PurposeTo study the management and evaluate anatomical and functional outcomes of patients with ipsilateral proximal and shaft femoral fractures.MethodsA retrospective, descriptive and analytic study lasted for ten years and a half ranging from January 1, 2005 to June 30, 2015. The following parameters were studied: epidemiology, fracture characteristics, therapeutic, anatomical and functional outcomes. The correlation between different parameters was analyzed with Fischer test. The significant threshold was defined for p value <0.05.ResultsTen medical files were registered. There were 7 men and 3 women, with a sex ratio of 2.33. The average age was 46 years (range: 29–62 years). It was about traffic road accidents in all cases. Motorcycle–motorcycle and motorcycle–car collision were most frequent. Average admission delay was 7 h (range: 1.5–24 h). Left side was most reached in 8 cases. According to Garden classification, there was type III cervical fracture in 2 cases, type II in 1 case and type IV in 1 case. According to Ender classification, there was type I trochanteric fracture in 3 cases, type VI in 2 cases and type VII in 1 case. According to AO classification, there was type A shaft fracture in 6 cases (A2 in 4 cases and A3 in 2 cases), type B in 2 cases (B1 in 1 case and B2 in 1 case) and type C in 2 cases (C1 in 1 case and C2 in 1 case). Average surgical delay was 28.7 days (range: 11–61 days). For proximal femoral fracture, Moore prosthesis was used in 1 case, blade plate 130° in 2 cases, long Gamma nail in 4 cases, double screwing in 2 cases and dynamic hip screw in 1 case. For shaft femoral fracture, blade plate 95° was used in 3 cases, low compressive plate in 2 cases. Osseous contention was achieved in 4 cases with long Gamma nail and in 1 case with long blade plate 130°. Nonunion of cervical fracture was achieved in 2 cases. The average osseous healing delay was 5.14 months (range: 3–12 months) for proximal femoral fracture and 5 months (range: 3–8 months) for shaft femoral fractures. According to Friedman and Wyman criteria, functional results were good in 4 cases, average in 4 cases and bad in 2 cases. Regarding implants, healing delay showed no statistic difference between one-implant group and two-implant group (p = 0.52), and among the patients with different functional outcomes (p = 0.52). Functional outcomes showed no statistic difference between one-implant group and two-implant group (p = 0.46).ConclusionIpsilateral proximal and shaft femoral fractures are relatively uncommon in our daily activities. It is difficult to recognize proximal femoral fractures which are unnoticed. Results are generally good if the doctors take the two fractures into account in the management.

Level IV-Historical cases.

Introduction: The increasing number of vehicles and the proliferation of two-wheeled vehicles accentuate the frequency of fractures in our country. The aim of this study is to describe the epidemiology of fractures in Cotonou. Materials and Methods: This prospective two-year study focused on all patients admitted to the emergency department of the National Teaching Hospital of Cotonou for a fracture injury. Results: 1794 fractures were collected in 1432 patients. Fractures accounted for 24.9% of surgical emergencies. The average age was 33.7 years (29 days -90 years). The dominance was male with a sex ratio of 3.62. Etiological circumstances were dominated by road traffic accidents (75.8%), The etiological circumstances were dominated by road accidents (75.8%), motorcyclists being the most affected (48.5%). The admission average was 27.33 hours (15 minutes -29 days). Fractures preferentially sat on the lower limbs (64.4%). In descending order of frequency, were distinguished the fractures of leg (32.2%), of the femur (19.8%) and of the forearm (14.8%). Conclusion: fractures are common.

Introduction: The management of polytrauma patient should be beforehand and always in keeping in mind the damage control. the surgical treatment is secondary to the stabilization of the patient. Clinical Case: we are reporting a 34 years old polytrauma patient from a motor vehicle accident. On physical examination, we noted : a severe brain injury, a closed articular fracture of right distal radius associated to a dislocation of distal radius and ulna distal joint, a closed bilateral fracture of both trochanters, an open communitive tibial fracture of proximal epiphysis methaphysis and diaphysis. The last one was classified as type IIIB of Gustilo and Anderson and associated to a closed fracture of the head and the neck of right fibula, a closed fracture of the right lateral malleolus. After patient stabilization, the head injury improves to normal Glasgow score on 8th day of admission. Necrosis of soft tissus and exposition of the tibia was noted. The surgical treatment was done on 2 stages due to financial issues. A bone synthesis of the trochanteric fracture was done only on the left and external frame as well as a muscle flap was done for the right tibial fracture on the 18th day. On the 42nd day a PAPINEAU technic associated to a proximal inter tibiofibular graft was done. The functional outcome of the orthopaedic treatment of the wrist was bad (malunion). That last complication was managed by a SAUVE KAPANDJI surgery (at 6 months) and the contracture (pronation and supination) at 12 months post trauma. The outcome was fair good despite patient financial issue and local complications that compromise an optimal surgical management and a delay. He resumes normal professional activities at about 2 years. At 5 years follow up, functional and anatomical results were satisfactory. Conclusion: In a limited ressources’ setting, the management of lesions including a multiple fractures is a challenge for the practitioner and the injuried patient. A management taking into account social and economic ressources is mandatory to minimise sequelae. Keywords: Management, Polytrauma, Limited ressources.

Background: Fractures of the distal humerus represent 1.3% of fractures in Cotonou. Their treatment is often surgical. The aim of this work was to assess the results of their osteosynthesis in a disadvantaged environment.Methods: This retrospective study from 2001 to 2015 included 38 operated patients for distal humerus fracture with a minimum follow-up of 12 months. The average age was 33.6 years; the predominance was male (27 cases). The major etiology was traffic accidents (31 cases), According to the AO classification, the fractures were type A (10 cases), type B (02 cases) and type C (26 cases). The average time of surgery was 21 days. The Lecestre plate was the most used (29 cases). An iliac cortico-cancellous graft was used in 03 cases. The mean hospital stay was 20 days.Results: The mean follow-up was 37 months. Functionally, the mean Mayo elbow performance score (MEPS) score was 66.3 points. The results were excellent (08 cases), good (13 cases), average (10 cases) and bad (7 cases). The patients were satisfied or very satisfied in 29 cases. Radiographically, the reduction was anatomical in 34 cases. Anatomical reductions were obtained with Lecestre plates. Consolidation was achieved in 36 cases within an average of 9 weeks. As complications we noted: radial nerve paresis (03 cases); secondary displacement (02 cases); superficial infection of the operating site (02 cases), wire migration or screw retraction (05 cases), non-union (03 cases), malunion in varus (04 cases) and osteitis of the proximal ulna (01 case).Conclusions: Fractures of the distal humerus are infrequent. The anatomical and functional results despite little technical support provided and the long delay before surgery are quite good.

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We report the case of a traumatic amputation by circular saw of the ring and small fingers, associated with middle finger nail matrix loss and tendon, bone and joint exposure. The replantation was not attempted with patient's consent. Since the nail unit from the ring finger was intact, we decided to harvest the ring finger nail unit for major finger reconstruction. Although the principle of vascularized transfer from a severely damaged finger is widely recognized and the vascularized nail transfer from toe is a relatively common procedure, there is no description of a vascularized nail transfer from a non-replantable digit in the literature.

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