Hip Disarticulation for Severely Injured Lowerlimbs about 11 Cases and Literature Review

Introduction: Hip disarticulation (HD) consists of a removal of the entire lower limb at the height of the hip-femoral joint. It is an extremely mutilating intervention with a major functional and psychological impact. We report 11 cases of hip disarticulation following severe trauma of the lower limb. The aim of the study is to analyze the frequency, the clinical aspect and present their management results and the patients’ becoming. Patients and methods: A 13-year retrospective study was conducted in our traumatology department. Eleven cases of hip disarticulation were identified. We analyzed the following data: the epidemiological parameters (age, sex, accidentology), Clinico-radiological (gravity injury severity score (ISS), mangled extremity severity score (MESS), associated lesion), admission time, evolutionary aspects and finally the patients’ becoming). Results: The series consisted of 3 males and 8 females, with an average age of 24 years. All experienced a HD following the lower limb severe traumatism due to a road accident. The category of victims was dominated by pedestrians. The average admission time was 13 hours with extremes of 9 and 28 hours. Our series average ISS was 28 with extremes of 15 - 69. The associated lesions were dominated by Gustilo Type III A III B open fractures. The mean MESS at admission was 10 with extremes from 8 to 14. Complications were dominated by infection (at least 72%) with a mortality rate of 36.36%. Algohallucinosis affects all these patients post-operatively at varied degrees. Aggressive components and denial of bereavement were most noticeable. Only one patient was able to honor her Canadian prosthetic equipment. All the victims changed their personal and professional activities. Conclusion: HD is an extremely mutilating surgery with a major functional and psychological impact. Quality of life of the disarticulated patient is taught because of the persistence of the pain, the occurrence of a major motor handicap and the impossibility of apparatus limiting the social and relational life.

Clinical Case of Bilateral Rupture of the Patellar Tendon of the Late Diagnosis

Defined as a continuity solution on the muscular-osseous-tendinous chain of the knee, ensuring the extension of the leg on the thigh, the traumatic rupture of the knee’s extensor apparatus is often reported in literature. They are dominated by patellar fractures. The patellar or quadricipital tendon damage is rare and even exceptional in a bilateral topography. The aim of this work was to highlight the clinical case of bilateral rupture of the patellar tendon of late diagnosis, occurring in an adult with a particular field. It was an adult, who presented a bilateral rupture of the knee extensor apparatus following a minimal traumatism. Anamnesis found a chronic kidney disease correctly follow-up. The diagnosis was delayed so was the surgical management (Krackow’s technique and protection by a metallic frame). At 8 months post surgery the functional result is acceptable. The bilateral rupture of the patellar tendon stays a rare pathologic entity, which always seems associated at a particular field. The diagnosis delay (and so did the care) is an important bad prognosis factor. Treatment of this old form (unknown) is exclusively surgical.

Inveterate Posterior Shoulder Dislocation Treated by Sub-Scapular Transfer, about One Case

Glena-humeral dislocation is rare. More than the half of those dislocations is unremarked because the diagnostic is not an emergency. A delayed diagnostic alters the functional prognostic and sometimes forces to do a complex surgery with complications whose success rate remains uncertain. We report a case of inveterate posterior shoulder dislocation on a 42-year-old adult occurred during a sport accident and treated by sub-scapulars transfer (modified Mac Laughlin’s technical). The aim of this article is to highlight this pathology to ameliorate its diagnostic rate indeed prognostic. Our diagnostic approach and injury, noticed during surgery and therapeutic propositions, are described at the light of literature data on this subject.