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Open Journal of Orthopedics 2015年第11期5卷 350-354页

作者： Atchi Walla anani abalo Malewé Kolou Service de Chirurgie Orthopédique et Traumatologique CHU Sylvanus Olympio Lomé Togo Service d’Immuno-Hématologie CHU Campus Lomé Togo

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.

关键词： Streptococcus pneumoniae Septic Arthritis Wrist IgG4 Subclass Deficiency

Elbow Dislocation with Ipsilateral Galeazzi Fracture: A Case Report

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Open Journal of Orthopedics 2016年第9期6卷 276-282页

作者： anani abalo Koulima K. Akloa Yaovi Yannick Dellanh Department of Orthopaedics Tokoin Teaching Hospital Lomé Togo

Elbow dislocation associated with ipsilateral Galeazzi fracture is a rare pattern of injury. Only seven cases were reported in the literature. We reported another case in a 42 years old man. Closed reduction of the dislocated elbow joint was immediately performed under sedation. Because the patient did not want surgery for radius, it was decided to manage the fracture conservatively. The lack of clinical improvement motivated operative treatment for Galeazzi fracture 56 days after injury. We have discussed the treatment option and the result obtained. The prognosis of this associated injury is related to the DRUJ dislocation, which should not be misdiagnosed.

关键词： Dislocation Elbow Distal Radio-Ulnar Joint Galeazzi Fracture Radius

Simultaneous extraarticular fracture of the base of the first metacarpal and dislocation of the metacarpophalangeal joint of the thumb： A case report

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Chinese Journal of Traumatology 2015年第4期18卷 232-234页

作者： anani abalo Sena Amouzou Kouami Amakoutou Assang Dossim Service de Traumatologie Orthopedie CHU Sylvanus Olympio Lomb Togo

Double fracture-dislocations of the thumb are rare. Only a single case report of a simultaneous extraarticular fracture of the base of the first metacarpal and dislocation of the metacarpophalangeal joint has been previously reported. We report the second case report of this injury in a 20-year-old man. The patient had an excellent outcome after treatment.

关键词： Carpometacarpal joints Metacarpophalangeal joint Extraarticular fracture Thumb

Internal Fixation of Gunshot Induced Fractures in Civilians: Anatomic and Functional Results of a Standard Protocol at an Urban Trauma Center

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Open Journal of Orthopedics 2016年第3期6卷 63-70页

作者： anani abalo Atsi Walla Gamal Ayouba Yaovi Yannick Dellanh Kosivi Fortey Assang Dossim Department of Orthopaedics Tokoin Teaching Hospital Lomé Togo

Introduction: Despite extensive experience with civilian gunshot fractures or wounds, no consensus exists on a standard protocol to manage these injuries. Many authors recommended immediate debridement, but the optimal timing of internal fixation and the use of antibiotic have not been determined. The purpose of this paper is to present and discuss our experience. Material and methods: In January 2007, a treatment protocol was put in place for the evaluation and management of fractured extremities resulting from civilian gunshot wounds. Sixty-three patients with 64 fractures had been managed by this protocol for gunshot fractures between January 2005 and January 2012. There were 56 male and seven female. Their mean age was 33.1 years (range: 17 - 61 years). Thirteen patients (20.6%) were able to provide a description of the weapon. Only 15 patients had entry and exit wounds. The mean follow-up period was 27 (range, 20 - 58) months. The main factors assessed were the surgical site infection, the fracture union and the functional status. Results: Out of the 63 patients, 14 patients developed a wound infection (five superficial and seven deep infections). Wound infection was significantly associated with associated injuries (p = 0.0388), fractures sites requiring fixation (p = 0.024), the fracture pattern (p = 0.0412), operative modalities (p = 0.0400). There were nine cases (14.1%) of fracture non-union. The mean time to union was 15 weeks (range: 5 - 32 weeks). Five patients developed chronics osteomyelitis. The average SMFA score for all of the patients was 23.8 (range: 0 - 56.3). The mean dysfunctional and bother indexes were 18.3 (range: 0 - 52.7) and 22.6 (range: 0 - 66.1), respectively. The SMFA total score and dysfunction index had a significant correlation based on presence or absence of associated injuries (p < 0.0001). But bother index did not show the same correlation (p = 0.452). The average length of hospital stay was 11.3 days (range: 3 - 64). Conclusion

关键词： Fracture Gunshot Fracture Internal Fixation Wound Infection Surgical Treatment

Bone Defect Reconstruction in a 2 Years Old Boy with Non-Vascularized Fibular Graft Using the Induced Membrane Technique in Country with Low-Income: A Case Report

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Open Journal of Orthopedics 2018年第12期8卷 453-463页

作者： Kombate Noufanangue Kanfitine Ayouba Gamal Bakriga Batarabadja Walla Atchi abalo anani Grégoire Department of Orthopaedic and Traumatology Surgery Saint-Jean de Dieu d’Afagnan Hospital Lomé Togo Department of Orthopaedic and Traumatology Surgery Teaching University Hospital Sylvanus Olympio Lomé Togo Department of Orthopaedic and Traumatology Surgery Campus Teaching University Hospital Lomé Togo

Chronic osteomyelitis in children is frequent in the developing countries. Their complications and morbidity burden the functional prognosis. The reconstruction of diaphyseal bone loss after sequestrectomy in young children remains a difficult and expensive challenge in our context. The delay in care and the lack of social security for all, are risk factors for morbidity. The induced membrane technique described by Masquelet starts to be applied and showed satisfactory results. We report the results of a case of reconstruction of the proximal humerus by using a non-vascularized fibula and supplemental bone substitute in a boy of 2 years with sickle cell. No scarring occurred at the sampling site. The process of bone consolidation is underway.

关键词： Chronic Osteomyelitis Bone Defect Bony Bone Reconstruction Induced Membrane Fibula

Sagittal Unicondylar Fracture of the Femur on Nail of Küntscher

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Open Journal of Orthopedics 2017年第7期7卷 192-197页

作者： Tchatchuang Paul Urich Tambekou Batarabadja Bakriga Noufanangue Kombate Atchi Walla anani abalo Assang Michel Dossim Department of Orthopaedics Tokoin Teaching Hospital Lomé Togo Afagna Hospital Afagnan Togo

Unicondylar fractures of the femur on osteosynthesis equipment are a particular entity in terms of the lesion mechanisms and therapeutic difficulties. We report this case because of its exceptional nature and discuss the mechanism of occurrence. It was a lateral sagittal unicondylar fracture of the femur on a nail of Küntscher that had been laid for medio-diaphyseal fracture. The causal mechanism was direct. A double screwing on each side of the nail after an open reduction followed by an early rehabilitation was carried out. Consolidation was obtained at 3 months and the nail removed at 18 months with a good functional knee result. Anatomical reduction and fixation allowing early rehabilitation represent a guarantee for a good long-term result.

关键词： Fracture Unicondylar Femur Nail of Küntscher Surgical Treatment

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

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Open Journal of Orthopedics 2015年第11期5卷 361-368页

作者： Atchi Walla Gamal Ayouba Dadja Essoya Landoh Batarabadja Bakriga Tchaa Towoezim anani abalo Assang Michel Dossim Service de Chirurgie Orthopédique et Traumatologique CHU Sylvanus Olympio Lomé Togo Service de Chirurgie Générale du Centre Hospitalier de Kpalimé Kpalimé Togo Division de l’Epidémiologie Ministère de la Santé 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

关键词： Humerus Shaft Fracture Nonunion Predisposing Factors

Primary Malignant Musculosqueletal Tumors of Members in Adult in Togo

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Open Journal of Orthopedics 2016年第4期6卷 103-107页

作者： Atchi Walla Faré Gnandi-Pio Piriziwè Dossim Gamal Ayouba Tchaa Towoezim Tchin Darre anani abalo Michel Dossim Service de Chirurgie Orthopédique et Traumatologique CHU SylvanusOlympio Lomé Togo Service de Chirurgie Orthopédique et Traumatologique CHU Kara Kara Togo Service de Chirurgie Générale du CHP de Kpalimé Kpalimé Togo Laboratoire d’Anatomie et Cytologie Pathologiques CHU SylvanusOlympio Lomé 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.

关键词： Primary Bone Tumors Soft Tissue Tumors Osteosarcoma Rhabdomyosarcoma Togo

Fracture-Dislocations of Lisfranc Joint in Lomé(Togo)

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Open Journal of Orthopedics 2016年第1期6卷 16-21页

作者： Atchi Walla anani abalo Agbékponou Lagnéblé Sényo Tsolenyanu Tchaa Towoezim N. K. Kombaté Michel Assang Dossim Service de chirurgie orthopédique et traumatologique CHU Sylvanus Olympio Lomé Togo Service de chirurgie orthopédique et traumatologique de l’hopital Saint-Jean de Dieu d’Afagnan Afagnan 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.

关键词： Dislocation Fracture Lisfranc Joint Pinning

Marjolin’s Ulcer at the Kara Teaching Hospital (Togo)

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Surgical Science 2022年第1期13卷 34-39页

作者： Tchaa Hodabalo Towoezim Tamegnon Dossouvi Yaovi Yanick Dellanh Kokou Kanassoua Irokoura Kassegne Pio-Faré Gnandi anani abalo Ekoué David Dosseh Department of Traumatology Teaching Hospital of Kara University of Kara Kara Togo Department of General Surgery Teaching Hospital of Kara University of Kara Kara Togo Department of Traumatology Regional Hospital of Sokodé University of Lomé Lomé Togo Department of General Surgery Regional Hospital of Kara University of Kara Kara Togo Department of Traumatology Sylvanus Olympio Teaching Hospital of Lomé-Togo University of Lomé Lomé Togo Department of General Surgery Sylvanus Olympio Teaching Hospital of Lomé-Togo University of Lomé Lomé Togo

Marjolin’s ulcer is an aggressive tumor that occurs on a chronic non-healing wounds or burn scars. It’s a rare disease. Histologically, it is most often a squamous cell carcinoma. The real frequency is not known. Its incidence would be higher in developing countries where ancestral beliefs and financial difficulties cause consultation delays. Thus the diagnosis is delayed, due in part to the lack or insufficiency of diagnostic means. Our study aimed to describe the epidemiological, diagnostic and therapeutic particularities through three cases treated in our center. The delay in consultation resulted in the death of one patient, while for the other two, amputation prevented the extension of the tumor. Limb amputation is increasingly rare in the management of Marjolin’s ulcer, but in our difficult conditions it is still widely practiced when the tumor is localized at the extremity of the limb, without signs of remote invasion.

关键词： Ulcer Marjolin Cancer Squamous Cell Carcinoma Amputation