Exclusive Fibula Osteosynthesis for Treating Open Fractures Gustillo I-III B of the Distal Half of the Leg Bones in a Resources-Limited Setting

Introduction: Management of open leg bones fractures is a challenging health issue for the surgeon, particularly true in resource-limited settings. In this study, we evaluate exclusive fibular osteosynthesis in the treatment of open fractures of the distal half of the leg bones as a therapeutic option in our context. Methods: This is a prospective, experimental, multicenter study of 30 open fractures of the distal half of the leg bones treated with exclusive fibula osteosynthesis, conducted in 3 hospitals in the DRC from January 1, 2013 to September 30, 2016. Results: The age range of 20 to 40 years grouped 22 (73.4%) patients, the sex ratio was 1:1 and the unemployed were the most involved with 16 (53.3%) cases. The Gustilo II, I, III B and III A types represented 40%, 33.3%, 20% and 6.7%, respectively. The fractures were located in the distal third in 12 (40%) cases, in the middle third in 11 (36.7%) cases, and in both malleoli in 7 cases (23.3%). Osteosynthesis of the fibula by screw plate was applied in 22 (73.3%) patients and pinning in 8 (26.7%). Satisfactory reduction of the tibial fracture site was achieved in 29 (96.7%) cases and 100% bone healing was achieved within an average of 10 weeks. Four (13.3%) loss of alignment, 1 (3.3%) infection, 1 (3.3%) skin necrosis and 2 (6.7%) ankle stiffness complicated our fractures. Conclusion: Exclusive osteosynthesis of the fibula as a common technique for fractures of the distal half of the leg bones allowed us to reduce, immobilize and consolidate the tibial fracture in the required time and to preserve the mobility of the ankle.

Fractures by Firearms in Conflict Town

For nearly two decades, the eastern Democratic Republic of Congo (DRC) has been plagued by war and abnormal movement of firearms is commonplace. The consequence of this is the increasing number of victim patients from gunshot wound at the hospitals. The aim of this study is to make an assessment of fractures caused by firearms and their management in a post conflict town. This is a retrospective, descriptive, multicenter study involving 123 cases with 128 fractures by firearms recorded during a period of 24 months from 1st January 2011 to 31st December 2012. Patients were recruited from 3 major hospitals in Bukavu town having a unit of fractures management. One hundred and six (86.9%) patients were males with the modal age in the ranks from 20 to 40 years old (mean 29.9 years). Seventy-one (57.7%) were civilians and 52 (42.3%) patients were soldiers;86 (78.2%) came from countryside. The reprisal was implicated in 77 (62.6%) cases. In 62.5% of cases, fractures were localized in the lower limbs and were treated orthopedically in ?50% of cases. The gunshot fractures in eastern DRC were mainly concerning the civilian young people living in the countryside and necessarily affected the bones of low limb. A study on fracture by firearms should be carried in the area where people have been wounded. Reducing the flow of gunshot could reduce the rate of fractures by firearms.

Fracture of Limbs Bones in a Town in Post Conflict (Case of Bukavu Town)

Background: Rapid urbanization and increasing fleet in low-income countries are the basis of the higher rate of trauma and fractures. In a post conflict environment, the abnormal movement of firearms and poverty from them may change the configuration’s epidemiological, anatomical and clinical fractures of the limbs bones as well as their care. Goal: To make an inventory on the fractures of the limb bones in Bukavu town, a town in post armed conflict. Method: This work is transversal, retrospective and descriptive on 500 fractures of the limbs bones recorded on a period of 3 months from 1st June to 31st August 2013. Twenty investigators went around different places of Bukavu town to interview and complete a research protocol ad hoc. In total, we recorded 500 subjects with 570 fractures of the limb bones. Results: The average age is 29.4 years old and 37% are male fractured. The main circumstances of occurrence of the fracture of the limbs bones are the falls (31.7%), firearms (22.2%) followed closely by road traffic accidents (21.9%). Students (38.6%) and the unemployed (29.4%) are most victims’ fractures of limb bones. The forearm bones (31.7%) and leg bones (27.2%) are most concerned, 52.2% fractured turned to modern medicine against 41.8% for traditional medicine. Conclusion: The fractures of the limbs bones in Bukavu mainly concern young male subjects. They occur with the waning of a fall and preferentially affect the bones of the forearm. Good governance would reduce the incidence of fractures of the limbs bones and their assessment.