Résultats à moyen terme du traitement des fractures décollements épiphysaires du tibia distal.

Evaluer les résultats du traitement des fractures décollements épiphysaires du tibia distal. Les auteurs ont analysé rétrospectivement les dossiers médicaux de 41 enfants âgés en moyenne de 11,7 ans, traités entre 2000 et 2010 pour un décollement épiphysaire récent du tibia distal. Les lésions étaient réparties selon la classification de Salter et Harris: type I=3 cas (7,5%), type II=29 cas (70,7%), type III=6 cas (14,6%) et type IV=3 cas (7,5%). En première intention, une réduction suivie d’un plâtre cruro-pédieux pour les types I et II, et un vissage et/ou un brochage à ciel ouvert pour les types III et IV étaient institués. L’évaluation des résultats s’est basée sur l’étude clinique et radiologique du membre inférieur avec un recul moyen de 2,1 ans (extrêmes: 1- 5 ans). Une consolidation sans séquelle a été observée chez 35 patients (85,3%) et six patients (14,6%) ont présenté des séquelles. Les séquelles étaient représentées par les troubles de la croissance secondaires à une épiphysiodèse dans 4 cas (9,7%) et une raideur de la cheville dans 2 cas (4,8%). Des complications post opératoires sont survenues chez six patients dont quatre présentaient des lésions de type II et les deux autres des lésions de type III. Il s’agissait de cinq cas d’irréductibilité par interposition périostée et un cas de déplacement secondaire. Les résultats étaient bons dans 85,3% des cas, mais une surveillance prolongée s’avère indispensable car les troubles de la croissance prédominaient parmi les complications.Mots-clés : décollement épiphysaire; enfant; tibia distal

Delayed treatment of supracondylar elbow fractures in children

SummaryBackgroundSupracondylar fractures are the most common elbow fractures in children and are usually treated on an emergency basis, using percutaneous pinning. However, the treatment is often delayed in areas where healthcare resources are scarce.HypothesisDelaying treatment does not influence the perioperative complication rate.Materials and methodWe retrospectively reviewed the medical charts of 89 children aged 2 to 15 years in whom surgery for extension-type supracondylar elbow fractures was delayed by more than 48hours. The 53 boys and 36 girls with a mean age of 6 years 9 months had severe fracture displacement (28 stage III and 61 stage IV according to Lagrange and Rigault classification scheme). Mean time to treatment was 4.5 days (range: 2–17 days). Open reduction and crossed K-wire fixation via the posterior approach were performed in all 89 patients. Postoperative complications and sequelae were collected. Functional outcomes were evaluated using Flynn's criteria.ResultsOutcomes were satisfactory in 74 (83.2%) of patients. Postoperative complications occurred in 13 (14.6%) patients and consisted of surgical site infection (n=7, 7.8%), iatrogenic nerve injury (n=3, 3.4%), and reoperation (n=3, 3.4%). At last follow-up after a mean of 5 months, three (3.4%) patients had cubitus varus and one had a recurrent fracture due to massaging. Elbow motion was limited in 11 (12.4%) patients. No case of compartment syndrome was recorded.DiscussionDespite an average time to surgery of 4.5 days, the outcome was satisfactory in 83% of cases. Delayed treatment was not associated with an increased rate of perioperative complications.Level of evidenceLevel IV, retrospective study

Surveillance épidémiologique de la rage humaine dans un contexte d’endémie de rage canine en Cote d’Ivoire

International audienceThe objective of this study was to analyze the epidemiologic monitoring of human rabies in the rabies medical center of Abidjan.A cross-sectional study was undertaken based on files of patients having consulted in the rabies center after exposure and suspicion of human rabies between January 2001 and June 2009.Twenty-six cases of human rabies were reported in 10,706,136 inhabitants (annual incidence of 0.028 cases per 100,000). The number of detected cases increased considerably after reinforcing the monitoring of the disease. Most cases occurred in an urban environment and concerned both sexes. The most concerned age range was under 31 years. The patients' were mostly school children and housewives. In all cases, the rabid animal was a dog and the type of exposure was a bite. Fifty-six percent of the victims had not received any local treatment and almost all no post-exposure prophylaxis. The mean delay before the first symptoms was 49.5 days after exposure and for death, 4 days after the onset of symptoms. Virological diagnosis was made in four cases.In spite of the increase of cases observed since 2006, certainly due to reinforcement of the monitoring network, improvement is needed to assess the real incidence of rabies in the Ivory Coast