Background: It is recommended that the management of open lower-leg fractures should occur within six hours to avoid complications affecting both prognosis and functionality. This study aimed to evaluate the time taken for each step of management, identify causes of delay, and propose solutions to reduce the rate of complications. Patients and methods: This was a prospective study involving 153 patients treated from January 2011 to December 2012. Standardized data collection forms documented the times taken for each management step from the accident until surgical intervention. Results: For patients admitted directly to our institution, median time to surgical debridement from arrival was 5 hours. Median time for bone fixation was 24 hours. External fixation was used in 119 patients. There were several causes of delay; lack of financial resources was the most common. Certain causes of delay were significantly correlated with time to debridement. However, although 86.7% of patients who developed an infection had a time from injury to debridement greater than six hours, there was no statistically significant association between infection and delay beyond six hours (p = 0.403). Conclusion: By identifying causes of treatment delay, we hope to be able to avoid complications, and therefore reduce the socioeconomic impact of these important surgical emergencies.

Background: We report a retrospective study of 47 total prosthesis of hip put in place among the young adult of less than fifty years in the service of Traumatology and Orthopedics at the Wing IV of the CHU Ibn Rochd of Casablanca, over a period from January 2008 to March 2014, with an average rate of decline of 42 months. Results: The deliberate group of 43 patients (47 hips including 4 bilateral) consisted of 26 women, either 60, 47% and 17 men, either 39, 53%. The average age of our patients was 36 years. In our series, the predominant etiology has been conducted for the indication of the hip replacement was the aseptic osteonecrosis of the femoral head which has represented 31.91%. With regards to the choice of implants, 85% of PTH were non-cemented, the cemented PTH has been used in 15% of cases. The Friction Torque metal/polyethylene was used in all cases. The functional outcome was appreciated by the rating of Merle of Aubigne before and after arthroplasty. The average rate of decline of 42 months, and the results were generally satisfactory. They were excellent in 27.78% of cases, very good in 19.44% of cases and good in 44.44% of cases. The results on the Pain were remarkable: the rating of the pain going 2.8 in pre-operative at 5.6 at the latest decline. The results on the walking and mobility were also good. It was noted as a complication: 4 cases of prosthetic dislocation, 1 case of aseptic descellement bipolar, 2 cases of early sepsis on hardware, 3 cases of paralysis of the sciatic external popliteal and 4 cases of periprothetiques ossification. In total, 5 total prosthesis of hip were occasions. The young age does not seem to be an obstacle to the prosthetic surgery. Conclusion: However, a major question remains concerning the distant future of these prostheses in young active subjects, because they will be submitted for many years in a job which can cause the descellement of prosthetic parts.

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