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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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Intramedullary Nailing of Type I and Type II Open leg Fractures after 6 Hours at Yopougon Teaching Hospital

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Open Journal of Orthopedics 2016年第8期6卷 227-233页

作者： Traoré Alidou Mbende Alban Slim sery bada justin léopold Niaoré Mobiot-Aka Christelle Soumaro Kanaté Daouda Boka Eva Rebecca Sie Essoh Jean Baptiste Bamba Insa lambin Yves Trauma and Orthopaedics Department Yopougon Teaching Hospital Abidjan Ivory Coast Neurosurgery Unit Yopougon Teaching Hospital Abidjan Ivory Coast

Emergency debridement has long been the standard of care for open fractures of the tibia as infection is an important complication. In developing countries, patients are admitted to teaching hospitals 6 to 24 hours after their initial trauma. We sought to evaluate outcomes of nailing and correlations between the risk of infection and the delay in surgery. Materials and methods: Medical files of 48 men and 15 women with a combined total of 63 open fractures of the leg during a 12-year period were reviewed. The mean age was 29 years. Thirty-four type I and 29 type II open fractures according to the classification of Cauchoix and Duparc were treated with Küntscher nail after excision/debridement. Preoperative CRP was performed in 27 patients and in 22 cases it was positive. Twenty-six fractures were treated within a period of 6 to 24 hours, and a further 37 was operated on beyond 24 hours. The average waiting time before surgery was 2 days. Results: The infection was present in 11 patients (17.5%). We failed to establish any correlation between the time of treatment and the occurrence of infection for both type I and type II fractures treated during the same intervals with p = 0.244 (p > 0.05). But we established a correlation between the type of open fracture and the occurrence of infection with p = 0.01 (p ldn’t find a correlation between the positive value of the preoperative CRP and the occurrence of infection. Seven cases of infection were treated with appropriate antibiotherapy and early revision surgery. Four others cases complicated to bone infection (n = 2) and septic nonunion (n = 2). The average time of hospitalization was 22 days. The average time for fracture healing was 7 months. Conclusion: The rule of six hours is hardly applicable in our contexts. Our study showed no correlation between the preoperative period and the occurrence of infection.

关键词： Intramedullary Nailing Open Fracture leg Six Hours

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Osteoarticular lesions of the Shoulder Girdle by Hippopotamus Bite: Highly Septic lesion

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Open Journal of Orthopedics 2024年第2期14卷 114-121页

作者： Jr Pierre Germain Ochou Achié Jean Régis Akobe Yao Aboh Ganyn Robert Arnaud Assere Kouamé Jean-Eric Kouassi Adelaïde Aya Natacha Kouassi Ibrahim Soumahoro Zolopégué Marcel Soro Sédi loues De Randolphe Akpro Gbalé Yannick Blé Kouamé Innocent M’bra loukou Blaise Yao bada Juste léopold Niaorésery Koffi léopold Krah Michel Kodo Department of Orthopaedic and Traumatological Surgery Bouaké University Hospital Bouaké Ivory Coast Raoul Follereau Institute Manikro Centre Bouaké Ivory Coast

Hippopotamus bites are rare in medical consultations, despite several studies exposing their aggressive character. A case of a hippopotamus bite on the shoulder of a fisherman has been reported. In addition to the osteoarticular aspect representing a therapeutic problem, the infectious aspect was marked by sepsis, with a death in less than 48 hours. Based on this observation, a protocol for the initial management of large animal bites was submitted.

关键词： Bite Hippopotamus Septic Shock

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Triceps Brachii Tendon Reconstruction with V-Y Plasty: Indication and Functional Results of a Case at BouakéTeaching Hospital

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Open Journal of Orthopedics 2017年第12期7卷 396-399页

作者： Krah Koffi léopold sery bada léopold Kone Samba Digbeu Kévin Assere Arnaud Kouassi Aya Natacha Kouassi Eric M’Bra Innocent Yao loukou Blaise Kodo Michel Traumatology and Orthopedics Surgery of the University Hospital of Bouaké Bouaké C&ocirc te d’Ivoire Traumatology and Orthopedics Surgery of the University Hospital of Abidjan Abidjan C&ocirc te d’Ivoire

Repair of an old lesion of the triceps brachii tendon is infrequent. A V-Y plasty was performed 4 years after the injury in an adult. Post traumatic osteoarthritis limits functional outcomes. The patient is satisfied.

关键词： Reconstruction Tendon Triceps Brachii

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Madelung’s Deformity: Reverse Wedge Osteotomy of the Distal Radius Associate Ulnar Wedge Osteotomy: A Case Report

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Open Journal of Orthopedics 2018年第2期8卷 33-38页

作者： Kouassi Kouamé Jean Eric sery bada justin leopoeld Niaoré Yao loukou Blaise M’bra Kouame Innocent Krah Koffi léopold Kouassi Aya Adelaide Nathacha Assere Yao Aboh Ganyn Robert Arnaud Kodo Michel Traumatology and Orthopedics Surgery of the University Hospital of Bouake Bouake Cote d’Ivoire

Madelung deformity is rare, accounting for 1.7% of congenital anomalies. The treatment is essentially surgical and several techniques have been described. We report the result of a case treated in an adult patient by ... 详细信息

关键词： Madelung Deformity Cuneiform Osteotomy Radius Ulna

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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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Epidemiological and Clinical Characteristics of Renal Diseases Diagnosed by Biopsies in Ivory Coast

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Open Journal of Pathology 2022年第3期12卷 100-113页

作者： Kouame justin N’Dah Weu Melanie Tia Alain Didier Abouna Ibrahiman Toure Amelie Delphine lagou Monley Cyr Guei Ibrahim Cherif Moussa Traore Eyram Amekoudi Attaah Ange Rebecca Kobenan sery Patrick Olivier Diopo Kouame Hubert Yao N’Guessan Clement Ackoundou Koffi laurence Adonis Dazé Apolinaire Gnionsahié Mohenou Isidore Jean Marie Diomande Department of Anatomic Pathology University Teaching Hospital of Bouake Bouake Ivory Coast Department of Nephrology University Teaching Hospital of Bouake Bouake Ivory Coast Department of Anatomic Pathology University Teaching Hospital of Cocody Abidjan Ivory Coast Department of Nephrology University Teaching Hospital of Yopougon Abidjan Ivory Coast Department of Nephrology University Teaching Hospital of Donka Conakry Guinea Department of Nephrology Sylvanus Olympio University Teaching Hospital Lomé Togo Department of Nephrology University Teaching Hospital of Treichville Abidjan Ivory Coast Department of Pediatric Nephrology University Teaching Hospital of Yopougon Abidjan Ivory Coast

Renal biopsy is an invasive procedure used to evaluate the activity and the therapeutic management of kidney disease and kidney transplantation. Objective: The aim of this study was to describe the epidemiological, clinical, and pathological features of kidney disease diagnosed by biopsy in the Ivory Coast. Materials and Methods: This was a descriptive and prospective study conducted between January 2015 and December 2018 in the Department of Anatomy and Cytology of the Pathology of Cocody (Abidjan) and Bouake. Specimens were obtained from the nephrology department of Ivory Coast and from teaching hospitals in Togo, Guinea, Burkina Faso, and Mali. Samples were analyzed according to standard renal biopsy procedures. One kidney fragment was fixed in acetic acid formalin (AAF) for optical microscopy examination. The other fragment, soaked in physiological water, was immediately sent for immunofluorescence examination. All renal pathologies were included in this study. The study parameters were frequency, age, sex, origin, occupation, clinical and biological signs, and pathological aspects with optical microscopy, and immunofluorescence. Results: 153 cases (2.23%) of kidney biopsies were examined on a total of 10,573 specimens. Ivory Coast specimens accounted for 91.5% of cases (n = 140). Nephrotic syndrome (49%) was the most common clinical sign and indication for renal biopsy, followed by acute renal failure (16.3%), chronic renal failure (19.6%), and a combination of chronic renal failure with hypertension (11.18%) and glomerulonephritis (4%). Mean proteinuria was 3.03 g/24h (range, 0.14 to 11.5 g/24h). Histologically, 90.8% (n = 139) were glomerular nephropathies, including 26.6% HIV-associated nephropathy, 17.3% focal segmental glomerulosclerosis, 13.6% nephroangiosclerosis, 11.5% post-infectious glomerulonephritis, 9.3% membranous glomerulonephritis, and 21.6% miscellaneous glomerular nephropathies (n = 30). The incidence of various tubulo-interstitial lesions was

关键词： Kidney Biopsy Disease Pathology Ivory Coast

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Focal Segmental Glomerulosclerosis in Côte d’Ivoire: Epidemiological, Clinical and Pathological Aspects

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Open Journal of Pathology 2022年第4期12卷 146-155页

作者： N’Dah Kouame justin Tia Weu Melanie Akpro Sedy louess De Randorphe lagou Delphine Amélie Toure Ibrahiman Kobenan Atta Anne Rebecca Abouna Alain Didier Guei Monley Cyr Tuo Wonko-Tian Alice Oka Kouamé Hubert Diopo sery Patrick Olivier Delma Samuel Cherif Ibrahima Traore Moussa Amekoudi Eyram Ouattara Belarsi Safiatou Yao Kouame Hubert Ackoundou Nguessan Clément Adonis Koffi laurence Yao Gnangoran Victor Gnionsahie Dazé Apolinaire Mohenou Isidore Jean-Marie Diomandé Department of Anatomic Pathology University Teaching Hospital of Bouake Bouake Ivory Coast Department of Nephrology University Teaching Hospital of Bouake Bouake Ivory Coast Department of Nephrology University Teaching Hospital of Yopougon Abidjan Ivory Coast Department of Anatomic Pathology University Teaching Hospital of Cocody Abidjan Ivory Coast Department of Nephrology University Teaching Hospital of Treichville Abidjan Ivory Coast Department of Nephrology University Teaching Hospital of Blaise Compaore Ouagadougou Burkina Faso Department of Anatomic Pathology University Teaching Hospital of Donka Conakry Guinea Department of Nephrology University Teaching Hospital of Sylvanus Olympio Lome Togo Department of Nephrology University Teaching Hospital of Treichville Abidjan Ivory Coast

Focal segmental glomerulosclerosis (FSGS) is characterized histologically by hyalinosis and sclerosis of glomeruli associated or not with podocyte involvement. The objective of our work was to clarify the epidemiological aspects and histological variants of FSGS in Côte d’Ivoire. Materials and Methods: This was a descriptive retrospective study, conducted from January 2015 to December 2019 using the renal biopsy registers (RB) of the Pathological Anatomy and Cytology departments of the Teaching Hospital of Cocody and Bouake in collaboration with the Nephrology Services of Côte d'Ivoire and the sub-region. The biopsies underwent conventional histopathology and/or immunofluorescence techniques. The parameters analyzed were: frequency, age, gender, proteinuria, biopsy indications and histological aspects and the different correlations between histological aspects and socio-demographic characteristics. Results: FSGS represented 58.1% (n = 104) of glomerular nephropathies. The average age of patients was 32.1 ± 13.3 years, with extremes of 13 and 70 years. The sex ratio was equal to 1. Nephrotic syndrome (68.9%), chronic renal failure (14.3%) and acute renal failure (10.1%) were the main indications for renal biopsy (RB). The mean proteinuria at the time of diagnosis was 4 ± 3.7 g/24 h. It was massive (3.5 g/24 h) in 42.3% of patients. FSGS was primary in 29.8% (n = 31) and secondary in 70.2% (n = 73) of patients, of which 27.9% (n = 35) was due to HIV. According to the Columbia classification, 62.5% NOS type was found;23.1% collapsing type;7.7% tip lesion type;4.8% cell type and 1.9% perihilary type. Conclusion: FSGS is a complex heterogeneous entity. It affects young people in our context with a homogeneous gender distribution. Understanding its histogenesis is essential for optimal patient management.

关键词： Kidney Glomerulus Histology FSGS Côte d’Ivoire

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