Anani Abalo

Risk Factors for Surgical Wound Infection in HIV-Positive Patients Undergoing Surgery for Orthopaedic Trauma

Purpose. To identify risk factors associated with surgical wound infection in patients infected with human immunodeficiency virus (HIV) undergoing surgery for orthopaedic trauma. Methods. Records of 29 male and 7 female HIV-positive patients aged 18 to 47 years who underwent surgery for orthopaedic trauma were reviewed. Data on HIV-specific variables (HIV clinical classification, CD4+ lymphocyte count) and highly active antiretroviral therapy were retrieved, as were data on wound class, fracture type, surgery type, surgical wound infections, and outcomes. Possible risk factors associated with surgical wound infection were analysed. Results. The median follow-up period was 27 (range, 19–41) months. Of the 36 patients, 14 (39%) developed surgical wound infections (4 were deep and 10 superficial). 89% and 67% of them were in HIV clinical category B and in CD4+ T-lymphocyte category 3, respectively. 12 of these infections resolved after debridement and prolonged antibiotic treatment, and 2 developed chronic osteomyelitis. Four of the patients had non-union. Surgical wound infections were associated with HIV clinical category B (p<0.001), CD4+ T-lymphocyte category of ≥2 (p=0.041), and contaminated wounds (p=0.003). Conclusion. Identification of risk factors may help minimise morbidity in HIV-positive patients.

Intramedullary fixation using multiple Kirschner wires for forearm fractures: a developing country perspective.

Purpose. To evaluate treatment results of intramedullary fixation using multiple Kirschner wires for diaphyseal forearm fractures. Methods. Between January 2001 and January 2004, 184 patients (122 men and 62 women) with 288 displaced diaphyseal forearm fractures underwent intramedullary fixation using multiple Kirschner wires. The wires were inserted by opening the fracture site because radiographic facility for closed pinning was unavailable. The time to union, functional recovery, and the complication rates were assessed. Results. 11 patients were lost to follow-up, leaving 173 whose data was analysed. In 167 (97%) of the patients the fractures united, and in 14 (8%) of them union was delayed. The mean time to union for closed fractures was 13 (range, 7–16) weeks and for open fractures it was 15 (range, 12–22) weeks. The mean time in cast was 6 (range, 3–14) weeks. In all, 34/173 (20%) had complications: superficial infection (n=13), deep infection (n=4), cross-union between bones (n=4), open fracture ‘needing’ a skin graft (n=2), radial nerve palsy (n=3), paraesthesia (n=1), and non-union (n=7). Among the 173 analysed patients, the infection rate was 10% and the non-union rate was 4%. 130 (75%) of the patients had the wires removed; no re-fracture occurred after wire removal. Based on the Anderson criteria, 47 (27%) of the patients attained excellent, 78 (45%) satisfactory, and 39 (23%) unsatisfactory results. In 9 (5%) of the patients, union failed (7 plain non-union and 2 due to chronic osteomyelitis). Conclusion. Kirschner wires are much cheaper than plates and screws, and require minimal expertise for insertion and removal. They remain acceptable for stabilising displaced diaphyseal forearm fractures in developing countries.

Surgical treatment of chronic Achilles tendon rupture functional and anatomical outcomes over a mean follow-up period of two years

Background: The aim of this paper was to report the functional and clinical results of subcutaneous Achilles tendon rupture repairs through two surgical plasty techniques, with a mean follow-up of 2 years. Patients and methods: This study carries out a retrospective analysis of 27 patients presenting a subcutaneous rupture of Achilles tendon who enderwent surgical treatment between January 2012 and December 2016. Surgical treatment was carried out using the Chigot-Lynn technique for 19 patients and the Bosworth-Lynn technique for the remaining 8 patients. Functional and clinical results were evaluated according to McComis criteria and patient satisfaction. Results: Clinical measurement of the of ankle motion range revealed average flexion of 15 ° and an average extension of 40 °. Amyotrophy of the triceps surae muscle was found in all patients, with an average 2 cm. Residual pain was found in four patients. Average sick leave was 4 months. 8 patients had resumed sport at their previous level of training, 3 patients had returned to lower levels of sport, and one patient had abandoned their sporting activity. The results were considered highly satisfactory or satisfactory by 24 patients, good by two patients and poor by one patient. Conclusion: Chronic ruptures of the Achilles tendon remain a therapeutic challenge for the orthopaedic surgeon. Surgery with a reinforcement plasty must be proposed to patients who are active or have sports activities. Surgical repair reduce iterative ruptures and ensure the best functional recovery.

Hand replantation: First experience in a sub-Saharan African country (Togo)

Fifty years after Chen has performed the first forearm replantation, we report our first case of hand replantation in a sub-Saharan African country. The etiology of the amputation was machete due to interpersonal violence. The amputation was trans-carpal, guillotine-type, subtotal non-viable maintained with a small skin bridge. The replantation procedure was successful. At one year follow-up, the functional result according to Chens criteria was excellent. Through this first experience, we can state that hand replantation can be performed successfully both in survival and function in a non-specialized hospital of a sub-Saharan African country.

PLAIE ACCIDENTELLE DE L’ARTERE RADIALE LORS DE L’ABORD ANTERIEUR DE L’AVANTBRAS : INTERET DU NON USAGE DU GARROT

Purpose: this study aimed to analyze the epidemiological aspects and evaluate the impact of late diagnosis on prognosis of gastrointestinal surgical emergencies at the National Hospital of Zinder (Niger). Patients and method: this is a prospective study from 1 January to 31 December 2013. All patients underwent surgery for digestive emergency were included. Results: We collected 302 patients. Emergencies digestive surgery accounted for 22% of 1358 cases of surgical emergencies recorded over the period of the study period. The sex ratio is 3/1 in favor of men. The average age of patients was 23 years. Digestive surgical emergencies affect more children (45%) and young adults (43%). The majority (70%) of our patients did not attend school and 49% were from rural areas. The diagnosis delay rule, 171 patients (57%) arrived to emergency department more than 48 hours after onset of symptoms. Abdominal pain with or without other signs was the main reason for consultation (92% of patients). 182 patients had a poor general status. The etiologies were dominated by peritonitis (52%) followed by intestinal obstruction (28%), and abdominal trauma with 10% of cases. The parietal suppuration isolated or associated with other morbidities was the main postoperative (28%). The average length of hospital stay was 9 days. 36 patients (12%) had died. Almost half of the deaths (47%) occurred within the first 48 hours of admission. The delay of admission and the surgical management was statistically significant effect on the prognosis (P<0.006, p< 0.0001). Conclusion: The prognosis of gastrointestinal surgical emergencies is highly correlated with the speed of diagnosis leading to appropriate treatment as soon as possible. This promptness is the only guarantee of a decline in the high morbidity and mortality which is often linked to dysfunction of our hospitals and/or accessibility problems faced by patients.

DEVENIR DES MACRO-AMPUTES TRAUMATIQUES DU MEMBRE THORACIQUE : CAS D’UN PAYS EN DEVELOPPEMENT

Purpose: this study aimed to analyze the epidemiological aspects and evaluate the impact of late diagnosis on prognosis of gastrointestinal surgical emergencies at the National Hospital of Zinder (Niger). Patients and method: this is a prospective study from 1 January to 31 December 2013. All patients underwent surgery for digestive emergency were included. Results: We collected 302 patients. Emergencies digestive surgery accounted for 22% of 1358 cases of surgical emergencies recorded over the period of the study period. The sex ratio is 3/1 in favor of men. The average age of patients was 23 years. Digestive surgical emergencies affect more children (45%) and young adults (43%). The majority (70%) of our patients did not attend school and 49% were from rural areas. The diagnosis delay rule, 171 patients (57%) arrived to emergency department more than 48 hours after onset of symptoms. Abdominal pain with or without other signs was the main reason for consultation (92% of patients). 182 patients had a poor general status. The etiologies were dominated by peritonitis (52%) followed by intestinal obstruction (28%), and abdominal trauma with 10% of cases. The parietal suppuration isolated or associated with other morbidities was the main postoperative (28%). The average length of hospital stay was 9 days. 36 patients (12%) had died. Almost half of the deaths (47%) occurred within the first 48 hours of admission. The delay of admission and the surgical management was statistically significant effect on the prognosis (P<0.006, p< 0.0001). Conclusion: The prognosis of gastrointestinal surgical emergencies is highly correlated with the speed of diagnosis leading to appropriate treatment as soon as possible. This promptness is the only guarantee of a decline in the high morbidity and mortality which is often linked to dysfunction of our hospitals and/or accessibility problems faced by patients.