino , Processo Odontoide/diagnóstico por imagem , Radiografia , Medição de Risco , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fatores de Tempo , Resultado do TratamentoRESUMO
The purpose of this work is to estimate our anatomical and functional results of the surgical technique based on the AO principle of tension band wiring. We led a retrospective continuous study on the basis of 70 files brought together from January, 1999 till December, 2006. We had included all the patients who presented a recent fracture of the olecranon treated by tension band wiring and having a follow-up more than 6 month. Seven (7) files were excluded giving to the study one population of 63 patients. The fracture was classified according to the classification of Mayo clinic and the associated hurts were noted. The tension band wiring was the exclusive treatment. The evaluation looked for the complications and appreciated the radiological and functional results according to the score of Mayo Elbow Performance Score. We had found 48 fractures of type II and 15 fractures of type III. There were 5 cases of cutaneous punctiforme opening, a fracture of the ipsilateral forearm in 3 cases, a fracture of the thighbone in 1 case and a dislocation of the elbow associated with a fracture of the humerus in 1 case. The consolidation was obtained at 60 patient's at the end of 4 months on average (extremes: 3 and 6 months). There were 3 cases of non union and 5 cases of pins migrations. On the functional plan, we obtained 15 very good results, 26 good results, 19 average results and 3 bad results. The most frequent and the most common fractures of the elbow, the olecranon fractures treated by tension band wiring give good results.
Assuntos
Fios Ortopédicos , Fraturas da Ulna/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
Umbilical hernia is as frequent pathology in our country. The skin excess is a real problem for the surgeon because it is inesthetical. We report 77 cases of children with umbilical hernia who we operated between 1999 and 2000. Fifty-five of them have a umbilical plasty. For this, we used three surgical techniques: lateral left plasty, "horseshoe" plasty and umbilical graft. We classed our results into three groups: 40 good results, seven middle results and three bad results. Twenty-seven patients are lost. These three surgical techniques are a simple and safe solution to this problem of skin excess in the umbilical hernia.