Indications and Results of Hip Arthroplasty and Hemiarthroplasty at Treichville University Teaching Hospital

Objective: Hip arthroplasty has variable and codified indications. The interest of this study results from the need to adapt our practices to the socio-economic status of our patients. The aim of this study was to describe the epidemiological profile of patients, the indications and results of hip arthroplasties performed in our hospital. Methodology: A descriptive monocentric study was conducted from January 2010 to December 2019 at Treichville University Teaching Hospital. All patients, who underwent total hip arthroplasty or hemiarthroplasty with intermediate or cervico-cephalic prosthesis, were included in the study. Epidemiological, clinical, therapeutic and follow-up data were analysed. Results: We collected 95 patients with 97 hips operated. The mean age was 67 years. 56% of patients were male. Arthroplasty was performed after femoral neck fractures in 78% of cases, followed by osteonecrosis of the femoral head (15%). The left side was affected in 51% of cases. The Moore’s posterior approach was used in 79% of cases, followed by the Hardinge’s lateral approach (21%). Hemiarthroplasties were implanted in 78% of patients. We observed 4 dislocations and 3 post-operative infections at 48 months of follow-up. The mean Harris score was 75.2. Conclusion: Arthroplasty has improved the function of our patients. Most of young males undergo the arthroplasty. Intermediate prostheses are commonly used implants.

Reconstruction of Post-Traumatic Bone Loss (BL) Members: Our Experience about 27 Cases

The purpose of this study is to evaluate our results of treatment of post-traumatic bone defect of members through various bone reconstruction techniques. Patients and method: It is a retrospective study continues from January 2008 to December 2012. It involved 27 patients who had bone loss following trauma members. The average age of patients was 36.2 years. We noted a male predominance (22 men). The causes of injuries were dominated by accidents of public roads (12 cases) and ballistic trauma (14 cases). We noted one case of work accident. The BL was localized in 10 cases the tibia, femur in 4 cases, 8 cases in the humerus, 2 cases in the fibula, 1 case was located in the olecranon, 1 case at the distal radius and 1 case to the ball. All lesions were open fractures. After a mean of support for 3 days, we performed emergency around 19 associated with internal fixation (10 cases external fixation, internal fixation 9 cases), 8 single around. Bone reconstruction was performed secondarily in the majority of cases (24 cases). Only 4 reconstructions were performed in emergency. Reconstruction techniques were dominated by conventional grafts (24 cases) associated or not with the technique of induced membrane. Bone reconstruction techniques we used were as follows: 24 cases of traditional autografts and 3 cases of intertibio-fibular graft. After an average decline of 43.6 months, our patients were evaluated clinically (axis and limb length) and radiological (bone healing). Results: bone healing was achieved in 22 cases after a mean of 3.8 surgeries and an average of 14.8 months. Conclusion: the main principles governing the reconstruction of a defect are pre healing associated infection and repair soft tissue whenever it can do. The current trend is to hybridization of the reconstruction process of the great losses of substance by developing strategies based on both the deliberate shortening.

Mechanical Complications after Limb Osteosynthesis: Analysis of Etiologic Factors in 42 Cases

The purpose of this study is to identify the causes of mechanical complications of osteosynthesis of members to prevent and improve the results of our surgical treatments. Patients and Method: Retrospective study including all patients diagnosed with mechanical complications after osteosynthesis of the limbs and who received medical follow-up. 42 patients with an average age of 42.2 years, with a male predominance (36 cases) were selected. These complications predominated in the femur with 26 cases. The implants involved were predominantly screwed plates with 25 cases. We investigated and analyzed the different types of dismantling of material as well as the etiological factors that may be at the origin of these disassembly. Results: After a mean follow-up of 15.47 months, four types of complications were identified: material expulsion (20 cases), migration (3 cases), incurvation (7 cases), fracture of material (12 cases). 4 types of factors causing dismantling have been identified: the factors related to the patient, factors related to fracture, the factors related to the implant and factors related to the surgeon. Conclusion: Disassembly of orthopedic implants is most often of multifactorial origin. These factors may act in isolation but are most often entangled in the patient. Proper preoperative planning can help prevent them. However, unexpected stresses of the implant and certain factors related to the ground remain difficult to control.

A Recurrent Solitary Exostosis of the Distal End of the Right Radius: A Case Report with a 17-Year Follow-Up

Solitary exostosis is a benign tumor usually encountered in children and adolescents. Its treatment is based on complete surgical excision which ensures complete healing. The resumption of a tumor process raises two questions: is it a recurrence or a malignant transformation into chondrosarcoma? We report a case of a resumption of the tumor process of solitary exostosis of the lower metaphysis of the right radius in a 33-year-old patient. This recurrence occurred 10 years after the first surgery and was accompanied by signs of compression of the median nerve and a major bone remodeling raising fears of malignant transformation. But histological examination performed during the excision confirmed the benignity of this lesion. The long-term follow-up examination of 17 years found a patient in a good general condition with a satisfactory local condition. The malignant transformation of solitary exostosis is an exceptional event. Thus, faced with a resumption of the tumor process after excision of solitary exostosis, the inadequacy of the first excision remains the first diagnostic hypothesis.

Aseptic Pseudoarthrosis of Olecranon: Epidemiological Features and Therapeutic Assessment

Introduction: Pseudoarthrosis is one of the most dreadful complications of olecranon fractures. It seriously compromises the function of the elbow. Objectives: To determine the epidemiological factors of this complication in order to prevent them and to assess the results of the therapeutic management. Material and method: This was a retrospective study that involved patients with olecranon pseudoarthrosis who were treated in the department between January 2006 and December 2016. The diagnosis of pseudoarthrosis was made at least 6 months after the management of the fracture. There were 16 men and 5 women. We analyzed the epidemiological factors, the treatment of pseudoarthrosis, and the postoperative outcome. Results: The incriminated factors were the complexity of the fracture line and the quality of treatment of the recent fracture. The osteosynthesis of pseudoarthrosis is similar to that of recent fractures. It requires in some cases a bone graft. The results of the treatment are satisfactory with 100% of consolidation, and a good functional result in 75% of the cases. Conclusion: The treatment of olecranon pseudoarthrosis is based above all on prevention by an optimal management of the recent fractures. The curative treatment gives satisfactory functional results.