Primary Malignant Musculosqueletal Tumors of Members in Adult in Togo

Purpose: Primary malignant musculosqueletal tumors in adult are rare affections group and its treatment is still a real challenge today. The aim of this work was to describe the epidemiologic and treatment aspects of these tumors in the national reference center of our country. Materiel and Methods: It was a retrospective review of primary malignant musculosqueletal tumors treated in orthopedics and trauma unit of Sylvanus Olympio teaching hospital of Lomé, Togo from January 2000 to December 2014. Results: During the study period, 28 cases were selected and reviewed. There were 17 men (60.71%) and 11 women (39.29%). The average age was 32.7 years. There were 20 cases (71%) of primary malignant bone tumors (PMBT) and 8 cases (29%) of primary malignant soft tissues tumors (PMSTT). There were 6 (30%) of osteosarcoma. The tumor was located in the bones of the forearm and wrist/hand in 2 (10%) patients for each anatomical site;for the lower limb, around knee in 7 (35%) patients. Eight patients had PMSTT (28, 57%). There were three cases of rhabdomyosarcoma, 2 cases of fibrosarcoma. Tumors were located around knee in 4 cases and around ankle/foot in 3 cases. In the two groups of tumor, tumor resection was performed in 5 patients (17.86%) and limb amputation indicated in 23 patients (82.14%), was performed in 15 (53.57%) and 8 patients (37.78%), rejected it and left hospital against medical advice. Conclusion: Malignant musculoskeletal tumors are relatively rare in Togo. Their treatment is based on radical surgery which is often not supervised by adjuvant therapies. Ignorance, poverty of the population and embryonic state of diagnostic and treatment infrastructures are the obstacles to their care. Education and awareness must be integrated to care and fight against this group of diseases.

Wrist Septic Arthritis Due to <i>Streptococcus pneumoniae</i>Revealing a Selective Immunoglobulin G4 Subclass Deficiciency: A Case Report

The pneumococcal septic arthritis is uncommon in healthy adults. In most cases, it occurs in patients with immune deficiency. Its exceptional location at the wrist can maintain doubt with rheumatic causes which are more frequent. IgG4 deficiency found in this patient was the only cause that could be impugned. We report the case of a young woman of 46 years without any evident cause of immunodeficiency and any particular risk factor, managed for septic arthritis of the wrist due to Streptococcus pneumoniae. This case without any apparent risk factors demonstrates that pneumococcal infection in a more distant articulation of the ENT is still possible. Scan has been a very significant contribution in confirming the positive diagnosis that leads to surgical drainage. The approach of the systematic search for the gateway must be done. In the study of the patient’s immune status, the realization of the protein profile could be interesting and then guide the practitioner in the decision to vaccinate the patient against Streptococcus pneumoniae if he was not. We recommend looking always for a cause of immunodeficiency including primary Ig defiencies even among adult.

Giant Myositis Ossificans Circumscribed Post Traumatic of Gluteus and Adductor Muscles: Case Report

Myositis ossificans circumscribed is a bone and cartilage heterotopic non neoplastic proliferation inside the soft tissues. It is a benign focal heterotopic ossification process of soft tissues, and a rare disorder that occurs spontaneously or after local trauma. Clinical and radiographic appearances are quite hustler. A careful histological examination of biopsy straightens diagnosis is necessary. There is no consensus in support (surgical or/and medical). From Benign prognosis, evolution of this pathology is usually favorable. The authors report a case of giant myositis ossificans circumscribed post-traumatic localized on gluteus and adductor muscles of the right hip on a 26-year-old man. Through a review of literature the mechanism, the diagnostic methods and therapeutic will be discussed.

Profile of Knee’s Bone and Joint Tuberculosis in Adults: About 33 Cases

The authors report toward a monocentric retrospective and descriptive study on a 08 year period, 33 cases of knee osteoarticular tuberculosis (OAT) of adult, certified by bacteriologic and/or histolological evidence proof of the sample (synovial biopsy) after a knee arthrotomy. There were 07 cases of arthritis and 26 cases of osteoarthritis. The treatment of knee OAT was medical (anti-tubercular poly-chemotherapy) on one year duration. The surgery was useful in front of some clinical presentations. After a minimum of 18 months, a functional evaluation was done following the Lequesne algo-functionnal index. None had signs of local recurrence testifying the adequacy of medical treatment, even if it is long and binding. The main of our case series is to establish an epidemiological, clinical and biological profile of the knee tuberculosis of adult and to research elements of prognosis through an analysis of results.

Predictors of Nonunion in Humerus Shaft Fractures in Adults in Lomé(Togo)

Background: To identify predictors of humerus shaft fractures nonunion in adults whatever the type of treatment performed. Patients and Methods: We conducted a retrospective study among patients who had a fracture of the humeral shaft moving towards healing or nonunion. Patients were treated in the orthopedic trauma unit of Sylvanus Olympio Teaching Hospital and two other private clinics in Lomé between January 2008 and June 2012. On the X-ray of each patient, we measured the angulation, the diastasis, and inter fragmentary contact. For each included patient, we looked for: age, sex, medical history, body mass index (BMI), according to the third location of the shaft fracture, the type of fracture according to AO classification and the type of opening according Tscherne classification. Results: During the study period, 184 patients with humeral shaft fracture were identified. Of these 108 were men. The mean age of patients was 37.3 years. The fractures were treated conservatively in 100 patients (54.3%), 78 treated surgically and six (3.3%) have discharged from hospital against medical advice for traditional treatment. The factors that were associated with nonunion of humerus shaft fractures in these patients were: the opening of the fracture (RR = 4.5;95% CI = [2.9;7.1]), the presence of immediately radial paralysis (RR = 5.6;95% CI = [3.7;8.5]), the existence of other associated lesions or fracture (RR = 1.8;95% CI = [1.1;3.1]), energy of the trauma (RR = 2.3;95% CI = [1.3;4.4]) and type III classification of Tscherne (RR = 0.3;95% CI = [0.2;0.6]). After multivariate analysis, factors that remained significantly associated with the failure of consolidation were: the existence of diastasis > 2 mm (OR = 7.6;95% CI = [2.2;25.6)), the Body Mass Index (BMI) > 25 (OR = 1.3;95% CI = [1.1 - 1.6]) and the existence of other bone lesion (OR = 4.3;95% CI = [1.4 - 18.9]). Conclusion: BMI greater than 25, the existence of an interfragmentary gap of more than 2 mm and existence of other bone lesions are significant risk factors for nonunion in humerus shaft fractures. The traditional treatment, common singular factor to the African environment, should not be ignored. Control of these predictors is necessary in carrying out the treatment of humerus shaft fractures.

Study of Complications of Traditional Treatment. <br/>Member Fractures

Introduction: Since the times of our ancestors, traditional medicine has existed to cure all diseases [1]. The objective of this study was to assess the complications of traditional fracture treatment. Patients and Methods: This was a prospective study extending from January 01, 2018 to June 30, 2018, duration of six months. It concerned patients who had traditionally been treated beforehand for traumas with bone lesion in a traditional therapist and who had developed a complication, the definitive management of which was made in the department. Results: This study involved 102 patients, including 71 men (69.6%), with a sex ratio of 2.2. 33 patients or 32.4% were under 15 years old. The average of our patients’ age was 29.61 years with extremes of 2 and 89 years. Pupils/students (44 pupils and 5 students) were the most represented with 49 cases or 48.1% of the cases. The majority of patients (59.8% of cases) were educated or had a basic level. The majority of patients (36.3%) came as motif for a painful swelling. Gangrene was the most common complication with 37 cases or 36.3% of cases. Conclusion: At the end of our study, we have noticed that the traditional preliminary treatment of fractures was based mainly on trial and error. Practicing with inadequate means and measures without respecting the anatomical structures, is a real source of disabling handicaps. We have recorded 38, among the 102 patients who came for a complication of traditional treatment: that is 45.2% amputation, which is deplorable.

Fracture-Dislocations of Lisfranc Joint in Lomé(Togo)

Introduction: The purpose of this prospective study was to describe the clinic pathological varieties of fracture-dislocations of Lisfranc joint and outcome of treatment. Patients and Methods: This study was conducted on 21 cases of fracture-dislocations of the Lisfranc joint treated in our orthopedics trauma unit from 2010 to 2013. We selected middle foot pure dislocations or associated with Lisfranc joint bone fractures. Classification of Myerson was used to characterize the lesions. The results assessment criteria were clinical and radiological for foot and Massari score. Results: Fourteen (14) patients were male. The average age was 34.7 years. Five (5) clinic pathological forms were met by relying on the classification of Myerson;4 cases of type A;5 cases of type B1;B2, 6 cases;4 cases of type C1 and 2 cases of type C2. There were eight cases of pure dislocation and 13 dislocations were associated with fractures (metatarsal in 11 patients, cuneiform in 5 patients, cuboid bone in 2 patients and enucleation fracture of the medial cuneiform in 2 patients). It was noted 10 cases of skin openings. Treatment consisted on open reduction in all patients and stabilization by pin complemented by a foot plaster for 6 weeks. Four (4) immediately arthrodeses were made. All patients were followed up 7 month to 4 years (mean, 30 month). According to the criteria of Massiri, treatment outcomes were excellent in 19% of cases, good in 28%, fair in 30% and poor in 23%. Conclusion: In our context, these lesions are often open and associated with fractures of Lisfranc joint skeleton and treated after a period more or less long and sometimes, we face lesions totally old. Immediately arthrodesis can be a lasting solution and should not be overlooked.