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Treatment of Neglected Elbow Dislocations by Z-Lengthening of the Triceps Brachii

Open Journal of Orthopedics 2022年第4期12卷 142-152页

作者： M’Bra Kouamé Innocent Kouassi Kouamé Jean-Eric Yao Loukou Blaise AkobéJean Regis Achie Sery Bada Justin Léopold KouassiAya Adélaïde Natacha krah koffi leopold Michel Kodo Traumatology and Orthopedics Surgery of the University Hospital of Bouaké Bouaké C&ocirc te d’Ivoire

Introduction: Neglected elbow dislocations are much more common in developing and underdeveloped countries. The main reason for the delay in diagnosis is that patients initially seek treatment from traditional healers. These will immobilize the elbow in extension, which will lead to the retraction of the triceps muscle and collateral ligaments. Patients and Method: We carried out a prospective study over five years (2014-2019). The study involved patients with unreduced elbow dislocation older than 21 days. All patients with a dislocated fracture and those whose x-ray showed joint fusion were not included in the study. We collected 26 patients, 20 men and 6 women with an average age of 27.5 years (17 and 45 years). The average consultation time was 8.9 months (3 - 13). The approach was posterior about 8 cm above the olecranon and 2 cm below the olecranon, the ulnar nerve was identified and isolated. The triceps tendon was cut in a Z from its myotendin junction to the beak of the olecranon, and then lengthened. Results: The patients were reviewed after a mean follow-up of 24 months (12 - 36). The Mayo Clinic’s average elbow performance index was 77.1 (60 - 85), with 19 good and 6 average results. The mean flexion was 114°(100°- 135°) and the mean extension deficit was 31.15°(10°- 55°). The average range of motion was 82.5°(60°- 120°). We did not find a correlation between the duration of the lesion and functional recovery (p > 0.05). The Wilcoxon test showed that surgery significantly improved the overall range of motion of the elbow (p = 0.001). Discussion: Based on this study, open reduction with tendon lengthening should remain a treatment option regardless of the age and chronicity of the dislocation.

关键词： Elbow Dislocation Neglected Triceps Plasty Posterior Approach

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Ankle Arthrodesis in the Treatment of Neglected Ankle Fractures

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Open Journal of Orthopedics 2022年第4期12卷 123-130页

作者： M’bra Kouamé Innocent krah koffi leopold Kouassi Kouamé Jean-Eric Yao Loukou Blaise Akobé Jean Regis Achie Ochou Pierre Germain Jr Sery Bada Justin Léopold Kouassi Aya Adélaïde Michel Kodo Traumatology and Orthopedics Surgery of the University Hospital of Bouaké Bouaké C&ocirc te d’Ivoire

Introduction: Neglected ankle fractures are common in our regions. Patients first consult traditional healers and it is when the signs persist that they consult the surgeon for a swollen and painful ankle. Initially we always performed anatomical repairs with osteosynthesis, but the majority of patients still complained of pain and disability. We wondered whether a primary arthrodesis would not be indicated in old ankle fractures to avoid disabling pain for patients. We therefore performed a series of arthrodesis on neglected post-traumatic ankles. The objective of our study was to describe the results of arthrodesis on an old post-traumatic ankle and to propose a therapeutic indication in the face of any neglected ankle fracture. Material and Method: This was a prospective study over 8 years between December 2012 and November 2020, involving 36 cases of neglected ankle fractures treated by arthrodesis using Meary’s technique. We used AOFAS (American Orthopedic Foot and Ankle Score) preoperatively and postoperatively for an objective assessment. Results: The average follow-up was 4.2 years and our results were satisfactory (94.4%) with an average AOFAS score ranging from 27.8 preoperatively to 76.7 postoperatively. The fusion rate was 97.2%. Discussion: Arthrodesis appears here as an important alternative in the treatment of neglected ankle fractures with significant trophic disorders.

关键词： Arthrodesis Ankle Neglected Fracture Osteosynthesis Traditional Healers

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Giant Bursitis of Wrist and Multiple Tenosynovitis of Hand with Rice Body Formation: Unusual Case of an Atypical Mycobacteria Infection

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Open Journal of Rheumatology and Autoimmune Diseases 2016年第3期6卷 45-50页

作者： Kone Samba krah K. leopold Traore Moctar Gbane Mariam koffi Gerard Kouassi Adelaide Ngandeu Astrid Traumatology and Orthopedics Surgery of the University Hospital of Cocody Abidjan Cote d'Ivoire Traumatology and Orthopedics Surgery of the University Hospital of Bouaké Bouaké Cote d’Ivoire Traumatology and Orthopedics Surgery of the University Hospital of Treichville Abidjan Cote d’Ivoire Rheumatology Service of the University Hospital of Cocody Abidjan Cote d’Ivoire

We report an unusual manifestation of nontuberculous mycobacterial infection characterized by a giant bursitis on wrist and multiple tenosynovitis with many rice bodies formations. The clinical and radiological examinations are neither rather sensitive nor rather specific. The nuclear imagery of rice bodies formations provides elements of guidance. Cause of absence of the germ isolation, diagnosis was retained on probability items based on a suspicion of arguments beam: clinical, biological, bacteriological and histological. The patient was treated with medical and surgical procedure and provided a satisfactory evolution. At follow-up of 15 months, there were no clinical signs of local recurrence. Through a literature review, the problem of diagnosis of certainty will be discussed.

关键词： Rice Body Formations Nontuberculous Mycobacteria Tenosynovitis Bursitis Hand

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Unusual Posterior Traumatic Hip Dislocations at Yopougon/Abidjan Teaching Hospital

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Open Journal of Orthopedics 2016年第4期6卷 71-77页

作者： Alidou Traoré leopold koffi krah Daouda Kanaté Soumaro Rebecca Eva Boka Christelle Mobiot-Aka Alban Slim Mbende Mamadou Dosso Kader Sy Jean Baptiste Sie Essoh Insa Bamba Yves Lambin Trauma and Orthopaedic Surgery Unit Yopougon Teaching Hospital Abidjan Ivory Coast Neurosurgery Unit Yopougon Teaching Hospital Abidjan Ivory Coast

Traumatic dislocation of the hip is quite rare and accounts for 2% - 5% of all dislocations. We report on a case of a bilateral posterior hip dislocation associated with symmetric acetabular fracture and two cases of infracotyloid dislocation. The report included 2 men and one woman. The mean age of patients was 33 years. All dislocations followed a road traffic accident. Non-operative closed reduction was achieved within 19 hours of admission. The average follow-up time was 15 months. The hips were stable, mobile, and painless;and there was no radiographic sign of avascular necrosis of the femoral head.

关键词： Hip Dislocation Posterior Infracotyloid Posterior Wall

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Major Limb Amputation Secondary to Locally Advanced Cutaneous Squamous Cell Carcinoma in Tropical Environments: Determinants

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Open Journal of Orthopedics 2018年第4期8卷 139-147页

作者： Kouassi Kouamé Jean Eric Yao Loukou Blaise Sery Bada Justin leopold Niaoré M’bra Kouamé Innocent krah koffi Léopold Kouassi Aya Adelaide Nathacha Assere Yao Aboh Ganyn Robert Arnaud Kodo Michel Trauma and Orthopedics Department Bouake Teaching Hospital Bouake Ivory Coast

Objective: To identify the determinants of secondary limb amputation in advanced squamous cell carcinoma. Material and Methods: This was a retrospective study carried out in the Orthopedic Traumatology Department of the Bouaké University Hospital in Côte d’Ivoire from January 2013 to December 2016. It involved ten patients with locally advanced skin squamous cell carcinoma, confirmed by histology and having amputated limbs. The parameters studied were: demographic data (gender, age), socio-economic conditions (occupation, place of residence), the risk factors involved, the use of topical self-medication and the use of traditional medicine, antecedents and comorbidities factors, lifestyle, clinical aspects (seat, size), extension assessment (X-ray), anatomo-pathological examination data, duration of evolution of squamous cell carcinoma, the function of the affected limb, the treatment performed, the evolutionary modalities and the equipment. Results: Between 2013 and 2016, ten patients underwent either upper or lower limb amputations following locally advanced squamous cell carcinoma. The average age was 34.1 years (19 - 64 years). There were 7 men (70%) and 3 women (30%) and all our patients were black (sub-Saharan Africa). The majority of our patients were farmers (70%). The risk factors for squamous cell carcinoma were neglected chronic wounds. All our patients recognized during the interrogation a large use of the topicals of traditional medicine for the treatment of the initial cutaneous lesions. In terms of lifestyle, five (50%) were smokers and alcoholics. The mean time to progression of squamous cell carcinoma was 5.9 years. Lesions were localized preferentially to the pelvic limbs six (60%) cases and four (40%) to the limbs chest. The lesion was diagnosed late in all our patients. The size of the tumor in all our patients was greater than 5 cm and had a deep invasion (nerves, vessels and bone). The proximal ipsilateral ganglionic invasion was constant.

关键词： Amputation Squamous Cell Carcinoma Cutaneous Histology

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