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Watson-Jones Anatomical Approach for Open Reduction and Internal Fixation of Proximal Femoral Fractures without Image Intensifier in a Low-Resource Setting

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Open Journal of Orthopedics 2024年第4期14卷 173-186页

作者： Loïc Fonkoue Gaspary Fodjeu Kennedy Olivier Muluem Olivier ngongang Theophile Nana marie ange ngo yamben DésiréAkaba Urich Tambekou Daniel Eone Handy Department of Orthopaedics and Trauma Yaound&#233 General Hospital Yaound&#233 Cameroon. Department of Surgery and Specialities University of Yaound&#233 1 Yaound&#233 Cameroon Department of Orthopaedics and Trauma Yaound&#233 Emergency Center Yaound&#233 Cameroon Department of Orthopaedics and Trauma Yaound&#233 Central Hospital Yaound&#233 Cameroon

Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas o

关键词： Proximal Femoral Fracture Watson-Jones Approach Dynamic Hip Screw Low Resource Setting

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Traumatic Rupture of the Diaphragm: Retrospective Study of 27 Cases Operated in Three Hospitals in Yaoundé (Cameroon)

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Surgical Science 2022年第4期13卷 207-215页

作者： Guy Aristide Bang Georges Bwele Motto marie ange ngo yamben Christel Teddy Chappi Joseph Cyrille Chopkeng Daniel Biwole Biwole Bernadette ngo Nonga Departement of Surgery Yaoundé University Teaching Hospital Yaoundé Cameroon Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon Department of Digestive Central Hospital of Yaoundé Yaoundé Cameroon Department of Orthopaedic Surgery and Traumatology Yaoundé Emergency Centre Yaoundé Cameroon

Background: Traumatic ruptures of the diaphragm (TRD) are serious lesions that are often part of polytrauma. They pose a real diagnostic and therapeutic challenge in a disadvantaged environment such as ours. Methods: We conducted a descriptive observational study covering a period of 11 years in 3 referral hospitals in the city of Yaoundé (Cameroon). All patients who had undergone surgery for a traumatic rupture of the diaphragm between January 1, 2011 and December 31, 2020, and whose outcome within 30 days of surgery was known were included. Results: A total of 27 patients were collected. Their mean age was 36.4 ± 19.7 years. There was a strong male predominance with 22 cases (81.5%). The TRD occurred mainly after an assault (n = 9, 33.3%), was mainly on the left side (n = 25, 92.6%) and was most often part of a polytrauma (n = 17, 62.9%). The lesions associated with TRD were mainly visceral (n = 11) and bony (n = 6). The diagnosis was made preoperatively in only 13 patients (48.1%). The average length of the diaphragmatic breach was 6.4 ± 4.5 cm and a simple suture was most often used for the repair (26 cases or 96.3%). Four osteosynthesis procedures were performed at the same time as the diaphragmatic repair. The morbidity rate was 51.9%, with surgical site infection as the main complication. Six deaths (22.2%) were recorded;septic shock was the main etiology (n = 4). Conclusion: The hospital incidence of TRD remains low in our context. These lesions remain associated with significant morbidity and mortality and require a multidisciplinary approach.

关键词： Traumatic Rupture of the Diaphragm Morbidity Mortality Polytrauma

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Chronic Lymphoedema and Bone Infarction: Rare Complications of Multiple Segmental Fractures of the Lower Limb in a Young Adult

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Open Journal of Orthopedics 2022年第3期12卷 79-84页

作者： ngo yamben marie-ange Nana Chunteng Theophile Nseme Etouckey Eric Muluem Kennedy Olivier Tsiagadigui Tsiagadigui Jean Gustave Ndongo Mvela Laurent Stephane Manga Alexandre Guifo Marc Leroy Faculty of Medecine and Biomedical Sciences Department of Surgery and Specialities University of Yaounde 1 Yaounde Cameroon National Center of Rehabilitation of Disabilities Persons Yaounde Cameroon Faculty of Health Sciences Department of Surgery University of Buea Buea Cameroon Teaching Hospital of Yaounde Yaounde Cameroun

Multiple segmental fractures of the lower limbs, common in developing countries, are the prerogative of Road Traffic Accidents (RTA) involving two-wheeled vehicles. Their management is difficult, associated with complications, and is most often based on a two-stage strategy: Damage Control Orthopaedics, followed by delayed internal osteosynthesis. The aim is to allow early functional rehabilitation and rapid recovery of patients. We report the case of a 39-year-old man, bike rider, after his RTA, presented with segmental homolateral fractures of the femur and two bones of the left leg. Short-term evolution was marked by the appearance of significant lymphedema and bone infarctions of the lower left limb necessitating a transfemoral amputation. Through this observation, the authors highlight the problems related to the complexity of the management of multiple segmental fractures of the lower limb by emphasizing two post-traumatic complications rarely described but to be feared: chronic lymphedema and bone infarction.

关键词： Lymphœdema Multiple Fractures Bone Infarction Amputation Damage Control Orthopaedic

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Impact of Surgical Treatment of Patella Tendon Rupture Regarding Return to Sports in Yaounde

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Open Journal of Orthopedics 2022年第5期12卷 225-235页

作者： Olivier K. Muluem Loic Fonkoue ngo yamben marie-ange Sylvain N. Vofo Mohamadou E. Guemse Gael Dongmo Koufagued Kaldadak Daniel Handy Jean Bahebeck Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaounde Cameroon Yaounde General Hospital Yaounde Cameroon National Centre for the Rehabilitation of Patients with Disabilities Yaounde Cameroon Yaounde Military Hospital YaoundeCameroon

Introduction: Patella tendon rupture (PTR) is a cause of handicap in athletic patients. Surgery remains the actual therapeutic modality with a variety of techniques that permits a return to sport. Our objective was to evaluate the return to sporting activities after surgical repair of a PTR. Method: We conducted a retrospective cohort study over five years from January 2016 to April 2021. We included athletes from 18 to 65 years of operating for a PTR. We evaluated: the knee functional score, the level of satisfaction, Lysholm score, VISA-P questionnaire, and return to sports. Results: A total of twenty-one cases of PTR were identified. The median age was 36 years (18 - 63). After surgery, the median follow-up was 17 months (12 - 55). All patients were able to walk at 3 months. A total of 17 patients (85%) returned to sports. The median return to sports was 6 months (5 - 11). Patients who return to a similar sport with a similar initial level of sporting activity were 45% (9 patients). The median time to return to sports for patients at a similar level of sport was 7.5 months (6 - 13). Functional scores were satisfactory;with a VISA-P score of 90/100 (25 - 100) and a Lysholm score of 98/100 (40 - 100). Conclusion: Surgical repair of PTR in athletes offers good results regarding return to sports in terms of proportion and timing whatsoever the technique. The use of protection band wires is reserved for patients with relative satisfaction during suture repair.

关键词： Athletes Return to Sport Patella Tendon Surgical Treatment Protection Band Wire

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Quality of Life Following Major Limb Amputations in a Rural Community in Cameroon

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Open Journal of Orthopedics 2022年第3期12卷 97-112页

作者： Nana Theophile Chunteng ngo-yamben marie-ange Bombah F. Mertens Wamba Y. Jeazet Andrew Eyoh Edjua Ekani Boukar Mahamat Muluem Kennedy Manga Alex Assob Clement Department of Surgery Faculty of Health Sciences University of Buea Buea Cameroon Department of Surgery and Specialties Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Department of Surgery and Specialties Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of Journalism and Mass Communication Faculty of Social and Management Sciences University of Buea Buea Cameroon

Background: Limb amputation is considered the last resort when the limb is no longer salvageable or when the limb is dead or dying, viable but nonfunctional or endangering the patient’s life. It is associated with profound economic, social, and psychological effects on the patients. The aim of this study is to evaluate the quality of life of major limb amputees in a rural setting in western Cameroon. Methods: This was a cross-sectional descriptive and analytical study carried out at the BATSENGLA-DSCHANG community in the West Region of Cameroon. Participants were interviewed and data collected using a pre-defined accredited questionnaire of the WHOQOL-BREF to assess the quality of life. Results: There were 63 participants, and a majority (60.32%) reported trauma as the cause of amputation. Participants with prostheses had a better quality of life. Conclusion: The age range of the study participants was 18 to 85 years with a mean of 46.73 ± 18.31 years. The majority were males (74.6%). Most of them (41.27%) had attained at least a secondary level of education, a majority (80.95%) were unemployed and more than half (55.56%) have less than the guaranteed inter-professional minimum wage. Major limb amputations were mostly due to traumatic causes (72%) and involved the lower limbs. Only a few (12.70%) used prostheses. Almost all of them (90.48%) had symptoms consistent with a phantom limb. The quality of life after major limb amputation in this study was generally fair according to the WHO quality of life tool.

关键词： Amputation Limbs Phantom Limb Prosthesis Quality of Life

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Obstetric Brachial Plexus Palsy of Newborns and Infants: Functional Outcomes after Rehabilitation by Their Own Parents

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Open Journal of Orthopedics 2022年第4期12卷 212-224页

作者： ngo yamben marie-ange Manga Alexandre Muluem Kennedy Mvondo Obama Serge Arnaud Nseme Etouckey Eric Nana Chunteng Theophile Tsiagadigui Tsiagadigui Jean-Gustave Mosoh Franklin Muluh Mbassi Awa Ibrahima Farikou Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaounde Cameroon National Centre for the Rehabilitation of Persons with Disabilities in Yaoundé Yaounde Cameroon Yaoundé General Hospital Yaounde Cameroon Faculty of Health Sciences University of Buea Cameroon Mother-Children Center of the Chantal Biya Foundation of Yaoundé Yaounde Cameroon

Introduction: Obstetric palsy of the brachial plexus (OPBP) is a paralytic lesion common to obstetric trauma, whose clinical presentation varies according to the severity and extent of the root lesions at birth. Early and appropriate rehabilitation is necessary in order to improve the functional prognosis of the injured limb. Under special conditions, parents could carry out this physiotherapy themselves. Objective: The aim of this work was to assess limb functional recovery in newborns and infants with OPBP after rehabilitation by their parents. Patients and Methods: We conducted a prospective study at the NCRDP in Yaoundé over a period of 18 months. We included all patients aged 0 to 2 years with OPBP, isolated or associated with other lesions and followed at least two (02) years at the NCRDP. Results: We recruited 69 cases. The hospital frequency of OPBP was estimated at 1.02%. The age at first consultation was [0 - 28 d] in 50.8% of cases. The sex ratio was 0.68. The right side was reached in 54.4% of cases. The Erb’s palsy predominated in 79.7% of cases. The risk factors for OPBP were vaginal delivery, cephalic presentation, shoulder dystocia and macrosomia. Physiotherapy was performed as prescribed in 94.9% of cases allowing excellent and good functional recovery in 76.81% of cases. Conclusion: In the care of their children’s OPBP rehabilitation by sensitized, actively involved and supervised parents would be a good alternative to professional physiotherapy in all situations where the latter would not be possible.

关键词： Obstetric Palsy Brachial Plexus Functional Rehabilitation Macrosomia Childbirth Dystocia

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A Retrospective Analysis of the Patterns and Outcomes of Tile B and Tile C Pelvic Fractures in Cameroon

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Open Journal of Orthopedics 2023年第4期13卷 157-167页

作者： Chunteng Theophile Nana Tsiagadigui Tsiagadigui Jean Gustave ngo yamben marie-ange Batchom Daudet Bombah Freddy Muluem Kenedy Mokake Divine ngomba Ekani Boukar Mahamat Ali Mahamat Takou Bougoue Andre Gaetan Simo Wambo Tagakou Mboula Christian Fotso Ndasi Henry Pius Fokam Department of Surgery Faculty of Health Sciences University of Buea Buea Cameroon Department of Surgery and Specialties Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaounde Cameroon Department of Surgery and Specialties Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon

Background: Pelvic fractures constitute about 2% - 8% of all fractures. This incidence may rise up to 25% in poly-traumatised patients. These fractures have a high mortality rate due to the fact that they occur usually as a result of high energy trauma, and most of the injured are poly-traumatised with concomitant haemodynamic instability. The aim of this study is to describe the patterns of injury and complications of unstable pelvic fractures treated in a level III hospital in Cameroon. Methodology: This was a hospital based retrospective analysis of files of patients admitted and treated for unstable pelvic fractures at the Regional Hospital Limbe within a period of 10 years (from 1st of January 2009 to 31st of December 2018). Results: A total of 139 cases of pelvic fractures were identified, amongst which 77 were unstable;68 were finally analyzed. The ages ranged from 18 to 80 years with a mean of 39 ± 5 years. The age group from 20 - 40 years was most represented (58.88%, n = 40). There were 45 males and 23 females giving a sex-ratio of 2:1. Road traffic injuries accounted for most of the cases (73.53%, n = 50). Forty-five (66.2%) were classified Tile B and 23 (33.82%) were Tile C, and 15 cases were open fractures (22.06%). Associated lesions were recorded in 30 cases, fractures of the lower extremity being the most common (33.33%, n = 10). Most of the cases were definitively treated surgically (80.89%, n = 55). The most common complications were surgical site infections (23.64%, n = 13). Conclusion: Unstable pelvic fractures are relatively common. Young males in the age group 20 - 40 years are the most affected, and the most common cause of injury was road traffic accident. Surgical site infections, pressure ulcers, severe anaemia and thrombo-embolism are common complications.

关键词： Unstable Pelvic Fracture Patterns Complications Cameroon

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Radial Head Dislocation Associated with an Ipsilateral Open Type II Gustilo-Anderson Fracture of the Radial Shaft

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Open Journal of Orthopedics 2023年第4期13卷 168-172页

作者： Gilbert F. O. ngongang Paul U. Tambekou Tchatchuang Jean G. Tsiagadigui Loïc Fonkoue Gaspary Fodjeu marie A. ngo yamben Daniel E. Handy Yaoundé Emergency Centre “CURY” Yaoundé Cameroon Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon

Radial head dislocation associated with an ipsilateral radial shaft fracture is a rare lesion, even more so for open lesions. Few cases have been found in the literature. We report this case due to its exceptional nature and discuss the mechanism of onset. A twenty-five-year-old patient presented with a dislocation of the radial head associated with a GUSTILO ANDERSON type II open fracture of the radial shaft following an occupational accident. He was managed twenty-four hours after the trauma. The mechanism was a direct blow. The dislocation was reduced by external manoeuvre following open reduction of the radial shaft. The fracture was stabilized by two Kirschner wires following reduction. The result at 12 months was satisfactory from a clinical and radiological standpoint.

关键词： Radial Head Dislocation Radial Shaft Fracture Kirschner Wires

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