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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_17 | Pages 14 - 14
24 Nov 2023
MASQUELET TECHNIQUE FOR INFECTED SEGMENTAL DEFECTS OF LONG BONES IN A LOW-RESOURCE SETTING OF SUB-SAHARAN AFRICA: TECHNICAL ADAPTATIONS AND OUTCOME
Loïc F Sylvain W Kennedy M Theophile N Olivier NF Marie-Ange NY Jean B
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Aim

infected segmental bone defect (ISBD) is frequent in developing countries. The aim of this study was to assess the efficacy of the Masquelet technique in the treatment of ISBD in a low-resource setting.

Patients and Method

We performed a prospective cohort study during the period from 2018 to 2022. Patients with infected bone defect of long bones were included. Management protocol consisted of two stages in all patients. The first stage consisted in debridement, tissues biopsy for microbiological culture, stabilization with external fixator and defect filling with gentamicin cement spacer. The second stage consisted of reconstruction using a cancellous bone autograft alone, or a mixture of autograft with allograft (demineralized bone matrix + tricalcium phosphate) and 1 gram of vancomycin powder. All patients were followed-up for at least one year. The results were assessed based on both objective (clinical and radiographic evaluation) and subjective (limb function and patient satisfaction) criteria. Main outcomes were bone union, reoperation and failure rates, union time, and limb function.

Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_10 | Pages 16 - 16
1 Oct 2022
PREDICTIVE FACTORS OF CHRONIC OSTEOMYELITIS AFTER OPEN TIBIAL FRACTURES IN A LOW-INCOME SETTING
Loïc F Kennedy M Denis N Olivier NF Ange NYM Ulrich T Daniel HE
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Introduction

Open tibial fractures (OTF) rank first among lower limb fractures in sub-Saharan Africa and bone infection remains the main challenge. The aim of this study was to identify the factors associated with chronic bone infection after OTF in a limited-resource setting.

Methods

Patients aged 18 years and older, who underwent OTF treatment in a tertiary care hospital during the period from December 2015 to December 2020 were included in this retrospective study. Patients were contacted via phone calls and invited for a final clinical and radiological evaluation. Patients who met diagnostic criteria of chronic osteomyelitis were identified. Logistic regression was used to determine the predictive factors of OTF related chronic osteomyelitis.

Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_14 | Pages 41 - 41
1 Dec 2019
THE EXAMPLE OF BONE AND JOINT INFECTIONS IN CAMEROON SHOWS THE NEED TO CURB ANTIBIOTIC RESISTANCE IN DEVELOPING COUNTRIES
Loïc F Ngongang FO Yamben MAN Tambekou U Bitang LJ
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Aim

Bone and joint infections are frequent in African countries and their prevention and treatment remain a great challenge. This study aimed to determine the bacterial ecology and sensitivity of isolates to locally available antibiotics in orthopedic unit of a tertiary care hospital in Cameroun.

Method

During a 12 months period, all the patients presenting with osteomyelitis or septic arthritis irrespective of the mechanism and the location were enrolled in this study. Intraoperative samples (biopsies) were taken and sent for microbiological analysis, and all strains isolated were tested for antibiotic sensitivity according to conventional methods.

Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 497 - 498
1 Nov 2011
40. MINIMALLY INVASIVE MEDIAL APPROACH TO THE HIP JOINT: DESCRIPTION AND INDICATIONS
Chiron P Laffosse J Loïc-Paumier F Bonnevialle N
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Purpose of the study: Transadductor approaches to the hip joint have been described in the spastic child. Ludl-off as well as Ferguson pass behind the short adductor and the pectineus, a narrow route with a risk of injuring the obturator nerve. We describe a simple minimally invasive approach.

Material and method: The incision is made with the hip in the flexion, external rotation, abduction, from the pubic insertion of the long adductor following along the mass of the muscle for 6 to 8 cm. The aponeurosis of the long adductor is cut just deep enough to see the muscle fibres. Careful finger dissection of the muscle sheath common to the three anterior adductor muscles leads directly to the lesser trochanter. Two forceps are inserted on either side of the lesser trochanter, exposing the lesser trochanter and the tendon of the iliopsoas muscle. Dissection of the iliopsoas muscle held aside (follow the tendon on its lateral aspect leading to the vessels). An angled spreader is positioned between the anterior aspect of the capsule and the medial border of the tendon, displacing the tendon laterally and exposing the capsule. Extra-articular exposure of the capsule with a rugine to displace the posterior medial circumflex pedicle. Longitudinal incision of the capsule continued along the inter-trochanteric line to the peri-acetabular region. The medial as well as the anterior aspect of the neck can be visualized by rotating the hip. The inferior and anterior portion of the head is visible: the iliopubic branch and the entire superior and medial wall of the acetabulum can be exposed.

Results: We performed 29 medial approaches. Nine for periprostheic pain, four for fresh fracture of the femoral head during posterior dislocation, four for old fractures of the femoral head during posterior dislocation, three for chondromatosis, three for tumours of the femoral head or the acetabulum, six for retractile periarthritis without arthroplasty. Hip arthroplasty (7) or not (6), median pain could be induced by the presence of retractile periarthritis with presence of synovial adherences to the femoral neck penetrating into the joint space; release relieved pain in 11/13.

Conclusion: The medial approach to the hip joint is a useful orthopaedic technique with a rapid learning curve.

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