Pyogenic infections are common in tropical countries and draining pus is one of the most frequent surgical operations all over the developing world. While superficial abscesses are easily detectable by clinical means the diagnosis of deeper abscesses in muscles, joints, parenchymatous organs and body cavities is frequently difficult or even impossible. In those situations B-mode ultrasound represents a valuable diagnostic tool. Furthermore, diagnosis may be confirmed or defined by ultrasound guided needle aspiration and ultrasound-guided drainage. Those measures may save surgical interventions and cost. Based on our experience with more than 3820 ultrasound examinations in 2746 patients of Northern Zaire sonographic characteristics of pyogenic abscesses are defined. Clinical examples of pyogenic affections with the corresponding ultrasound morphology are presented.
In 1992, 15 of 152 patients with open fractures were treated with vacuum sealing. Drainage tubes are inserted into polyvinyl foam, which is used to fill in the wound or tissue defect. Polyvinyl foam and adjacent skin are covered with a transparent polyurethane dressing which is impermeable to bacteria. The connection of the drainage tubes to a suction device, such as vacuum bottles, produces negative pressure in the polyvinyl foam, which means a high-contact zone of the foam-wound interface. This results in efficient cleaning and conditioning of the wound, with marked proliferation of granulation tissue. Bone infection did not occur in any of our 15 patients; 1 patient sustained a soft tissue infection due to an insufficient sealing technique. When the correct technique was applied the infection cleared up.
In 1992, 15 of 152 patients with open fractures were treated with vacuum sealing. Drainage tubes are inserted into polyvinyl foam, which is used to fill in the wound or tissue defect. Polyvinyl foam and adjacent skin are covered with a transparent polyurethane dressing which is impermeable to bacteria. The connection of the drainage tubes to a suction device, such as vacuum bottles, produces negative pressure in the polyvinyl foam, which means a high-contact zone of the foam-wound interface. This results in efficient cleaning and conditioning of the wound, with marked proliferation of granulation tissue. Bone infection did not occur in any of our 15 patients; 1 patient sustained a soft tissue infection due to an insufficient sealing technique. When the correct technique was applied the infection cleared up.
In the period 1 January 1987 to 30 June 1989, 3003 operations were performed at the regional hospital of Gbadolite, northern Zaire. In 123 patients fractures were reduced operatively, in 86 patients by internal fixation and in 37 patients by external fixation. There was no additional bone infection after external fixation but six of 28 patients (21%) with internal fixation by plate and screws developed postoperative osteitis. Non-union was observed in 12% after intramedullary nailing, in 4% after screw fixation alone, and 14% after internal fixation by Kirschner wires. Based on these data, indications and contraindications for operative fracture treatment in tropical countries are defined.
Pulmonary complications during and after intramedullary nailing particularly in trauma patients have directed clinical interest to thromboembolic events and metabolic alterations, as found in different methods of fracture stabilisation. In 30 patients (mean age 34 years) isolated, closed or I-degrees open fractures of the tibia were operated on in three groups with reamed nailing (RN; n=11), unreamed nailing (UN; n=11) and external fixation (EF; n=8) respectively. In blood samples of the femoral vein of the fractured limb, a 5 - 7 fold increase of the thromboxane (TXB2) concentration was found in all patients. However, differences of TXB2 concentrations in the arterial blood after passage of the lungs were conspicuous. The highest arterial TXB2 concentrations were found in connection with RN, followed by UN and finally EF. The transpulmonary TXB2-clearance displayed the following relationship: EF > UN > RN (5.7 : 4,4 : 2.2). A similar correlation was found for PGF2alpha while other arachidonic acid metabolites showed no significant behaviour. TXB2 and PGF2alpha cause bronchoconstriction, pulmonary vasoconstriction ana aggregation of thrombocytes. These pulmonary disturbances may results in ARDS, a feared complication after intramedullary nailing.Conclusion: Early fracture stabilisation particularly in severely injured patients is an established procedure. To prevent pulmonary disturbances the external fixator is preferrable to the UN and finally the RN.Our data suggest that for the prevention of pulmonary disturbances EF is superior to UN and RN.
In tropical countries, the indication for operative treatment of fractures treatment must be restrictive. Based on our own experience and the treatment results, the prerequisites for operative treatment are given and proposals concerning indication, preoperative preparation and operative tactics. The osteosyntheses recommended are the different forms of external fixation, in particular the external fixator (AO) and the transfixational plaster cast technique. The external fixator is the basic tool in tropical traumatology.
In tropical countries, the indication for operative treatment of fractures treatment must be restrictive. Based on our own experience and the treatment results, the prerequisites for operative treatment are given and proposals concerning indication, preoperative preparation and operative tactics. The osteosyntheses recommended are the different forms of external fixation, in particular the external fixator (AO) and the transfixational plaster cast technique. The external fixator is the basic tool in tropical traumatology.
