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.

Current concepts in total femoral replacement

Total femoral replacement(TFR) is a salvage arthroplasty procedure used as an alternative to lower limb amputation. Since its initial description in the mid-20^(th) century, this procedure has been used in a variety of oncologic and non-oncologic indications. The most compelling advantage of TFR is the achievement of immediate fixation which permits early mobilization. It is anticipated that TFR will be increasingly performed as the rate of revision arthroplasty rises worldwide. The existing literature is mainly composed of a rather heterogeneous mix of retrospective case series and a wide assortment of case reports. Numerous TFR prostheses are currently available and the surgeon must understand the unique implications of each implant design. Long-term functional outcomes are dependent on adherence to proper technique and an appropriate physical therapy program for postoperative rehabilitation. Revision TFR is mainly performed for periprosthetic infection and the severe femoral bone loss associated with aseptic revisions. Depending on the likelihood of attaining infection clearance, it may sometimes be advisable to proceed directly to hip disarticulation without attempting salvage of the TFR. Other reported complications of TFR include hip joint instability, limb length discrepancy, device failure, component loosening, patellar maltracking and delayed wound healing. Further research is needed to better characterize the long-term functional outcomes and complications associated with this complex procedure.

A 16-day old baby with transposition of great arteries and interrupted aortic arch: a case report

We report a 16-day-old boy who had transposition of great arteries combined with interrupted aortic arch (IAA). The boy developed cyanotic lips and body bruising 2 h after birth. Color Doppler sonography showed transposition of great arteries. The patient underwent total surgical correction of the transfection and defects. We summarized our experience in the perioperative management of the patient, including maintenance of body temperature, close intraoperative monitoring, anesthesia management, cardiopulmonary bypass (CPB) management and so on.

Major Limb Amputations: Etiological and Clinical Profile in a Hospital in Sub-Saharan Africa

Introduction: During the 19th and 20th centuries, the Wars were the cause of many amputations among military and civilians. Despite the absence of armed conflict in our country, we notice a high frequency of major amputations in our activity. Objective: The aim of this work was to study the causes of major amputations observed in our practice in order to develop preventive measures. Materials and Method: This was a descriptive retrospective study over a 6-year period, from January 1, 2008 to December 31, 2014. The following parameters were studied: epidemiological aspects (age according to WHO age groups and gender of patients), type of amputation, level of amputation and causes. Results: Two hundred and fifty-two patients were included. The distribution of amputations by cause and age group showed two distinct entities: The forms of the young subject where there was a predominance of tumour and traumatic causes;and the forms of the elderly person caused by vascular infections and conditions. Infections were the main cause of amputation in both sexes. Conclusion: The causes of major limb amputations vary according to age and limb: tumor and trauma in young people and for the upper limb, infectious and vascular in the elderly and for the lower limb.