Les synostoses intracarpiennes sont rares (0,1 à 2% de la population). Parmi celles qui sont décrites, on retrouve assez fréquemment la synostose luno-triquétrale, suivie de la synostose capitato-hamatum. L'association de ces dernières ne semble pas avoir été décrite. Nous rapportons le cas d'un sujet de 30 ans, de sexe masculin, droitier, ayant en association une synostose luno-triquétrale, une synostose capitato-hamatum, une hypoplasie du scaphoïde et une synostose carpo-métacarpienne étendue épargnant le premier rayon à gauche. L'expression clinique se résumait à une limitation modérée de la mobilité du poignet. La découverte a été fortuite.

Objectif Évaluer les résultats anatomiques et fonctionnels du traitement chirurgical des fractures des plateaux tibiaux. Patients et méthode Soixante-dix patients avec un âge moyen de 43,9 ans ont été opérés pour une fracture des plateaux tibiaux entre le 1er janvier 2014 et le 31 décembre 2019. Selon la classification Schatkzer, les fractures étaient de type I (n=2), type II (n=11), type III (n=13), type IV (n=5), type V (n=14), type VI (n=25). Il a été réalisé une ostéosynthèse à ciel ouvert par plaque en L pour les fractures de type I, II et III avec relèvement et greffe osseuse pour les types II et III. Les type IV ont été opérés par ostéosynthèse par plaque en T tandis que les types V et VI ont été opérés par double ostéosynthèse par plaque en L latéral et en T médial ou vissage médial. Les résultats anatomiques et fonctionnels ont été évalués au recul moyen de 31 mois chez 67 patients. Résultats La réduction était jugée excellente (n=5), bonne (n=24), moyenne (n=35), et mauvaise (n=6). La consolidation osseuse a été obtenue chez 64 patients dans un délai moyen de cinq (05) mois. Les résultats fonctionnels étaient excellents et bons chez 58 patients. Conclusion L’ostéosynthèse à ciel ouvert par des plaques en T ou en L des fractures des plateaux tibiaux a permis d’obtenir d’excellents résultats. Mots clés : Fracture des plateaux tibiaux, Ostéosynthèse à ciel ouvert, Plaque vissée. Niveau de preuve : IV

Les luxations antérieures bilatérales invétérées de l'épaule surviennent souvent dans des situations particulières. Nous rapportons un cas de luxation antéro-interne bilatérale invétérée mettant l’accent sur l’âge et le contexte favorisant la méconnaissance de la luxation. Il s’agit d’une patiente de 99 ans aux antécédents de psychoses chroniques avec des périodes d’agitation nécessitant des contentions physiques. Elle a eu une luxation antéro-interne des deux épaules, passée inaperçue, et dont le diagnostic a été posé fortuitement lors d’une consultation aux urgences pour une plaie frontale après une chute. L’examen clinique et radiologique avait permis de retenir le diagnostic d’une luxation antéro-interne bilatérale des épaules. La fonction des épaules était bonne avec un score clinique de Rowe et Zarins qui était bon. Nous avons opté pour une abstention thérapeutique du fait de son âge, l’ancienneté des luxations, mais surtout la fonction de l’épaule qui était bien adaptée aux activités quotidiennes et à la demande fonctionnelle de la patiente. Nous insistons sur la nécessité de rechercher de façon systématique cette lésion chez des patients âgés ayant une pathologie psychologique avec agitations répétitives nécessitant des contentions physiques.

Objectif : Cette étude avait pour objectif principal de décrire les modalités et les résultats du traitement des fractures du pilon tibial dans un centre de référence béninois. Les objectifs secondaires étaient de préciser l’association entre l’état cutané et la survenue de complications cutanées d’une part et le drainage du foyer tibial et la survenue d’infection d’autre part. Patients et Méthodes : Il s’agissait d’une étude observationnelle, et transversale ayant porté sur des dossiers de patients hospitalisés pour une fracture récente du pilon tibial. L’évaluation anatomique était effectuée avec les critères de Arlettaz. L’évaluation fonctionnelle était faite par les critères de Biga. Le test de Chi-2 de Pearson ou le test exact de Fisher étaient utilisés pour déterminer la signification de l’association entre les variables catégorielles. Les résultats étaient significatifs quand la p-value est p< 0,05. Résultats : Cette étude était basée sur 35 fractures chez 34 patients. Le traitement opératoire a concerné 26 fractures. La méthode orthopédique était indiquée pour neuf fractures. Les résultats anatomiques étaient satisfaisants (n=21 ;60%). Les résultats fonctionnels étaient satisfaisants (n=22 ; 63%). Il y avait une association entre les contusions cutanées et la survenue des complications immédiates. Il n’existait pas d’association entre le drainage aspiratif et la survenue de complications infectieuses. Conclusion : Au Bénin, le traitement des fractures du pilon tibial est orthopédique ou chirurgical. La chirurgie à foyer ouvert utilise des plaques classiques de type AO après un contrôle des lésions des parties molles. Les complications cutanées étaient plus liées à la contusion initiale qu’au type de traitement appliqué. Mots-clés : Fractures du pilon tibial, Parties molles, Plaque AO

Background: Fractures are a common occurrence in pediatric traumatology, accounting for 10 to 25% of all fractures. This study aims was to describe their epidemiological characteristics and specify the therapeutic modalities available at DTH-OP. Methods: This was a retrospective, descriptive, and analytical monocentric study conducted in the surgery and emergency departments of DTH-OP. Medical records of patients aged 0 to 15 years admitted for fractures and seen between 1 January 2021 and 31 December 2022 were identified. Results: Two hundred and thirty (230) cases met the inclusion criteria for 266 fractures. The mean age was 7.6. There were 137 (59.6%) males and 93 (40.4%) females, giving a sex ratio of 1.5. The circumstances of occurrence were road accident and home accident in the same proportions (97 cases; 42.2%). Sport accident and work accident occurred in the same proportions (12 cases; 5.2%). The series included 134 fractures (50.4%) of the pelvic limbs and 96 fractures of the thoracic limbs (36.1%). One hundred and seventy-six (176) patients (76.5%) had received orthopaedic treatment. Treatment modalities included cast 149 cases (84.7%). Conclusions: Fractures in children are common, especially in older children and adolescents. Males were more affected than females. Etiological circumstances are dominated by road and domestic accidents. The treatment is essentially orthopaedic. The surgical treatment is based on thin pins and Metaizeau pins.

Objectif Evaluer les résultats anatomiques et fonctionnels de l’ostéosynthèse des fractures anciennes de l’acétabulum. Patients et méthodes Quarante et un patients avec un âge moyen de 37,1 ans ont étés opérés pour une fracture de l’acétabulum entre le 1 er janvier 2005 et le 31 décembre 2020. Selon la classification de Judet et Letournel, il y avait des fractures élémentaires (n=24) et des fractures complexes (n=17).Au sein des fractures simples 17 concernaient la paroi postérieure. Une luxation iliaque était associée chez 29 patients. Le délai opératoire moyen était de 27,5 jours. Il a été réalisé une réduction chirurgicale et une ostéosynthèse par plaque de reconstruction dans la plupart des cas. Les résultats anatomiques et fonctionnels ont été évalués à un recul moyen de 30,1 mois chez 35 patients. Résultats La réduction était jugée anatomique (n=18), satisfaisante (n=19) et non satisfaisante (n=4). La qualité de la réduction avait un lien significatif avec la complexité de la fracture (p=0,0042) et l’importance du déplacement (p=0,0056). Les résultats fonctionnels étaient excellents et bons chez 27 patients. Conclusion L’ostéosynthèse des fractures anciennes de l’acétabulum a permis d’obtenir des résultats satisfaisants. Elle permettra la réalisation plus aisée d’une arthroplastie ultérieure avec possibilité d’appui immédiat. Mots clés : acétabulum, fracture, ostéosynthèse. Niveau de preuve : IV

Background: Childhood fractures are frequent. The aim of this study was to evaluate their epidemiological and clinical peculiarities in our context. Materials and Methods: This was a retrospective study that focused on the files of children with a fracture. They were aged 0–15 years and received between January 2011 and December 2015 at the Emergency Department of the National Teaching Hospital of Cotonou. Results: Two hundred and eighty fractures were recorded in 257 children. The average age was 8.24 years (7 days–15 years). Older children (6–10 years) were the most affected with 33.8% of cases. The predominance was male (sex ratio = 2.3:1). The aetiologies were dominated by road traffic accidents (45.1%) followed by domestic accidents (42.7%). Fractures were predominant in the lower limbs (52.1%). The most affected segments were the leg (25.4%) and the femur (23.6%). The fracture was open in 13.9% of cases. Conclusion: Childhood fractures interest preferentially the older boys. Then, road traffic accidents are the most frequent circumstances of occurrence in our context. Measures to prevent the main causes of these fractures must be taken, in order to reduce their frequency and ensure the development of children.

Introduction Les fractures trochantériennes constituent un problème de santé publique de portée mondiale. Dans les pays en développement, les fractures trochantériennes intéressent tous les âges surtout le sujet jeune de sexe masculin actif lors de traumatismes violents. L’objectif de cette étude était de décrire l’épidémiologie de ces fractures chez l’adulte au CHU départemental de l’Ouémé-Plateau au Bénin. Méthodes Il s’agissait d’une étude rétrospective monocentrique, descriptive, et analytique de dossiers de patients hospitalisés entre le janvier 2009 et décembre 2020. Les données collectées ont concerné le sexe, l’âge, les circonstances étiologiques, le score de Parker, et le type de fracture (classification de Ender). Résultats La moyenne annuelle était de 7,2 cas. Sur 81 dossiers de patients colligés, il y avait 59 (73%) hommes et 22 (27%) femmes. Les adultes jeunes entre [20-40ans[ de sexe masculin étaient prédominants. Pour les personnes du 3e âge, les deux sexes étaient indifféremment concernés. Les patients de sexe masculin étaient trois fois plus impliqués dans les accidents de la circulation (n=45) que ceux du sexe féminin. Le Parker moyen était de 8,9 (6 – 9). Soixante-dix-sept patients (95%) avaient un Parker de 9. Les fractures de types I et II de Ender étaient les plus fréquentes (n=36 ;44%). Les fractures étaient fermées (n=78 ; 96%) et ouvertes (n=3 ;4%). Conclusion Au CHU départemental de l’Ouémé-Plateau au Bénin, les fractures trochantériennes sont fréquentes. Les fractures de type I et II selon Ender sont les plus courantes. Elles touchent surtout l’adulte jeune, de sexe masculin, victime d’un accident de la circulation. La plupart des fractures sont instables. Les accidents domestiques prédominent chez les femmes âgées. Mots-clés : Epidémiologie – Fractures – trochantériennes

Background: The aim of this study was to determine the factors predictive of resumption of activity in elderly subjects operated on for a fracture of the lower limb. Methods: This was a cross-sectional study with retrospective data collection in subjects aged 56 and over who had undergone lower-limb surgery with a minimum follow-up period of six months. Patients' walking autonomy was assessed using the Parker score. The modular integrated household survey on living conditions was used to assess patients' socio-economic status. Bivariate analysis was performed using the chi-square test and the calculation of measures of association. Results: The series included 113 patients with a mean age of 70±9.54 years and a sex ratio of 1.09. Fractures of the upper end of the femur predominated in 67.6% of cases. The most common surgical procedure was intermediate hip replacement in 30 patients (26.5%). Rehabilitation sessions were performed in 95 patients (84.1%). The postoperative Parker score at the last follow-up was 9/9 in 41 patients (36.3%). Resumption of educational and productive activities and interpersonal responsibilities was achieved in 90 patients (79%). Significant associations (p<0.05) were found between resumption of activities and age, sex, marital status, history of arterial hypertension, psychiatric history, preoperative Parker score, postoperative Parker score and return to a private residence. Conclusions: Older age, female gender, absence of a partner, high blood pressure, non-personal residence and poor Parker score are factors with a poor prognosis for return to activity.

Background: Fractures of the distal humerus represent 1.3% of fractures in Cotonou. Their treatment is often surgical. The aim of this work was to assess the results of their osteosynthesis in a disadvantaged environment.Methods: This retrospective study from 2001 to 2015 included 38 operated patients for distal humerus fracture with a minimum follow-up of 12 months. The average age was 33.6 years; the predominance was male (27 cases). The major etiology was traffic accidents (31 cases), According to the AO classification, the fractures were type A (10 cases), type B (02 cases) and type C (26 cases). The average time of surgery was 21 days. The Lecestre plate was the most used (29 cases). An iliac cortico-cancellous graft was used in 03 cases. The mean hospital stay was 20 days.Results: The mean follow-up was 37 months. Functionally, the mean Mayo elbow performance score (MEPS) score was 66.3 points. The results were excellent (08 cases), good (13 cases), average (10 cases) and bad (7 cases). The patients were satisfied or very satisfied in 29 cases. Radiographically, the reduction was anatomical in 34 cases. Anatomical reductions were obtained with Lecestre plates. Consolidation was achieved in 36 cases within an average of 9 weeks. As complications we noted: radial nerve paresis (03 cases); secondary displacement (02 cases); superficial infection of the operating site (02 cases), wire migration or screw retraction (05 cases), non-union (03 cases), malunion in varus (04 cases) and osteitis of the proximal ulna (01 case).Conclusions: Fractures of the distal humerus are infrequent. The anatomical and functional results despite little technical support provided and the long delay before surgery are quite good.

Background: Computer-assisted total knee arthroplasty (TKA) is associated with significant precision during the surgical installation of prosthesis. We aimed to compare the radiological outcomes between the prostheses’ positioning assisted by a passive computer system and with the conventional technique.Methods: Participants included in this study were divided into two mixed groups based on the use of classical procedure and the computer navigated method during the positioning of implants during fractures. Clinical factors such as degrees of knee amplitude, knee IKS score and IKS function score and radiological features including the stage of osteoarthritis according to Ahlbäck classification, HKA and HKS angles, femoral and tibial mechanical axes, tibial slope prior and after the surgical procedure were measured in each group and then were compared.Results: Of a total of 92 patients, there were 63 women and 29 men; among which 42 patients for were treated with conventional TKA and 50 patients benefited from navigated TKA. 76 patients had stage IV osteoarthritis, 15 patients were at stage III of Albäck classification, and one patient at stage V. The postoperative HKA angle was found to be better in the navigated cohort with a statistically significant difference. The IKS knee and function scores are significantly better in the navigated cohort.Conclusions: Computer surgical navigation practiced during the total arthroplasty of the knee highlighted significant improvement in the positioning of the implants; and is associated with better functioning of the knees.

Introduction: Malleolar fractures are joint lesions which are instable in most cases, cause the disorganization of ankle clamp and require operational treatment. This study aims to assess the morphological and functional outcomes of malleolar fracture osteosynthesis in our work settings characterized by limited resources. Methodology: This is A five-year retrospective involving 31 individuals treated using surgical procedures and who benefited of close follow-up on in the postoperative period. The anatomical assessment was based on the Lecestre and Ramadier criteria whereas the functional evaluation used the AOFAS criteria. Results: The mean duration of malleolar fracture consolidation was 17 weeks. The anatomical outcomes were well performed in 67.74% of cases, fair in 29.03% and, worse in 3.23%. The mean AOFAS score was 83.97. Reported complications included ankle osteoarthritis (2 cases), lateral malleolus pseudarthrosis (01 cases), and algoneurodystrophy (01 cases). Conclusion: Despite our limited resources, our study osteosynthesis of malleolar fractures revealed satisfactory outcomes in our settings.

INTRODUCTION:Trauma to the cervical spine is a real public health problem. They can cause neurological complications that are sometimes irreversible and mortality remains high. The causes are dominated by traffic and work accidents. We assess their epidemiological and lesional aspects in our work environment.MATERIAL AND METHOD:This was a descriptive retrospective study of any cervical spine trauma patient admitted to the National teaching hospital Hubert Koutoukou Maga of Cotonou between January 2010 and June 2014 for which the clinical file was complete.RESULTS:57 files were retained. The average age was 38.7 years (19 - 71 years). The predominance was male with a sex ratio of 4.2. The mean admission time was 27.5 days (3 hours - 175 days). As aetiologies, we found: traffic accidents (41 cases or 71.9%), work accidents (13 cases or 22.9%) and domestic accidents (3 cases or 5.3%). From an anatomopathological point of view, there were 16 simple fractures, one compression fracture, 13 dislocation fractures, 15 pure dislocations, 5 sprains, 2 post-traumatic disc herniations and 5 decompensations of cervicarthrosis myelopathy. The lesions involved the upper cervical spine (7%), the lower cervical spine (71.9%), the upper and lower cervical spine (21.1%). Thirty-two patients (56.1%) were quadriplegic and autonomic disorders were present in 7 patients (12.3%).CONCLUSION:Cervical spine trauma is frequent in Cotonou. They are often of interest to the young male subject. The lesions predominate on the lower cervical spine.

Background:. In low and middle-income countries (LMICs), individuals suffer from a disproportionately higher number of musculoskeletal (MSK) injuries compared with those living in a high-income setting. However, despite the higher burden of death and disability from MSK injuries in LMICs, there has been little policy, research, and funding invested in addressing this distinctly overlooked problem. Using a consensus-based approach, the aim of this study was to identify research priorities for clinical trials and research in MSK trauma care across sub-Saharan Africa. Methods:. A modified Delphi technique was utilized; it involved an initial scoping survey, a 2-round Delphi process, and, finally, review by an expert panel with members of the Orthopaedic Research Collaboration in Africa. This study was conducted among MSK health-care practitioners treating trauma in sub-Saharan Africa. Results:. Participants from 34 countries across sub-Saharan Africa contributed to the 2 rounds of the Delphi process, and priorities were scored from 1 (low priority) to 5 (high priority). Public health topics related to trauma care ranked higher than those focused on clinical effectiveness, with the top 10 public health research questions scoring higher than the top 10 questions for clinical effectiveness. Ten public health and 10 clinical effectiveness questions related to MSK trauma care were identified; the highest-ranked questions in the respective categories were related to education and training and to the management of femoral fractures. Conclusions:. This consensus-driven research priority study will guide health-care professionals, academics, researchers, and funders to improve the evidence on MSK trauma care across sub-Saharan Africa and inform funders about priority areas of future research.

Introduction: The management of polytrauma patient should be beforehand and always in keeping in mind the damage control. the surgical treatment is secondary to the stabilization of the patient. Clinical Case: we are reporting a 34 years old polytrauma patient from a motor vehicle accident. On physical examination, we noted : a severe brain injury, a closed articular fracture of right distal radius associated to a dislocation of distal radius and ulna distal joint, a closed bilateral fracture of both trochanters, an open communitive tibial fracture of proximal epiphysis methaphysis and diaphysis. The last one was classified as type IIIB of Gustilo and Anderson and associated to a closed fracture of the head and the neck of right fibula, a closed fracture of the right lateral malleolus. After patient stabilization, the head injury improves to normal Glasgow score on 8th day of admission. Necrosis of soft tissus and exposition of the tibia was noted. The surgical treatment was done on 2 stages due to financial issues. A bone synthesis of the trochanteric fracture was done only on the left and external frame as well as a muscle flap was done for the right tibial fracture on the 18th day. On the 42nd day a PAPINEAU technic associated to a proximal inter tibiofibular graft was done. The functional outcome of the orthopaedic treatment of the wrist was bad (malunion). That last complication was managed by a SAUVE KAPANDJI surgery (at 6 months) and the contracture (pronation and supination) at 12 months post trauma. The outcome was fair good despite patient financial issue and local complications that compromise an optimal surgical management and a delay. He resumes normal professional activities at about 2 years. At 5 years follow up, functional and anatomical results were satisfactory. Conclusion: In a limited ressources’ setting, the management of lesions including a multiple fractures is a challenge for the practitioner and the injuried patient. A management taking into account social and economic ressources is mandatory to minimise sequelae. Keywords: Management, Polytrauma, Limited ressources.

Objectives: Study the prevalence and factors associated with the occurrence of surgical site infections in University Clinics of Trauma-Orthopedics, Reconstructive Surgery and Urology in a developing country.Methods: This was a retrospective descriptive and analytical study of 384 people operated on during the period of 2019. Logistic regression was used to study the factors associated with surgical site infections. The associations between the dependent variable and the other variables were assessed by the odds ratio (OR) followed by their 95% confidence interval.Results: The prevalence of surgical site infections was 7.81% CI 95% = (5.12–10.51). The factors linked to the surgical site infections in the studied population were the patient&apos;s admission method [OR = 2.74; 95% CI = (1.08–6.95)] and the length of the postoperative stay [OR = 8.75; 95% CI = (2.83–26.98)]. The interview and direct observation identified health care system dysfunctions, medical errors, patient monitoring and financial unavailability as factors that could favor the onset of surgical site infections.Conclusion: Interventions should be focused on the factors identified for the effective management of operated patients.

Les cals vicieux de la cheville evoluent ineluctablement vers l'arthrose. Le but de ce travail etait de decrire leurs aspects epidemiologiques et les resultats de leur traitement chirurgical au Centre National Hospitalier et Universitaire Hubert Koutoukou MAGA (CNHU-HKM) de Cotonou. Il s'agissait d'une etude observationnelle retrospective sur 12 ans, realisee a la Clinique Universitaire de Traumatologie, d'Orthopedie et de Chirurgie Reparatrice (CUTO-CR) du CNHU-HKM de Cotonou de janvier 2003 a decembre 2015. Elle avait concerne 11 patients presentant un cal vicieux de la cheville, operes et suivis pendant au moins 6 mois. Le diagnostic de cal vicieux de la cheville avait ete retenu grâce a l'examen clinique et complete par les cliches radiographiques de la cheville de face et de profil. Le traitement etait chirurgical. Les resultats fonctionnels ont ete evalues selon le score de Kitaoka. Onze patients dont 8 hommes et 3 femmes d'âge moyen de 41 ans avec des extremes de 16 ans et 63 ans avaient un cal vicieux au niveau de la cheville. Les lesions initiales etaient : la fractures bi-malleolaire (n=6), la fracture tri-malleolaire (n=2), la fractures du pilon tibial (n=2) cas et la fracture du talus (n=1). Le traitement chirurgical consistait en une arthrodese dans 4 cas et une osteotomie de correction dans 7 cas. Le resultat fonctionnel etait juge bons dans 4 cas, moyen dans 6 cas et mauvais dans 1 cas. Les cals-vicieux de la cheville sont des lesions rares, polymorphes et graves. Ils sont frequents chez le sujet jeune de sexe masculin. Le traitement par arthrodese ou par osteotomie de correction nous a permis d'obtenir des resultats fonctionnels satisfaisants. Mots cles : cal vicieux, cheville, arthrodese, osteotomie.Malunion at the level of the ankle inevitably progresses to osteoarthritis. The aim of this study was to describe the epidemiological aspects as well as the outcome of the surgical treatment at the Cotonou Hubert Koutoukou MAGA National University Hospital (CNHU-HKM).This was an observational retrospective study over 12 years, carried out at the Traumatology , Orthopedics and Corrective Surgery University Clinic (CUTO-CR) of the Cotonou CNHU-HKM, from January 2003 to December 2015. The study involved 11 patients presenting a malunion at the level of the ankle, who underwent surgery and were followed up during a minimal period of 6 months. The diagnosis of ankle malunion was evocked based on clinical examination and confirmed by an X-ray of ankle with frontal and lateral views. The treatment was surgical. The functional outcome were evaluated by the Kitaoka score. Eleven patients including 8 males and 3 females with a mean age of 41 years,ranging between 16 and 63 years had a malunion at the level of the ankle. The initial lesions were: 6 bimalleolar fracture (n=6), 2 trimalleolar fracture (n=2), tibial pestle fracture (n=2) and talus fracture (n=1). The surgical treatment consisted of arthrodesis in 4 cases and corrective osteotomy in 7 cases. The functional outcome was evaluated to be good in 4 cases, average in 6 cases and poor in 1 case. Ankle malunion is an uncommon, polymorphous and severe lesion. It is frequent in young male patients. Arthrodesis or corrective osteotomy provided satisfactory functional results in our patients. Keywords: malunion, ankle, arthrodesis, osteotomy