Le pneumothorax spontané est une affection rare chez le nouveau-né. Tardivement diagnostiqué, il engage gravement le pronostic vital. Cependant, un signe clinique d’appel peut permettre un diagnostic et une prise en charge précoces. Un nouveau-né de sexe masculin, né à terme par voie basse dans un centre périphérique est référé à sa première heure de vie au centre hospitalier universitaire Sylvanus-Olympio (Togo) pour une tuméfaction thoracocervicale droite d’installation progressive, constatée 30 minutes après la naissance et symptomatique d’un emphysème cervical. Cet emphysème cervical a été révélateur d’un pneumothorax spontané du nouveau-né au cours des premières heures de vie. Ce cas de pneumothorax spontané chez un nouveau-né est rapporté pour rappeler que cette pathologie rare ou sousdiagnostiquée est une des étiologies des détresses respiratoires néonatales dans notre contexte sanitaire.

Acute scrotum in children constitutes an emergency that can jeopardize both the functional and vital prognosis of the testicle. Among the various diseases presenting as acute scrotum, there are some very rare such as encysted hydrocele of the cord, which are difficult to suspect on clinical examination. We report a case of acute scrotum in a 09 year old child mistaken for a strangulated inguino-scrotal hernia after clinical examination, in whom intraoperative findings and anatomopathological examination led to the conclusion of encysted hydrocele of the cord torsion.

Mature teratoma is a primary germ cell tumor frequently revealed during childhood in its sacrococcygeal and gonadal location, and rarely in the mediastinal location. The mode of the revelation of this tumor in the mediastinum ranges from incidental discovery to acute respiratory distress syndrome. We report the management of a case of mature mediastinal teratoma in a 10-year-old girl revealed by persistent chest pain evolving for 16 days. This observation will allow us to review the epidemiological, diagnostic, therapeutic, and prognostic aspects of this affection.

Pre-requis: La morbidite et la mortalite liees aux enfants restent elevees dans les pays d’Afrique subsaharienne. Pour atteindre les Objectifs du Millenium pour le Developpement, il importe de considerer les urgences medicales pediatriques qui y jouent un role important et de definir des interventions pour leur reduction. But: Decrire le profil epidemiologique des enfants admis dans les unites pediatriques de soins continus et rapporter la morbi-mortalite liee aux urgences en pediatrie. Methodologie: Etude retrospective portant sur 4791 dossiers d’enfants âges de 0 a 15 ans hospitalises pour une urgence dans les unites de soins continus du service de pediatrie du CHU Sylvanus Olympio de Lome du 1 er janvier 2014 au 31 decembre 2015. Resultats: les urgences ont represente 21,2% des consultations et 63,2% des hospitalisations. Dans les premieres 24 h, 30,7% des patients ont consulte. L’âge moyen des patients etait de 3,2 ± 3,6 ans. La majorite des patients (86,6%) avait moins de 5 ans. Il y avait 34,7% de nouveau-nes. Chez les nouveau-nes, les principaux types d’urgence etaient infectieuses (84,2%). Chez les enfants de plus de 1 mois, les urgences etaient hematologiques (48,7%), infectieuses (46,6%) et neurologiques (31,4%). Le taux de letalite etait de 18,7%. Chez les nouveau-nes, il etait de 23,8% et chez les enfants de plus de 1 mois 15,9%. La majorite des patients decedes (90%) avait moins de 5 ans. Conclusion: La reduction des deces d’enfants admis pour une urgence passe par une consultation precoce et la diffusion d’interventions multifacettes sur le paludisme et l’infection neonatale. Mots cles: urgences, reanimation pediatrique, Lome English Title: Pediatric emergencies medicine in intensive care unit at CHU Sylvanus Olympio Lome English Abstract Background: Morbidity and mortality of children still high in african subsaharian country. The pediatric medical emergencies must take important place in the causes and to reach millennium goals it’s important to considers them and determine how to manage. Objectives: To determine the epidemiological profile of pediatric medical emergencies and report their morbidity and mortality. Methods: We retrospectively reviewed the medical records of 4791 children aged 0 to 15 years hospitalized for medical emergencies in intensive care unit in pediatric department at CHU Sylvanus Olympio Lome between 1 st January 2014 and 31 December 2015. Results: Emergencies represented 21.2% of all consultation and 63.2% of hospitalization. In the first 24 hours, 30.7% of patients were admitted. Median (range) patient age was 3.2 ± 3.6 years. Most patients (86.6%) were under five years. There were 34.7% of newborn. In newborn, infectious disease accounted for 84.2%. In children aged more than 1 month, hematological events accounted for 48.7% of cases, infectious disease for 46,6%, and neurological events for 31,4%. The overall mortality rate was 18.7%. The mortality in newborn 23.8% and 15.9% in over 1 month. Most deaths (90%) occurred in children under five. Conclusion: Early specialist consultation and multi-disciplinary intervention targeting malaria and neonatal sepsis may reduce the mortality rate among neonates and children admitted for emergencies in tropical countries. Keywords: emergencies, intensive care unit, pediatric, Lome

Introduction: La fistule omphalo-mesenterique est une anomalie congenitale tres rare. Nous rapportons les aspects cliniques et radiologiques d’un cas observe dans le service de pediatrie du Centre Hospitalier Universitaire Sylvanus Olympio de Lome.Observation: un nourrisson de trois mois, ancien premature de 31 semaines d’amenorrhee, a presente depuis la naissance un ecoulement de liquide intestinal puis plus tard de selles par l’ombilic. L’examen local a montre une tumefaction ombilicale inflammatoire au sein de laquelle existait un pertuis catheterisable. Une fistulographie faite a permis d’objectiver la persistance d’un canal omphalo-mesenterique et de retenir le diagnostic de fistule omphalo-mesenterique.Discussion: La fistule omphalo-mesenterique est une affection tres rare. Son diagnostic repose sur l’examen clinique et les donnees de la fistulographie. De rare cas de regression spontanee apres la naissance ont ete decrits, mais le traitement curatif demeure chirurgical.Conclusion: Le diagnostic de la fistule omphalo-mesenterique doit se faire dans la periode neonatale pour une prise en charge precoce.Mots cles: Fistule omphalo-mesenterique, Lome, TogoEnglish Title: Patent omphalomesenteric duct (a case report)English AbstractIntroduction: Patent omphalomesenteric duct is a very rare congenital anomaly. We report the clinical and radiological aspects of a case observed in the pediatric department of the Lome University Hospital Sylvanus Olympio.Observation: A three-month-old infant, a preterm infant of 31 weeks of amenorrhea, had a flow of intestinal fluid and later stools through the umbilicus. The local examination showed an inflammatory umbilical swelling within which there was a catheterizable lumen. Fistulography had made it possible to objectify the persistence of an omphalomesenteric canal and to retain the diagnosis of a patent omphalomesenteric duct.Discussion: Patent omphalomesenteric duct is a very rare disease. Its diagnosis is based on clinical examination and fistulography data. Of rare cases of spontaneous regression after birth have been described, but the curative treatment remains surgical.Conclusion: The diagnosis of a patent omphalomesenteric duct should be made in the neonatal period for early management.Keywords: Patent omphalomesenteric duct; Omphalomesenteric fistula; Lome; Togo

Objective To describe indications, different modalities and results of surgical treatment of femur fractures in children. Patients and methods This is a retrospective study from January 2004 to December 2013 in the pediatric surgery department of Lomé Sylvanius Olympio teaching hospital, from the records of patients aged 0-15 years with femur fractured treated surgically. Results There were 66.1% (39 cases) of shaft fractures of which 53.57% localized in the middle third. Of the 33.9% (20 cases) of the lower extremity fracture, epiphyseal growth fractures accounted for 13 cases including seven (7) for type II among Salter-Harris classification. The indications were: femoral fracture occurred in the context of multiple trauma (4 cases), patients over 11 years (40 cases), failure of conservative treatment (2 patients), epiphyseal growth fractures of the distal femur after failure of conservative treatment (12 patients) and an epiphyseal growth fracture type 4 of Salter and Harris where surgery was indicated immediately (1 case). The average time of surgical treatment was 32 days. The elastic stable intramedullary nailing (ESIN) was made in 66.1% of patients, the plate in 18.6%, the pinning in 11.9% and screwing in 3.4%. The average duration of hospital stay was 45.16 days. Removal of osteosynthesis material was performed in 38 patients or 64.4% of cases. The average time of this removal was 8 months.Conclusion The methods of the most widely used surgical treatment are open ESIN because of the long waiting patients associated with very limited financial resources. This method has real advantages and should be encouraged in our communities by improving the technical facilities and living conditions of the population.

The purpose of this study is to describe a simple, non-expensive, accessible and effective technique of ureterovaginal fistula diagnosis, and to assess the results of surgical management in a resource-constrained hospital. During a campaign of obstetric fistulas repair, we diagnosed ureterovaginal fistulas by vaginal exam with the blue methylene test associated to abdominal ultrasonography, two simple and non-expensive explorations which permitted to identify ureterovaginal fistula and to do differential diagnosis with vesicovaginal fistula. The management was surgery, by ureterovesical reimplantation. Four ureterovaginal fistulas have been diagnosed in 32 women presented with obstetrical fistula. The mean age of those fistulas was 4.85 years; it was located on the left ureter in three cases, on the right in one case. The ureteral lesion was consecutive to a caesarean section in all patients and sited on the pelvic segment of ureter. In three patients, diagnosis was performed by the negativity of the blue test and unilateral dilation of ureter and kidney while the discovery was done during the treatment of vesicovaginal and rectovaginal fistulas associated in the last patient. After effects of surgery were simple, characterized by disappearance of urine leakage and dilation of ureter kidney. In resources-constrained context, techniques such as blue test and ultrasonography are enough to perform diagnosis of ureterovaginal fistula. Ureterovesical reimplantation is an effective therapeutic method for diagnosing ureterovaginal fistula.

A penetrating abdominal injuries with evisceration in a child caused by an explosion of a mobile phone battery, is a rare form of accident. This is a case report on a 7 year-old boy who has been brought by his parents to the Emergency Room of the Regional Hospital Center of Lomé Commune (Togo), for penetrating abdominal injury with bowel evisceration at the left flank. The boy was playing outside the house while a mobile phone battery exploded out of a burning waste, and hit him on the left flank. The examination revealed an evisceration of about 50 cm on the left flank. He benefited from a laparotomy 8 h later with lesion repair. The post-operative was simple.

Objective: To describe the epidemiology, mechanisms of occurrence and therapeutic management of the crushing member’s injuries in children. Materials and methods: It was a retrospective study of the records of patients less than 15 years treated in the Pediatric Surgery Department of the Sylvanus Olympio teaching hospital (Lome) for crushing members from January 2008 to December 2011. Results: We recorded 15 cases of crushing member’s injuries in children representing 1.7% of hospitalizations for trauma in the pediatric surgery department. The annual incidence was 3.7 cases. There were 7 males and 8 females. The average age of the patients was 8.8 years. Older children accounted for 10 cases (66.7%). Occurrences of accidents were the mechanisms of the public highway with 53.3% (8 cases) and 46.7% (7 cases) for domestic accidents. Five (5) patients had hemodynamic shock at admission. Treatment was radical in 10 patients (66.7%). It was an amputation. Conservative treatment consisted to the cast immobilization in three patients and intra focal osteosynthesis in two (2) patients. A suppuration of amputation stumps was recorded. The average length of hospital stay was 23.17 days (extremes: 1 and 60 days). Conclusion: Members’ crush injuries are relatively uncommon in pediatric units in Togo.

The congenital epulis is a benign congenital granular cell tumor arising most often of the alveolar ridge of the jawbone. When giant, it is source of digestive discomfort disabling feeding. We report the case of a newborn female, vaginal delivery, presented with a giant intraoral tumor. Tumor obstructing the mouth of the newborn and prevent the attachment and feeding. The treatment consisted of excision of the tumor under general anesthesia. The histology of the tumor was revealed that it was an epulis. Key words: Congenital epulis, newborn, oral cavity, Togo

présenter la « technique du sablier » pour l’ombilicoplastie dans les hernies ombilicales volumineuses (HOV) et d’analyser les résultats. il s’agit d’une étude retrospective et descriptive portant sur dix enfants traités par la « technique du sablier » entre juillet 2011 et juillet 2013. Chaque HOV a été caractérisée par la hauteur de la tuméfaction et le diamètre du collet. l’âge moyen des patients était de 4,45 ans. Le sex ratio était de 0,66. La hauteur de la tuméfaction ombilicale variait entre 03 et 10 cm. Le diamètre du collet variait entre 04 et 10 cm. La cure de la hernie ombilicale avec ombilicoplastie par la « technique du sablier » a été réalisée dans tous les cas. Dans quatre cas, une pathologie associée a été en même temps traitée. La durée moyenne de l’intervention était de 68 minutes. Avec un recul moyen de 19,25 mois, nos résultats étaient bons dans 08 cas. la « technique du sablier » est une méthode d’ombilicoplastie par lambeaux cutanés bien adapté aux volumineuses hernies de l’enfant. Elle assure un résultat anatomique et esthétique satisfaisant sous réserve de sa bonne maitrise.

Introduction Sickle cell disease is the most common molecular disease. The sickling of the haemoglobin S followed by micro-vascular occlusion leads to complications observable in several tissues. Osteoarticular complications represent the most frequent pattern of hospitalization of children with sickle cell disease. This review discusses osteoarticular complications of sickle cell disease in children. Materials and methods This study is a review concerning children <15 years of age. Phenotypes retained are SS, SC and AS, with or without thalassaemia or foetal haemoglobin. Osteomyelitis, arthritis and osteonecrosis are included. Ficat’s classification was used for osteonecrosis of femoral head. Discussion Osteomyelitis is the most frequent complication. It is classically due mainly to salmonella species, but currently, several studies have found other micro-organisms (Staphylococcus aureus, Streptococcus pneumonia, klebsiella). Multiple sites are affected at the same time. Long bones are the most affected and according to studies, the most frequent are the humerus, the tibia or the femur. Delay to diagnosis often leads to chronic osteomyelitis, with a high risk of orthopaedic sequela. Arthritis can affect all joints. Also due to salmonella and S. aureus, they can have multiple locations. The hip and knee are the favoured sites. Inadequate treatment can result in the destruction of the joints. Avascular osteonecrosis occurs later, after the age of 10. Their evolution is progressive and insidious, explaining the late diagnosis. Osteonecrosis of the femoral head is the most frequent, and poses the problem of hip arthroplasty in children. Conclusion The osteoarticular complications must be hunted in children with sickle cell disease in order to diagnose them early. A quick and efficient treatment enables to avoid serious orthopaedic sequela.

Introduction : Les fractures de la diaphyse humerale (FDH) de l’enfant sont peufrequentes et leur prise en charge est bien codifiee. Le but de notre etude est de preciser les differents aspects des FDH de l’enfant au CHU Sylvanus Olympio de Lome Materiel et methodes : Il s’agit d’une etude retrospective sur dossiers d’enfants pris en charge pour FDH non pathologique entre 2006 et 2010. Resultats : En 5 ans, 33 FDH ont ete traitees. Les FDH ont represente 29,70% des fractures de l’humerus et 4,59% des fractures de l’enfant. La sex-ratio etait de 0,83. L’âge moyen etait de 8 ans 3 mois. Le cote droit etait atteint 14 fois et le cote gauche 19 fois. Les accidents de la voie publique (45,45%), et les accidents de jeu (42,43%) etaient les principales etiologies. La tumefaction de la zone fracturee etait retrouvee dans 69,70% de cas et on notait une deformation du bras dans 15,15% de cas. Il n’y avait aucun cas de paralysie radiale. La fracture siegeait au tiers superieur, au tiers moyen ou au tiers inferieur dans respectivement 27,30%; 57,60%; 15,10% de cas. Le traitement a ete orthopedique dans 90,90% de cas et chirurgical dans 9,10% de cas. Les resultats etaient tres bons dans tous les cas avec un recul moyen de 3 ans. Conclusion : En l’absence de contre-indications, le traitement orthopedique des FDH est ideal chez l’enfant car il donne de tres bons resultats. Meme en cas de paralysie radiale, l’attitude therapeutique doit rester resolument orthopedique. Mots cles : Fractures, diaphyse humerale, enfants, Togo

Objectifs : - decrire les aspects epidemiologiques et diagnostiques des malformations du tube neural. - identifier les differentes malformations du tube neural. - decrire leur prise en charge. Materiel et methode : Il s’agit d’une etude retrospective ayant portee sur des dossiers d´enfants âges de moins de 15 ans admis pour malformations du tube neural dans le service de chirurgie pediatrique du CHU de Lome de janvier 1990 a decembre 2006. Resultats : Nous avons trouve 58 cas de malformations tube neural en 17 ans avec 45 cas de spina bifida (77,59%), 9 cas d´encephaloceles (15,52%) et 4 cas d´anencephalie (6,89%). Aucune des meres des patients n’avait pris l’acide folique au cours de la grossesse. La notion de consanguinite a ete retrouvee dans 13,80% des cas de spina bifida. Le diagnostic antenatal n’a ete fait que dans 12,07% des cas avec 2 cas d´encephalocele et 6 cas de sipina bifida. La cure chirurgicale a ete le principal mode de prise en charge des patients. Seuls 91,38% des cas ont ete operes. Pour toutes les malformations du tube neural, nous avons enregistre 7 deces dont 2 deces pour les spina bifida en post operatoire, 1 deces pour les encephaloceles avant tout traitement et 4 deces pour l'anencephalie. Les suites operatoires ont ete satisfaisantes chez tous les patients operes sauf un cas d´encephalocele ou les suites operatoires ont ete marquees par la persistance de tumefaction fronto-nasale dure. Conclusion : Cette etude a demontre la realite des malformations du tube neural au Togo. La meilleure facon de lutter contre ces anomalies c´est d´elaborer une strategie de prevention des malformations du tube neural par l’acide folique. Mots cles: malformation, tube neural, spina bifida, encephalocele, anencephalie, Togo. ABSTRACT Objectives : describe epidemiological and diagnostical aspects of neural tube defects, identify the different neural tube defects and describe their support. Materials and method: It is a retrospective study from folders of less than 15 years old patients treated in the Pediatric Surgery department of Lome teaching hospital for the neural tube defects from January 1990 to December 2006. Results : We found 58 cases of malformations, neural tube defects in 17 years with 45 cases of spina bifida (77.59%), 9 encephaloceles (15.52%) and 4 cases of anencephaly (6.89%). None of the mothers of the patients took folic acid during pregnancy. The concept of consanguinity was found in 13.80% of the cases of spinal bifida. The prenatal diagnosis was made in hundred percent of the cases with 2 cases of encephalocele and 6 cases of spinal bifida. Surgical treatment has been the primary mode of management of patients. Only 91.38% of the cases have been operated. For all of neural tube defects, we recorded 7 deaths including 2 deaths for spinal bifida in post operative, 1 death for encephalocele before treatment and 4 deaths for anencephaly. The post operative results were satisfactory in all patients operated except an encephalocele case where the post operative results were marked by the persistence of hard frontonasal swelling. Conclusion : This study demonstrated the reality of the neural tube defects in Togo. The best way to combat these abnormalities is to elaborate a strategy for the prevention of neural tube defects by folic acid. Keywords : Malformations, neural tube defects, spina bifida, encephalocele anencephaly, Togo.

Les jumeaux conjoints du groupe des thoracopages sont des monstres doubles qui resultent d’une anomalie malformative au cours de la grossesse gemellaire et qui presentent un cordon ombilical avec une fusion au niveau de la region thoracique. De tout ce groupe des teratopages, les thoracopages et les omphalopages sont les plus frequemment rapportes dans la litterature. Ce sont des malformations rares qui representent 1 pour 50000 naissances. Le diagnostic morphologique peut etre fait par un examen echographique antenatal. Observations :Nous rapportons deux cas de jumeaux thoraco-omphalopages nes vivants dans deux structures sanitaires du Togo. Il s’agissait de jumelles nees a terme par cesarienne. Chez les premieres, l’examen radiologique et surtout post-mortem a mis en evidence deux foies matures accoles l’un contre l’autre et deux coeurs enveloppes par un meme pericarde. Chez les deuxiemes, il s’agissait d’un coeur et d’un foie unique malforme. Conclusion :Le developpement des techniques chirurgicales et surtout des mesures de reanimation neonatale, permet de nos jours de realiser une separation chirurgicale lorsque ces jumeaux conjoints naissent vivants et surtout lorsque les elements anatomiques thoraco-abdominaux sont bien constitues. Mot cles : Jumeau conjoint, monstre double, teratopage. ABSTRACT Joint twins of the thoracopagus group are dual monsters that result from malformative abnormality during the twin pregnancy and that show one umbilical cord with a fusion over the thoracic area. Among the teratopages, thoracopages and omphalopages are the most frequently reported in the literature. That are rare malformations representing 01 over 50 000 births. The morphologic diagnosis can be done by antenatal sonography. Observations : We report two cases of thoraco-omphalopagus twins born alive in two hospitals in TOGO. That was twins born over time by C-section. For the first case, the radiologic and post-mortem examinations shew two mature livers placed side by side and two hearts wrapped in the same pericardium. For the second case, that was one heart and one liver, both malformed. Conclusion : The surgical techniques development and especially neonatal resuscitation measures allow nowadays achieving a surgical separation when that joint twins are born alive and especially when thoraco-abdominal organs are well constituted. Key words : Conjoined twins, dual monster, teratopagus.

This retrospective study, carried on files of children treated between January 2005 and December 2009 from humerus upper end fractures (HUEF), aimed to specify the epidemiological, diagnostic and therapeutic aspects of these fractures in the Tokoin Teaching Hospital of Lome. Results: During 5 years, 10 children (6 girls and 4 boys) were treated from HUEF. The HUEF represented 9% of humerus fractures and 1.39% of children fractures. The HUEF were due 8 times to game and sport accidents, and 2 times to home accidents. The shoulder pain, present in all cases, was associated with functional disability, absolute in 8 cases, and relative in 2 cases. The fracture was associated with concussion in one case. The shoulder x-ray showed that the fracture was metaphyseal 6 times, and epiphyseal 4 times. In any case, orthopedic treatment led to very good results. Conclusion: Even though the orthopedic treatment leads to very good results in the majority of cases, an early treatment helped with image intensifier when required is the guarantee of satisfactory results. Keywords : Fractures, humerus, children, Togo. J. Rech. Sci. Univ. Lome (Togo), 2012, Serie D , 14(1) : 105-110

Introduction: Les fractures diaphysaires du femur (FDF) de l’enfant sont frequentes. Pour les enfants de 0 a 6 ans, le traitement est souvent orthopedique, avec un bon pronostic. Le but de cette etude est de preciser les differents aspects des FDF chez les enfants de 0 a 6 ans au CHU Sylvanus Olympio (CHUSO) de Lome. Materiel et methodes: Etude descriptive transversale sur 10 ans (2001 a 2010), elle a inclus les enfants de 0 a 6 ans presentant une FDF non pathologique, traitee au CHU-SO. Les parametres epidemiologiques, diagnostiques et therapeutiques ont ete etudies. Resultats: En 10 ans, 218 enfants de 0 a 6 ans (138 garcons et 80 filles), d’âge moyen de 30 mois ont ete traites pour FDF au CHU-SO de Lome. Les etiologies etaient : chute lors d’un jeu (54,12%), accident de la voie publique (42, 21%), accident obstetrical (2,75%) et maltraitance (0,92%). La fracture siegeait dans 140 cas au 1/3 moyen, dans 48 cas au 1/3 superieur et dans 30 cas au 1/3 inferieur. Vingt et quatre enfants ont ete traites d’emblee par plâtre pelvipedieux alors que la traction collee suivie d’un plâtre pelvipedieux a ete utilisee chez 194 enfants. Avec un recul moyen de 5 ans les resultats etaient excellents dans 142 cas et satisfaisants dans 76 cas. Conclusion: Les FDF chez les enfants de 0 a 6 ans sont essentiellement dues aux accidents de jeu et de la voie publique. Le traitement orthopedique, peu contraignant, donne constamment de bons resultats. Mots cles: Fracture, diaphyse femorale, enfant, Togo English Title: Fractures of femoral shaft in children under 6 years old at Sylvanus Olympio Teaching Hospital in Lome (Togo) English Abstract Introduction: The fractures of femoral shaft in children are frequents. For children under 6 years old, orthopedic treatment is always performed and gives good results. This study aims to specify the different aspects of theses fractures in children under 6 years old at Sylvanus Olympio teaching hospital in Lome. Material and methods: It was descriptive and transversal study carried on a period of 10 years (from 2001 to 2010) which included children from 0 to 6 years, treated for non pathologic fractures of femoral shaft at Sylvanus Olympio teaching hospital in Lome. The epidemiological, diagnostic and therapeutic parameters were studied. Results: During ten years, 218 children from 0 to 6 years (138 boys and 80 girls) with average age of 30 months were treated for fractures of femoral shaft. The causes were: game accident (54.12%), public way accidents (42.21%), obstetrical accident (2.75%) and a rough handling (0.92%). The fracture sited at superior third in 140 cases (64.22%), at middle third in 48 cases (22.02%) and at inferior third in 30 cases (13.76%). Twenty two children were immediately treated by cast and 194 were treated by cast after traction. With a mean follow up of 5 years, results were excellent in 142 cases and satisfying in 76 cases. Conclusion: fractures of femoral shaft are frequents in children under 6 years old at Sylvanus Olympio teaching hospital in Lome. Game accident and public way accidents are frequent causes. Orthopedic treatment is not much restricting and still gives good results. Keywords: Fracture, femoral shaft, child, Togo