Profile of Traumatic Hip Dislocations in a West African Teaching Hospital

Purpose: Traumatic hip dislocations (THD) are rarely reported from developing countries. The aim of the current study is to describe the trauma, the presentation, the treatment and the outcome patterns of THD received in the trauma unit of an emergency department (ED) in west Africa. Patients and Methods: A retrospective ongoing study from 2008 to 2014 was performed at the ED. All patients over 15 years with an unreduced THD and an anteroposterior pelvic radiograph were studied. Data were collected and analyzed by means of a statistical software. Results: A total of 50 THD were included in the study. We found an average of seven dislocations per year with a mean age of 36 years mainly males (n = 37). Road traffic accidents by motorcycle (n = 20) were the common circumstance of trauma. Forty-five extra-pelvic THD were diagnosed. According to the Bigelow classification, THD were classified posterior (n = 33), anterior (n = 10) and irregular (n = 2). Associated acetabular fractures (n = 36), ipsilateral lower limb fractures (n = 10) and sciatic nerve palsy (n = 2) were also found. The THD cases were treated by closed reduction (n = 34), open reduction (n = 6) and Girdlestone procedure (n = 1). The outcome after 16 months showed 21 good and excellent functional results and one death. The short term complications were post traumatic arthritis (n = 10) and osteonecrosis (n = 2). Conclusion: The THD occurrences are important in our emergency department. They are characterized by the place of motorcycle accidents and by the delayed reduction due to hospital’s locations and numbers and beliefs. A reduction before four hours, an earlier rehabilitation, a non-use of traction and a short hospitalization time below 14 days gave better results.

Results of Femoral Neck Fractures Screwing in Adults at University Hospital of Brazzaville

Purpose: The good of this survey was to analyze the epidemiological aspects and evaluate anatomical and functional results of the treatment by screwing of femoral neck fracture in adulthood at the Teaching Hospital of an underequipped country. Material and Methods: This is a retrospective study from January 1, 2011 to December 31, 2015, concerning patients hospitalized for fractures of femoral neck and having been operated by screwing. The variables studied were epidemiological and therapeutic aspects. Anatomical results were examined on standard x rays of the pelvis in front and the hip in profil, based on the consolidation of the bony axis. Functional results were analyzed according to the quotation of Postel Merle D’Aubigné. Results: Eleven screwings of femoral neck have been done to 11 patients (9 men and 2 women), average age was 47 years (29 and 60 years) from January 2011 to December 2015, at the mean recoil of 19 months (12 and 24 months). Amongst consolidated patients (n = 7), one patient presented a necrosis of femoral head at two years hindsight. Four patients presented an aseptic pseudarthrosis of femoral neck, or a bad anatomical result. Amidst this group of patients, one underwent a joint replacement type Moore and suggestion of intermediary prothesis was recommended to three patients. According to the quotation of Postel Merle D’Aubigné, results were very satisfactory to 5 patients, good to 2 patients and bad to 4 patients. According to the score of Parker, 7 patients presented a score of 9 and 4 patients a score of 7. Conclusion: The treatment of femoral neck fractures in adulthood requires a surgical approach by osteosynthesis and must be precocious before 24 hours in order to reduce risks of pseudarthrosis of femoral neck and necrosis of femoral head.

Primary Total Hip Arthroplasty on Complex Hips Conditions in a Low-Resource Setting

Introduction: Total hip arthroplasty of complex morphology is a challenge for the orthopaedic surgeon. Careful analysis of the hip’s anatomy helps to unravel the difficulties and anticipate the procedures to be performed and the implants to be planned. The aim was to identify the types of hip that make first-line THR difficult, specify the technical procedures to be used on these sites, and assess the functional results of the series. Material and Methods: This was a retrospective study that concerned patients operated on for total hip arthroplasty between January 2015 and December 2022 at the medical center “La Grâce” in Bobo-Dioulasso, Burkina Faso. Patients with coxarthrosis (on hip dysplasia, acetabular protrusio, acetabular malunion or neurological hip) and those with ankylosis of the hip, osteonecrosis secondary to neglected dislocation of the hip or hemoglobinopathy were included. Results: A total of 31 total hip replacements were performed in 30 patients. The mean age of patients at the surgery time was 36.2 years with extremes of 17 and 61 years. The male-to-female sex ratio was 1. The main indications for THA were the dysplasic hip osteoarthritis (11 cases) and the neglected hip dislocations (7 cases). In situ femoral neck osteotomy before hip dislocation was performed in seven cases. The acetabulum reconstruction techniques varied from the structural iliac bone graft (n = 3) and cancellous bone graft (n = 4) to the Kerboull plate (n = 1). After 45 months of mean follow-up, all hips were evaluated. The mean PMA score increased from 7.1 [4 - 8] before the surgery to 13.2 [13 - 17]. Conclusion: The large spectrum of challenges in complex hip management requires effective preoperative planning. Preoperative planning minimizes complications and ensures a better outcome.