Impact of Multifidus Muscle Morphometry on the Clinical Evolution of Chronic Low Back Pain

Purpose: The multifidus muscle is an important extensor muscle of the lumbar spine. It plays a major role in the stability and realization of axial rotation movements of the thoraco-lumbar spine. Its atrophy by fatty degeneration would be at the origin of the occurrence of chronic low back pain which constitutes a public health problem in Senegal. Taking into account its anatomy is essential for the etiopathogenic analysis and the treatment of low back pain. The purpose of our work was to investigate the impact of multifidus muscle morphometry on the anatomy-clinical evolution of low back pain. Material and method: this was a prospective study over a period of 30 months from November 2019 to May 2022. It involved 100 patients seen in the neurology department of Fann Hospital for chronic low back pain and who had already had a scanner falling within the criteria for low back pain. We used 3D Slicer, SPSS 20, Excel 2016 software to model and analyze the morphometric data of the multifidus muscle after physiotherapy and control lumbar scans. Results: The sex ratio was 2.23. The average age of the patients was 45 ± 7 years. On the initial CT scan, according to the Hadar classification, we noted a predominance of grade 2 with 56% in L5/S1, followed by grade 1 with 32% and grade 3 with 14%. In L4/L5, the majority of patients, 67%, had grade 1. A conflicting circumferential disc bulge with the roots predominating in L5/S1 was present in 94% of men (p-value = 0.02). Before physiotherapy, the average volume of the multifidus was 193 mm3 ± 39, after physiotherapy it was 203 mm3 ± 42 with a progression rate of 5.2%. Clinically, severe type pain had regressed from 86% before physiotherapy to 0% after physiotherapy (p-value = 0.03). Conclusion: Taking into account the morphometry of the multifidus is an essential element in the management of chronic low back pain.

Challenges of Total Arthroplasty for Neglected Fracture-Dislocations of the Hip

This study examined neglected hip fracture-dislocations in developing countries, focusing on five cases in Dakar. The research adopted a prospective method, assessing epidemiological, clinical, radiological, and therapeutic aspects, utilizing the Postel Merle d’Aubigné scoring system for functional assessment. Results demonstrated that total joint replacement surgery, predominantly following traffic accidents, significantly improved mobility and reduced limb length disparity, with most patients achieving independent walking post-operation. The study concludes that early diagnosis and total hip arthroplasty are critical for optimal outcomes.

Ilizarov Femoral Limb Lenghtening in Lower Limb Discrepancy. Radio-Clinic Results. About 32 Cases

Introduction: The progressive osseous lengthening on a single site corticotomy such as described by Ilizarov is a reliable but difficult method in the treatment of limb length discrepancies. The objective of this study was to appreciate the results of the recent application of this method in a low-income country such as Senegal. Material and Method: It was a retrospective study on 32 patients among whom 19 were men (people) and 13 were women over one continuous period of 7 years. The mean age was of 19 years with extremes of 10 and 36 years. Etiologies were dominated by osteoarthritis of the hip in 77.8%, traumatic sequela in 16.7% and the aseptic osteonecrosis of femoral head in 5.6%. The average duration of treatment was of 232 days with extremes of 110 and 363 days. Results: On the anatomical plan, the average lengthening was 55.89 mm that is 12.03% of the initial length with extremes of 35 and 110 mm. The equalization, in terms of length of the members, was obtained in 33.3% of the cases. The average index of cure was of 56.29 days, six patients, which are 18.75% of the cases, complained about pain at the end of treatment and walking without crutches was possible in 83.33%. The complications, in the phase of lengthening, were either mechanics, with 5 subluxations (3 at the level of the hip and 2 at the level of the knee), or biological with 7 infections (superficial 5 and 2 deep), 2 premature consolidations and 1 bleeding. The complications in the consolidation phase were also mechanical with 32 articular stiffness, 8 plastic deformations, 7 subluxations, a fracture and a collapse of the regenerate, or biological with 8 infections among which an osteitis and bleeding. Conclusion: Despite a strong rate of complications and sometimes not reached objectives, the results of this first series of lengthening are encouraging and rich in education and do not seem to be a limiting factor for the implementation of the method in developing countries.

The Radial Nerve Entrapment in Pediatric Extension-Type Supracondylar Humeral Fractures. About Two Cases Reports

Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar cases in the mechanism of injury, the clinical findings and the treatment and propose therapeutic guidelines.

Traumatic Floating Bone. About 11 Cases and a Literature Review

Introduction: Floating bone injury or bipolar dislocation is a concurrent dislocation at both ends of a long bone or a flat bone. It is an exceptional injury. We report 11 consecutives cases of floating bones. Objectives: The aim of the study is to analyze the frequency, the mechanism of injury and clinical forms of floating bones, and to present the results of their management. Material and Methods: A ten years ongoing retrospective study was held in four trauma departments. Eleven cases of floating bones were identified. The floating bones characteristics such as the injured bone, the patient age and sex, the mechanism of injury, the dislocations directions, the associated complications, the treatment and the outcome were studied. Results: Nine male and two female patients, with a mean age of 37 years [19 - 65 years range] presented a concurrent bipolar dislocation of one bone or a group of bones. They sustained a road traffic accident (n = 5), a workplace accident (n = 3), a fall from height (n = 2), and a sport accident (n = 1). The clavicle (n = 3) and the first metatarsal (n = 3) were the most frequently involved. The others floating bones were the radius-ulna complex (n = 1), the radius-lunatum complex (n = 1), the first metacarpal (n = 1), the first phalanx (n = 1) and the femur (n = 1). The floating bones ends displacement occurred in the sagittal plane (the forearm, the femur, the first phalanx and the first metatarsal) and in the horizontal plane (the clavicle, the first metatarsal and the first metacarpal). We defined direction displacements as bidirectional asymmetric (n = 10) or unidirectional symmetric (n = 1). Associated complications were fractures (wrist, hip, tarso-metatarsal joints) and wounds (fingers, metatarso-phalangeal joint). Dislocations were treated conservatively (n = 5) and surgically (n = 17) with excellent results (n = 13/16 joints). Three patients were lost of view. Conclusion: Our study described the characteristics of this exceptional injury. For any joint dislocation, we promote the systematic examination of the other end of the dislocated bone.

Threatened Aortic Injury by Thoracic Pedicle Screw: A Case Report

Iatrogenic vascular injury during posterior spinal surgery is a rare but potentially serious complication with treatment challenges. We report the case of threatened aortic injury by pedicle screw impingement during posterior fixation of thoracic spine T7 - T8 fracture dislocation. The removal of the conflicting screws was done posteriorly after a visual control of the absence of adventitious break-in by a thoracotomy.

Pure Talocrural Dislocation without Associated Malleolar Fracture

Pure talocrural dislocation is an uncommon injury of the ankle. Malleolar fracture is usually associated. We report two cases of pure talocrural dislocation, to describe its therapeutic and prognostic clinical aspects through a review of the literature.