Open total talar dislocation is a rare but well known injury. Its management is controversial and fraught with complications such as infection, avascular necrosis, and post-traumatic osteoarthritis. We report the case of a woman sustaining a pure open talar dislocation reduced in the emergency room. Debridement was done three days after the injury in the operating room. There was no infection. One year after surgery she complained of occasional pain. Ambulation was normal. She wore regular shoes. The overall alignment of the ankle, hindfoot, and midfoot was normal. Movements of the tibiotalar and subtalar joints were not impaired. She has resumed her regular activities. Radiographs showed no signs of avascular necrosis. All components of the treatment strategy of open total dislocation should be carried out in emergency. This results in environment close to the original biological state. Good results can be achieved if infection is avoided.

OBJECTIVE:To evaluate the results of multiple closed intramedullary Kirschner wiring via a supracondylar entry point for humeral shaft fractures.PATIENTS AND METHODS:The charts of 37 patients with humeral shaft fractures treated with the Hackethal's technique between January 2007 and December 2011 were reviewed retrospectively. The operation was performed with the patient lying in supine (n = 22) or lateral (n = 15) position. The elbow was flexed over an articulated support with the arm kept in a vertical position. Thirty-three patients were available for final evaluation with a mean follow-up delay of 14 (range, 6-24) months. We were concerned about fracture union, range of motion of the shoulder and the elbow, and complications. Final evaluation used the criteria by Qidwai.RESULTS:Bone union rate was 94%. Restriction of ranges of motion of the shoulder more than 20° was noticed in two patients due to protruding wires. Three patients developed limitation of elbow extension owing to backing out of the wires. The overall results were excellent (n = 26; 79%), good (n = 4; 12%), and poor (n = 3; 9%).CONCLUSION:Closed Hackethal's technique using K-wires gives satisfactory results in terms of bone union and elbow and shoulder function in selected humeral shaft fractures. The articulated support precludes the transolecranon traction.

OBJECTIVES:To evaluate the early clinical and radiological results using the Bösch technique to treat hallux valgus.MATERIAL AND METHODS:We reviewed retrospectively four patients with 6 feet undergoing the Bösch technique for mild and moderate hallux valgus from 2009 to 2012 with an average follow-up of 10.8 months. All patients complained of pain around the first metatarsophalangeal joint. They had cosmetic concerns, and difficulty in wearing shoes. At final follow-up patients were asked about the improvement of pain, cosmetic appearance of the foot, problems with wearing shoes, the ability to walk, and their satisfaction with the operation. Complications encountered were also recorded. The radiographic evaluation considered osteotomy site union, the hallux valgus angle, and the intermetatarsal angle.RESULTS:All patients complained of mild or no pain. They had a satisfactory cosmetic result, wore normal shoes without problems with no limitation of walking ability. They were satisfied with the procedure. One case of superficial infection was noticed. All osteotomies healed primarily within three months. The average hallux valgus angle improved from 32.7° preoperatively to 14.8° at final follow-up and the average intermetatarsal angle from 17.5° to 9.2°.CONCLUSION:The Bösch technique is a cost effective procedure that yields good clinical and radiological results while correcting mild and moderate symptomatic hallux valgus with reduced risk of surgery related complications.

ABSTRACT:In this retrospective study, we present our experience using open Küntscher nailing (K-nailing) which is still performed in developing countries for femoral fractures. Of 157 acute fractures treated between January 2003 and December 2009, 100 were stable (63.7%) and 135 were located within the middle third of the shaft (86%). Comminution was absent or minimal in 135 (86%) cases. Fracture union was achieved at an average of 14 weeks (range, 10 - 25). The duration of follow-up was 17 months (range, 6 - 36). Final evaluation showed that 129 (82.2%) patients had a good result according to modified Kempf's criteria. The predominant complications were infection (n=5; 3.2%), nonunion (n=9; 5.5%), implant failure (n=11; 7%), and malunion (n=27; 17.3%). Open reduction and fixation with a tight fitting Knail can give good results in selected acute femoral shaft fractures but knowledge of potential complications is needed.KEY WORDS:femoral shaft fracture, Intramedullary nailing, Open reduction.

De nombreuses techniques cliniques et radiologiques ont été développées afin de déterminer les longueurs et les angles des membres inférieurs. Cependant, à ce jour aucune de ces techniques n’est totalement fiable et reproductible. Dans ce contexte, le système EOS permet grâce à deux clichés bidimensionnels numériques, orthogonaux et en charge d’obtenir une reconstruction tridimensionnelle du membre inférieur. Le traitement informatique des clichés permet le calcul de ces paramètres. La reproductibilité de cette technique n’a jamais été évaluée à ce jour.La mesure des paramètres de longueurs de membre réalisées par le système 3D EOS présente une reproductibilité inter et intra-observateur très satisfaisante et celle-ci est supérieure à celle des mesures réalisées sur des projections 2D.Vingt-cinq patients programmés pour une PTH ont été inclus dans l’étude (soit 50 membres inférieurs). Deux observateurs indépendants ont effectué, à deux reprises, les calculs de mesures des paramètres sur le pangonogramme standard numérisé et sur les reconstructions tridimensionnelles EOS (longueur du fémur, longueur du tibia, longueur du membre entier, angle HKA, angle HKS, offset fémoral, angle cervicodiaphysaire, diamètre de la tête fémorale, et longueur du col fémoral). La reproductibilité inter et intra-observateur a été évaluée par le coefficient de corrélation intra-classe.La reproductibilité inter et intra-observateur du système EOS ont été excellent, plus spécifiquement de 0,997 et 0,997 pour la longueur du fémur, de 0,996 et 0,995 pour le tibia, de 0,999 et 0,999 pour la longueur du membre inférieur, de 0,894 et 0,891 pour l’angle HKS, de 0,993 et 0,994 pour l’angle HKA, de 0,870 et 0,845 pour l’offset fémoral, de 0,765 et 0,851 pour l’angle cervicodiaphysaire. La meilleure reproductibilité des reconstructions EOS se confirme sur l’ensemble des paramètres testés.Nos résultats nous permettent de montrer que le système EOS est un outil reproductible et que les mesures réalisées sur les reconstructions 3D EOS ont une meilleure reproductibilité inter et intra-observateur que les mesures réalisées sur les projections 2D. Son utilisation dans le cadre de prise de décision opératoire et lors de la planification préopératoire dans le cadre de la réalisation d’une arthroplastie du membre inférieur semble donc être essentielle afin d’adapter le geste chirurgical en conséquence.Niveau III : étude prospective diagnostique.

OBJECTIVES:The aim of this retrospective study was to present our experience using condylar buttress plate in the treatment of distal femoral fractures.PATIENTS AND METHODS:Thirty-two patients underwent open reduction and internal fixation with condylar buttress plates for distal femoral fractures from October 2000 through May 2010. Patient demographics, type of fracture, treatment, complications, results achieved, and follow-up assessment were reviewed. The fractures were classified with the AO system. The functional outcome was rated according to Schatzker and Lambert criteria.RESULTS:There were 22 men and 10 women with an average age was 44 (range 19-87) years. The fractures were classified as A1 (n = 7; 21.8%), A2 (n = 4; 12%), A3 (n = 5; 15.6%); C1 (n = 4; 12.5%), C2 (n = 6; 18.8%), and C3 (n = 6; 18.8%). The mean delay from injury to operation was 15 (range 1-27) days. Iliac bone graft was performed in four patients. Postoperatively, a posterior splint or a plaster cast was applied for 3 weeks. No patient had an intra-articular step-off of more than 2 mm. Sepsis of the operative wound occurred in two patients. Fractures healed in 22 (91.7%) patients with a mean duration of 4 (range 3-8) months. Twenty-four patients were followed up on an average of 15 (range 7-28) months. Varus deformity (>10°) was observed in five (20.8%) patients. Knee flexion was less than 90° in 11 (45.3%) cases. Non-union occurred in two (8.3%) patients. Functional results were good to excellent in 11 (45.8%) patients and considered as fair or failure in 13 (54.2%).CONCLUSION:The current report also identifies varus deformity as a major concern of this implant. The main finding of this study was the ensuing knee stiffness after a prolonged immobilization and delay in performing surgery and rehabilitation program due to socioeconomic and logistic reasons.

Objectifs. Evaluer les resultats de la prise en charge multidisciplinaire du pied diabetique et determiner les facteurs d’echec. Materiels et methodes. Cette etude retrospective (de 2002 a 2004) portait sur 89 patients diabetiques, dont 61 hommes et 28 femmes, presentant des lesions au pied. Leur âge moyen etait de 56 ans. Parmi ces patients, 41 (46,06 %) etaient d’un niveau socio-economique faible. La typologie dominante du diabete etait de type 2 (n=83). Les aspects cliniques etaient evalues en utilisant la classification de Wagner. L’echodoppler avait ete realisee chez 57 patients (64,04%), la radiographie standard chez 62 patients (69,66%) et l’ecouvillonnage chez 33 patients. Resultats. Chez 10 patients le diabete etait decouvert au decours d’une gangrene et les stades 4 et 5 de Wagner representaient a eux seuls 39 cas, soit 43,82%. Une arteriopathie etait diagnostiquee chez 49 patients et une osteite chez 15 autres. Parmi les germes isoles, les enterocoques etaient dominants (30,30%). Des soins locaux etaient impartis a 7 patients et le traitement chirurgical etait applique a 82 patients. Il etait conservateur chez 50 patients et une amputation majeure etait pratiquee chez 32 patients. Outre les facteurs classiques tels que l’infection, l’arteriopathie et la neuropathie, on constatait que le retard de consultation, le niveau socio-economique faible et la mauvaise observance du traitement constituaient les principaux facteurs d’echecs. Le taux de mortalite etait de 5,6%.

Talar neck fractures (TNFs) are complex injuries and treatment is fraught with complications. We retrospectively studied 18 patients with TNFs: 6 Hawkins type-I, 7 type-II, 4 type-III, and 1 type-IV. Five patients with type-I and 2 with type-II fractures were treated conservatively. The remaining 11 patients underwent operative treatment. Open reduction via posterolateral approach was performed in 10 patients while closed reduction was used in one patient. All operatively reduced fractures were stabilized with screws. The following postoperative complications were encountered: wound dehiscence (n=1), avascular necrosis (n=2), and post-traumatic osteoarthritis (n=12). Fifteen patients were available for final evaluation at a mean follow- up period of three years (range 10 months to 6 years). Using the American Orthopaedic Foot and Ankle Society (AOFAS) score, the mean for type-I fracture was 96.4 points, 80.2 points for type-II, 68.5 points for type-III and 55 points for type-IV fractures. TNFs remain a devastating injury as the prognosis and outcomes of treatment continued to be hampered by the consequences of injury.

We present a case of combined avulsion fracture of the tibial tubercle (AFTT) and avulsion of the patellar ligament in a 15-year-old boy. This injury was treated by open reduction and fixation of both lesions using staples with satisfactory results. This constellation of injury is rare but a high index of suspicion is needed when faced with a displaced AFTT. Open reduction and internal fixation should be the treatment of choice.

The reconstruction of defect after wide resection for distal radius giant cell tumour remains a daunting task for the orthopaedic surgeon and has been the topic of extensive discussions in the literature. Out of the various reconstructive procedures described, the option of non vascularised proximal fibular autograft has been widely used with satisfactory results. The case of a woman presenting with Campanacci grade 3 giant cell tumour treated by this method with a follow-up of 30 months is reported. Emphasis is placed on the surgical technique.Key words: Autograft, Distal radius, Fibula, Giant cell tumour

Objective: To present the results of open reduction of neglected elbow dislocations using a consistent surgical protocol. Patients and methods: Between 2000 and 2005 eight patients with neglected elbow dislocations were operated on using the Speed\'s posterior approach with lengthening of the triceps by V-Y musculoplasty. The average age of patients was 32.2 years. The average delay from injury to the initial examination was 6.2 months. At the time of the initial presentation to hospital, all patients experienced elbow stiffness with non functional range of motion. Main outcome measure: Functional results were assessed by measuring the active range of flexion-extension. Results: All elbows had improved flexion at follow-up which ranged from three to eighteen months (average 10.7 months). The average arc of flexion improved from 21° (range 0° to 45°) to 82° (range 40° to 140°). The average maximum flexion at the elbow improved from 60° (range 30° to 85°) to 99° (range 70° to 140°). The mean flexion contracture at the elbow decreased from 39° to 18°. No patient had recurrence of dislocation. Conclusion: The Speed technique is a viable option in treating non functional neglected elbow dislocations. The midterm results are encouraging although they are mainly hampered by inadequate follow-up and difficulties in performing the rehabilitation program in low-income countries. Keywords: Elbow, Neglected dislocation, Speed procedure Nigerian Journal of Orthopaedics and Trauma Vol. 7 (1) 2008 pp. 13-16

Objective: To profile the patients with sports related fractures. Patients and methods: This was a retrospective study of patients sustaining a sport related fracture between January 2000 and December 2006. The medical records including the demographic data, type of sport, mechanism and location of injury, and treatment applied were reviewed. Results: A total of 74 patients with 74 fractures were included in this study. All the patients except one were male with a mean age of 21.6 years. Fractures occurred in 67 (90.6%) patients while playing football. Twenty-four (32.5%) patients sustained their fractures during competitive edition of games, with 21 (28.4%) being amateur players and three (4.1%) professional players. Fifty (67.5%) patients suffered from fractures during recreational sporting activities. Non contact fractures were seen in 24 (32.4%) patients. Contact fractures accounted for 39 (52.7%) cases. The mechanism was unknown in 11(14.9%) patients. Fractures were located in the lower limb in 47 (63.5%) cases, while the upper limb was involved in 27 (26.5%) patients. Forty-two (56.7%) patients were treated by conservative means, while 22 (29.7%) were handled surgically. Ten (13.5%) patients went to traditional healers. Conclusion: Sports related fractures are important and in our environment football accounts for the majority of these fractures. Increasing participation of youth in sports activities will likely magnify the impact of such fractures on the healthcare system. Keywords: Fractures, Sport Nigeria Journal of Orthopaedics and Trauma Vol. 7 (2) 2008: pp. 70-72

Background: Trochanteric fractures have become a major focus of orthopaedic interest. Surgical management is the best option for treating such fractures. Objective: To present our experience with the surgical treatment of trochanteric fractures with special attention to short-term results. Design: A retrospective study performed between 1993 and 2002. Setting: Department of orthopaedics surgery, Yopougon teaching hospital, Abidjan, Côte d'Ivoire. Patients and methods: There were 48 men and 17 women with a mean age of 44 years at the moment of the injury. Road traffic accident was the main cause of fractures accounting for 42 cases. Mean preoperative delay was 22 days. Surgical implants used were the Judet screw plate and Küntscher nail. Results: Postoperative death occurred in three cases. Fracture healing was achieved in 57 patients at an average of four months. Malunion and displacement into varus was noticed in 11.7% of patients. Infection occurred in seven patients, wound hematoma in eight and decubital ulcer in five. Conclusions: Trochanteric fractures in our environment are caused by severe trauma. These injuries could be managed surgically with simple methods that are readily available with immediate satisfactory outcome. Keywords: trochanteric fractures, surgical care Judet screw plate, Küntscher nail, complications Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 187–190

Ipsilateral dislocation of the shoulder and elbow is uncommon. Shoulder dislocation is often misdiagnosed on admission. We report the case of an 31-year old male whose dislocations were both recognised at the initial examination. Diagnosis pitfalls, mechanism, and management of this rare injury are reviewed. Keywords : dislocation, elbow, ipsilateral Nigerian Journal of Surgical Research Vol. 7(3&4) 2005: 319-320

Distal femoral fracture associated with knee extensor apparatus injury is a rare event.The authors report the case of a 19-year-old boy featuring an unicondylar femoral fracture with an intra-articular dislocation of the ipsilateral patella. Both injuries were treated surgically. Emphasis is placed on the mechanism of the lesions and the surgical approach. Keywords : Extensor mechanism, knee, patella dislocation, unicondylar femoral fracture. African Journal of Paediatric Surgery Vol. 3 (1) 2006: pp. 38-40

A 27- year old female patient suffered from a closed medial subtalar dislocation treated by conservative means. This relatively rare injury is reported to outline the problems encountered in diagnosis and management of such troublesome pattern of dislocation in developing countries. Keywords: dislocation, peritalar, subtalar, developing countries Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 196–198

Few studies have been published in the literature regarding fractures of limbs in patients with poliomyelitis. We have conducted a retrospective study from 1992 to 2004 in order to present our data on fractures of lower limbs in adult patients with residua of poliomyelitis. During the thirteen-year period under study, only eight fractures of the lower limbs in seven patients were observed. There were three males and four females with a mean age of 42.6 years at the time of the injury. Fractures were caused by moderate trauma in four patients and severe trauma in three. Six patients were walking while one used wheelchair before the injury. The femur was the bone injured in all cases. Treatment performed in four patients consisted of surgical operation. However although the small number of patients remains the primary limitation of this investigation, the patients constitute a homogeneous group which is representative of the condition in respect of the location of fractures and mechanism. We think that in our medical environment, despite the influence of traditional bonesetters, every effort should be made to maintain the patient's independence by surgical treatment of displaced femoral fractures in adults with residua of poliomyelitis. This can allow for a quick return to the pre-injury level.Keywords:adult, fracture, lower limb, poliomyelitis Nigerian Medical Practitioner Vol. 48(3) 2005: 67-69