Skin and Soft Tissue Infections in the Surgical Area at the Kara Teaching Hospital

Objective: To report the management of skin and soft tissue infections in the surgical area of Kara University Hospital in Togo. Material and Methods: This study was conducted retrospectively from January 1, 2021, to December 31, 2022, in the general surgery and orthopedic trauma departments. The study focused on soft tissue infections of the pelvic and thoracic limbs and analyzed epidemiological, clinical, paraclinical, therapeutic, and evolutionary data. Results: We registered 165 patients, comprising 109 men and 56 women.The sex ratio (F/H) were 0.51. The mean age was 45 years with extremes ranging from 23 to 90 years. Farmers (64.8%) followed by housewives (34.0%) were the social strata most affected. The consultation period varied between 1 and 90 days. The pathologies found were necrotizing fasciitis (53.3%), erysipelas (18.2%), infected limb wounds (12.1%), pyomyositis (9.7%), and necrotizing dermo-hypodermitis (1.8%). The main procedures performed were necrosectomy and grafting (62.9%), sample necrosectomy (18.8%), drainage (9.7%), and pelvic limb amputation (1.2%). Follow-up was favorable in 86.7% of cases. The study noted a death rate of 13.3% due to septic shock secondary to a delay in consultation. Conclusion: Skin and soft tissue infections were a common reason for surgical hospitalization at Kara University Hospital, with a high mortality rate due to delayed consultations.

Mechanism of spinal cord injury regeneration and the effect of human neural stem cells-secretome treatment in rat model

BACKGROUND Globally,complete neurological recovery of spinal cord injury(SCI)is still less than 1%,and 90%experience permanent disability.The key issue is that a pharmacological neuroprotective-neuroregenerative agent and SCI regeneration mechanism have not been found.The secretomes of stem cell are an emerging neurotrophic agent,but the effect of human neural stem cells(HNSCs)secretome on SCI is still unclear.AIM To investigate the regeneration mechanism of SCI and neuroprotective-neuroregenerative effects of HNSCs-secretome on subacute SCI post-laminectomy in rats.METHODS An experimental study was conducted with 45 Rattus norvegicus,divided into 15 normal,15 control(10 mL physiologic saline),and 15 treatment(30μL HNSCssecretome,intrathecal T10,three days post-traumatic).Locomotor function was evaluated weekly by blinded evaluators.Fifty-six days post-injury,specimens were collected,and spinal cord lesion,free radical oxidative stress(F2-Isoprostanes),nuclear factor-kappa B(NF-κB),matrix metallopeptidase 9(MMP9),tumor necrosis factor-alpha(TNF-α),interleukin-10(IL-10),transforming growth factor-beta(TGF-β),vascular endothelial growth factor(VEGF),B cell lymphoma-2(Bcl-2),nestin,brain-derived neurotrophic factor(BDNF),glial cell line-derived neurotrophic factor(GDNF)were analyzed.The SCI regeneration mechanism was analyzed using partial least squares structural equation modeling(PLS SEM).RESULTS HNSCs-secretome significantly improved locomotor recovery according to Basso,Beattie,Bresnahan(BBB)scores and increased neurogenesis(nestin,BDNF,and GDNF),neuroangiogenesis(VEGF),anti-apoptotic(Bcl-2),anti-inflammatory(IL-10 and TGF-β),but decreased proinflammatory(NF-κB,MMP9,TNF-α),F2-Isoprostanes,and spinal cord lesion size.The SCI regeneration mechanism is valid by analyzed outer model,inner model,and hypothesis testing in PLS SEM,started with pro-inflammation followed by anti-inflammation,anti-apoptotic,neuroangiogenesis,neurogenesis,and locomotor function.CONCLUSION HNSCs-secretome as a potential neuroprotective-neuroregenerative agent for the treatment of SCI and uncover the SCI regeneration mechanism.

Blount Method in the Management of Supracondylar Fractures of the Humerus in Children

Supracondylar fractures of the humerus are the most common traumatic elbow injury in children. Several techniques are described in their support. Blount’s method is one of the widely used orthopedic means. The objective of our study was to evaluate the results of supracondylar fractures of the humerus treated by this method in our department. This was a descriptive, longitudinal study with the prospective collection over a period of 12 months from May 2018 to April 2019. It focused on children aged 0 to 15 years treated in the Orthopedic Traumatology Department of the CHU of Kati for a supracondylar fracture of the humerus in extension. A minimum follow-up period of 6 months was necessary for inclusion. 12 patients were collected. The sociodemographic, anatomopathologic, therapeutic and evolutionary aspects were studied. The results were evaluated according to Flynn’s criteria. The male sex was predominant with a ratio of 2. The average age was 5.5 years. The average admission time was 12.5 hours. Domestic accidents were the main etiology (66.66%) and Type II fracture was the most frequent with 58.33%. The duration of immobilization was 42 days for 11 patients. Complications were 1 case of secondary displacement and 1 case of 12&#730 flexion deficit. The average Baumann angle was 72&#730. The result was satisfactory for all our patients. Supracondylar fractures of the humerus are common in children, especially boys. The method of Blount when it is well carried out by respecting the indications gives good results.

Deferoxamine promotes recovery of traumatic spinal cord injury by inhibiting ferroptosis

Ferroptosis is an iron-dependent novel cell death pathway. Deferoxamine, a ferroptosis inhibitor, has been reported to promote spinal cord injury repair. It has yet to be clarified whether ferroptosis inhibition represents the mechanism of action of Deferoxamine on spinal cord injury recovery. A rat model of Deferoxamine at thoracic 10 segment was established using a modified Allen's method. Ninety 8-week-old female Wistar rats were used. Rats in the Deferoxamine group were intraperitoneally injected with 100 mg/kg Deferoxamine 30 minutes before injury. Simultaneously, the Sham and Deferoxamine groups served as controls. Drug administration was conducted for 7 consecutive days. The results were as follows:(1) Electron microscopy revealed shrunken mitochondria in the spinal cord injury group.(2) The Basso, Beattie and Bresnahan locomotor rating score showed that recovery of the hindlimb was remarkably better in the Deferoxamine group than in the spinal cord injury group.(3) The iron concentration was lower in the Deferoxamine group than in the spinal cord injury group after injury.(4) Western blot assay revealed that, compared with the spinal cord injury group, GPX4, xCT, and glutathione expression was markedly increased in the Deferoxamine group.(5) Real-time polymerase chain reaction revealed that, compared with the Deferoxamine group, mRNA levels of ferroptosis-related genes Acyl-CoA synthetase family member 2(ACSF2) and iron-responsive element-binding protein 2(IREB2) were up-regulated in the Deferoxamine group.(6) Deferoxamine increased survival of neurons and inhibited gliosis. These findings confirm that Deferoxamine can repair spinal cord injury by inhibiting ferroptosis. Targeting ferroptosis is therefore a promising therapeutic approach for spinal cord injury.

Hernia mesh prevent dislocation after wide excision and reconstruction of giant cell tumor distal radius

Giant cell tumor(GCT) remains as major health problem. GCT which located at the lower end of the radius tends to be more aggressive. Wide excision and reconstruction of the wrist in stage 3 of distal radius GCT lesion is an optimal modality to prevent tumor recurrence. However, dislocation often occurs as its complication. We are reporting patient with GCT of distal radius treated with wide excision and reconstruction using nonvascularized fibular graft and the addition of hernia mesh. Circumferential non-absorbable polypropylene hernia mesh was applied, covered radioulnar joint and volar aspect of radius, and served as additional support to prevent dislocation. During five years and two months of follow-up, we found no dislocation in our patient. Furthermore, good functional outcome was obtained. Our finding suggests that the addition of hernia mesh after wide excision and reconstruction with nonvascularized fibular graft may benefit to prevent dislocation and provides an excellent functional outcome.

Pain inhibition through transplantation of fetal neuronal progenitors into the injured spinal cord in rats

Neuropathic pain after spinal cord injury(SCI) is a complex condition that responds poorly to usual treatments. Cell transplantation represents a promising therapy;nevertheless, the ideal cell type in terms of neurogenic potential and effectiveness against pain remains largely controversial. Here, we evaluated the ability of fetal neural stem cells(fNSC) to relieve chronic pain and, secondarily, their effects on motor recovery. Adult Wistar rats with traumatic SCI were treated, 10 days after injury, with intra-spinal injections of culture medium(sham) or fNSCs extracted from telencephalic vesicles(TV group) or the ventral medulla(VM group) of E/14 embryos. Sensory(von Frey filaments and hot plate) and motor(the Basso, Beattie,Bresnahan locomotor rating scale and inclined plane test) assessments were performed during 8 weeks. Thereafter, spinal cords were processed for immunofluorescence and transplanted cells were quantified by stereology. The results showed improvement of thermal hyperalgesia in the TV and VM groups at 4 and 5 weeks after transplantation, respectively. Moreover, mechanical allodynia improved in both the TV and VM groups at 8 weeks. No significant motor recovery was observed in the TV or VM groups compared with sham. Stereological analyses showed that ~70% of TV and VM cells differentiated into NeuN+ neurons,with a high proportion of enkephalinergic and GABAergic cells in the TV group and enkephalinergic and serotoninergic cells in the VM group. Our study suggests that neuronal precursors from TV and VM, once implanted into the injured spinal cord, maturate into different neuronal subtypes, mainly GABAergic, serotoninergic, and enkephalinergic, and all subtypes alleviate pain, despite no significant motor recovery. The study was approved by the Animal Ethics Committee of the Medical School of the University of S?o Paulo(protocol number 033/14) on March 4, 2016.

Effect of 4-week Whole Body Vibration onDistal Radius Density

Objective To assess the effects of high-frequency loading using whole body vibration on distal radius density in adults. Methods The volunteers diagnosed with osteoporosis or osteopenia in the First Hospital of Jilin University from January 2011 to December 2014 were recruited. All the subjects performed foot-based, whole body vibrations on the vibration platform(35 Hz, 0.25 g) once a day, for 15 minutes per session over a period of 4 weeks. The bone mineral density of distal radius(rB MD) was measured using dual-energy X-ray absorptiometry at before, 2-week, and 4-week after the vibration treatment. Blood pressures were measured at the end of the vibration treatment. Results A total of 114 volunteers were enrolled. The average rB MD before the treatment was 0.331±0.014 g/cm^2. It was reached 0.337±0.019 g/cm2 at the end of the fourth week, increased by 1.79%(P<0.05). Whole body vibration increased rB MD of men and women respectively(1.77% and 1.80%, P<0.05). Blood pressures did not change in any of the groups. Conclusion A 4-week whole body vibration was feasible and contributed to increase of rBMD.

Time Management of Open Lower-Leg Fractures in Morocco

Background: It is recommended that the management of open lower-leg fractures should occur within six hours to avoid complications affecting both prognosis and functionality. This study aimed to evaluate the time taken for each step of management, identify causes of delay, and propose solutions to reduce the rate of complications. Patients and methods: This was a prospective study involving 153 patients treated from January 2011 to December 2012. Standardized data collection forms documented the times taken for each management step from the accident until surgical intervention. Results: For patients admitted directly to our institution, median time to surgical debridement from arrival was 5 hours. Median time for bone fixation was 24 hours. External fixation was used in 119 patients. There were several causes of delay;lack of financial resources was the most common. Certain causes of delay were significantly correlated with time to debridement. However, although 86.7% of patients who developed an infection had a time from injury to debridement greater than six hours, there was no statistically significant association between infection and delay beyond six hours (p = 0.403). Conclusion: By identifying causes of treatment delay, we hope to be able to avoid complications, and therefore reduce the socio- economic impact of these important surgical emergencies.

Breast Cancer in Young Women about 87 Cases in the General Surgery Department CHU Gabriel Touré

Our objectives were to determine the frequency of breast cancer in young women, to determine the risk factors for breast cancer in young women, to detail the diagnostic process of the disease, to determine the different therapeutic strategies. This was a retrospective and descriptive study going from January 2005 to December 2021, a period of 17 years. The study involved 87 women with an average age of 33.2 years. Patients consulted 66 times or 75.9% for breast mass. The size of the tumor was greater than or equal to 5 cm in 62 patients;it was localized in the supero external quadrant 41 times or 47.1%. Molecular classification revealed the following results: Luminal A 21.4%;receptive (HER2) positive 28.6%, and triple negative 42.9%. Stage II was the most represented with 47.4%. Histology found infiltrating carcinoma of non-specific type in 76 patients. The treatment was mastectomy axillary dissection in 66 patients, quadrantectomy + axillary dissection in 6 cases (6.9%) associated with radiotherapy in 6 patients, chemotherapy was performed in 79 of our patients and hormone therapy in 10 patients. Conclusion: Breast cancer is frequent in our country. Patients generally consult us at a late stage. The possibility of determining certain receptors and carrying out certain non-surgical treatments on site would improve the prognosis.

Surgical Treatment by Pinning of Carpometacarpal Dislocation at the Donka University Hospital Center: A Propos of 12 Cases

Carpo-metacarpal dislocations are rare hand injuries. They are misdiagnosed due to their non-specific clinical signs. The authors report on their experience in the management of carpometacarpal dislocations in a specialized hand surgery center. Our study included patients received and treated in the department for a carpometacarpal dislocation. Dislocation fractures of Bennett and Rolando were excluded. The postoperative functional evaluation took place after 18 months by the DASH score. Twelve patients participated: one case of neuro-algodystrophy and one pin infection. The mean DASH functional outcome score was 1.10 at 18 months. Since carpometacarpal dislocations are rare and easily misdiagnosed, the surgeon should assume the possibility of them in patients with high-energy trauma, and imaging studies should be carefully evaluated. Pinning is an effective treatment option that provides good long-term functional results.

Trochanteric Buttress Plate Combined with Proximal Femoral Nail for Unstable Intertrochanteric Fractures. [Innovative Technique]

Introduction: Proximal femoral nail is a better choice of implant for the treatment of an unstable trochanteric fracture, however it is associated with screw migration and cutout because of greater trochanteric comminution and coronal split. This study is to evaluate the results of Trochanteric Buttress Plate (TBP) combined with PFN in an unstable IT fractures for buttressing lateral wall and reinforcing fixation. Materials and Methods: We carried out a consecutive study of 32 patients of Unstable intertrochanteric fracture femur with lateral wall comminution. It was studied at Ashwini Sahakari Rugnalaya and Sanshodhan Kendra Solapur India and Government medical college Chandrapur India from April-2015 to December-2017 using innovative Trochanteric buttress plate along with PFN. Eighteen male and fourteen female in the age group of 55 to 80 years were included in the study. There were 26 cases of A3 and six cases of A2 were fixed by PFN combined with trochanteric buttress plate to augment the comminuted lateral wall. Results: The bone healing is observed in all the cases in the mean period of 12.6 weeks. Four patients developed complications, including lateral migration of neck screws (n = 2), superficial infection (n = 2). Patients were followed up for a mean of 10.6 months. At the end of follow-up the Salvati and Wilson hip function was 36 (out of 40) in 87.5% of patients [twenty eight patients]. The clinical, radiological and functional outcomes were found to be satisfactory. Conclusion: The stabilization of lateral trochanteric wall with trochanteric buttress plate restores anatomy, increases the stability of construct and prevents inherent complication of screw migration and cutout.

Hip resurfacing arthroplasty complicated by mismatched implant components

Metal-on-metal hip resurfacing has gained popularity as a feasible treatment option for young and active patients with hip osteoarthritis and high functional expectations.This procedure should only be performed by surgeons who have trained specifically in this technique.Preoperative planning is essential for hip resurfacing in order to execute a successful operation and preview any technical problems.The authors present a case of a man who underwent a resurfacing arthroplasty for osteoarthritis of the left hip that was complicated by mismatched implant components that were revised three days afterwards for severe pain and leg length discrepancy.Such mistakes,although rare,can be prevented by educating operating room staff in the size and colour code tables provided by the companies on their prostheses or implant boxes.

Total Hip Replacement in Young Adults Less Than Fifty Year Old: Our Experience

Background: We report a retrospective study of 47 total prosthesis of hip put in place among the young adult of less than fifty years in the service of Traumatology and Orthopedics at the Wing IV of the CHU Ibn Rochd of Casablanca, over a period from January 2008 to March 2014, with an average rate of decline of 42 months. Results: The deliberate group of 43 patients (47 hips including 4 bilateral) consisted of 26 women, either 60, 47% and 17 men, either 39, 53%. The average age of our patients was 36 years. In our series, the predominant etiology has been conducted for the indication of the hip replacement was the aseptic osteonecrosis of the femoral head which has represented 31.91%. With regards to the choice of implants, 85% of PTH were non-cemented, the cemented PTH has been used in 15% of cases. The Friction Torque metal/polyethylene was used in all cases. The functional outcome was appreciated by the rating of Merle of Aubigne before and after arthroplasty. The average rate of decline of 42 months, and the results were generally satisfactory. They were excellent in 27.78% of cases, very good in 19.44% of cases and good in 44.44% of cases. The results on the Pain were remarkable: the rating of the pain going 2.8 in pre-operative at 5.6 at the latest decline. The results on the walking and mobility were also good. It was noted as a complication: 4 cases of prosthetic dislocation, 1 case of aseptic descellement bipolar, 2 cases of early sepsis on hardware, 3 cases of paralysis of the sciatic external popliteal and 4 cases of periprothetiques ossification. In total, 5 total prosthesis of hip were occasions. The young age does not seem to be an obstacle to the prosthetic surgery. Conclusion: However, a major question remains concerning the distant future of these prostheses in young active subjects, because they will be submitted for many years in a job which can cause the descellement of prosthetic parts.

Treatment Options for Pin Site Infection during Kirschner Wires in Elective Forefoot Surgery

The Kirschner wires (K-wires) are stiff and straight wires made of smooth stainless steel. These are used in surgery to aid in repairing the process of a fractured bone. In forefoot elective surgeries, these pins are mostly used for fixation of the phalangeal or metatarsal area. These wires are usually either buried or exposed, The exposed wires do not require another operation to remove them and are generally preferred. In using the forefoot surgery history of a single surgeon which was taken for 3 years. The purpose of this study is to evaluate the occurrence of infections following elective surgeries of the forefoot that were fixed using k-pins and to indicate an effective treatment option for resolving the infection. The inclusion criteria set for this study was to remove any patient having any disease except for diabetes. Moreover, the age limit was set to be 18 - 44, making a final sample of 50 people, prescribed prophylactic antibiotics or early removal of k-pins, where necessary. The researcher recorded demographic and biological data from the patients such as age, BMI, and smoking status were recorded. The researcher conducted a Univariate analysis via a Chi-square test. 50 Patients (82 K-wires) were analyzed. Results showed that surgery type, BMI, and smoking were three variables that affect the infection growth significantly while diabetes and type of cleaning disinfectant had marginal effects. Further study is required to clarify the best treatments in this area, as the treatment option antibiotics have nearly similar results.

Bacterial Isolates and Their Antibiotic Susceptibility Pattern among Patients with Infected Wounds Admited in Orthopaedic and Trauma Ward in Tertiary Care Hospital North-Eastern Tanzania

The hospital environment contributes to wound infections. Effects of such infections include prolonged hospitalization, increased morbidity, potential for antibiotics resistance and mortality due to sepsis. An updated knowledge of antibiotics susceptibility profiles of clinical isolates will assist both in choosing the most appropriate antibiotic treatment for wound infections and help in curbing the escalation of drug resistance. Cross sectional hospital based study, analysis of 125 pus samples collected from January 2018 to December 2020 was conducted. Identification and characterization of isolates were performed on the basis of Gram staining, microscopic characteristics, colony characteristic, and biochemical tests using standard microbiological methods. Antibiotic susceptibilities of bacterial isolates were determined by Kirby Bauer disc diffusion. A total of 125 pus samples were studied, 94 (75%) were from male patients, mean age was 38.5 (SD ± 19) years. Single bacterial isolates were recovered from 120 (96%) samples, 67 (53.6%) shows Multiple Drug Resistance (MDR) pattern, 74 (59.2%) were gram negative, the predominant organism isolated was Staphylococcus aureus 46 (36.8%). Gram negative isolates showed high resistance to ampicillin and cephalosporins. Gram positive isolates showed high resistance to erythromycin. Both gram positive and negative were found to be highly susceptible to gentamicin, amikacin, clindamycin, ciprofloxacin and amoxicillin/clavulanic acid. The study showed that Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli are the major bacteria isolated from pus samples. High proportion (53.6%) of the isolates was MDR. In the light of these findings, a change in antibiotic prescription policy is required at this hospital.

Lumbar Paraspinal Hemangiopericytoma, An Unusual Location: Surgery with Preoperative Embolization

Background: Lumbar paraspinal hemangiopericytoma is rare. The hemorrhagic nature of the tumor causes problems of hemostasis and makes the resection delicate. We report a rare case of lumbar paraspinal hemangiopericytoma managed with preoperative embolization. Clinical Case: It is about a woman of 31 years, admitted for a large left lumbar paraspinal mass that evolved for 6 years. The clinical exam showed an asymmetry of the left paraspinal muscle. The mass painless was extended from the lumbar region. The neurological exam was normal. MRI showed the left large paraspinal mass tissue. It was extended from lumbar vertebrae, L1 to L4, and measured 100 × 50 × 50 mm. It was an iso-intense signal on T1-weighted with strong enhancement after gadolinium. It was hypervascular and supplied by left intercostal T12, L1, and L2 pedicles. The complete exclusion of the hyper-vascular left paraspinal tumor was obtained after selective embolization of the artery left L1 of the pedicle of the intercostal left L1 and trunks intercostal T12 and L2 left. The total resection of a mass encapsulated was performed. The operative outcome was good. The histology concluded to a hemangiopericytoma. No chemotherapy or radiotherapy was prescribed. After 5 years, the patient was asymptomatic. MRI control confirmed tumor resection with a residue at the level of the left intervertebral foramen L1 - L2. Conclusion: Lumbar paraspinal hemangiopericytoma is an extremely rare tumor. Selective preoperative embolization is recommended before the resection of large tumors to reduce vascular supply. A follow-up extended for these patients is necessary, given the frequency of recurrences.

Low expression of vascular endothelial growth factor and high serum level of cyclic guanine monophosphate as the risk factors of femoral head osteonecrosis in alcohol-exposed Wistar rat

Purpose:Severe damage to the femoral head in patients with osteonecrosis has a high impact on morbidity.Despite early diagnosis,the treatment outcome is still unsatisfactory.This study aimed to explore the expression of vascular endothelial growth factor(VEGF)and cyclic guanine monophosphate(cGMP)serum level as the risk factors of femoral head osteonecrosis in alcohol-exposed Wistar rats.Methods:This was an exper imental study using randomized post-test only control group design,with samples using 10-14 weeks Wistar male rats.Rats were then divided into 6 groups:3 groups without intervention,and 3 groups with intervention using 40%alcohol given perorally.Each one group from intervention and control group was euthanized by the end of the week for 3 consecutive weeks.Proximal femurs were examined under microscope for osteonecrosis,immunohistochemically for VEGF,and blood serum for cGMP levels.Results:VEGF expression in the femoral head of alcohol-exposed Wistar rats was lower than those not exposed to alcohol(p<0.005).Blood serum cGMP levels of alcohol-exposed Wistar rats were higher than those not exposed to alcohol(p<0.005).The number of necrotic osteocytes in the femoral head of Wistar rats exposed to alcohol was greater than those not exposed to alcohol(p<0.005).There are significant differences between VEGF,cGMP levels,and number of necrotic osteocytes in the control group and treatment at 1st,2nd'and 3rd week(p<0.005).Conclusions:Based on the result of this study,VEGF and cGMP may be considered as diagnostic bio-markers for alcohol-induced femoral head osteonecrosis.