Background: Congenital dislocation of the hip is currently a public health and socioeconomic problem. Delayed treatment impairs the functional prognosis of the affected hip and increases the need for surgical treatment. Aim: To evaluate the therapeutic results of the treatment by orthosis and the cost of the treatment. Material and Methods: This retroprospective descriptive study was carried out at the CHUAM of Antananarivo and the CRMM of Antsirabe on patients with congenital hip dislocation treated with braces; from January 2017 to August 2021. Results: Forty-eight cases were retained during this study. A female predominance was mentioned with a sex ratio of 0.45 and an average age of 7.8 ± 5.5 months at the beginning of the treatment. A left dislocation was observed in 27.1% of cases. Twenty-nine patients were treated with abduction pants. A recentered femoral head showing a good result was present in 37 patients. Five dislocations were observed at follow-up, and 5 residual subluxations. No cases of avascular necrosis of the femoral head have been reported. The total cost of orthosis treatment was on the average of 138.554,5 ± 51.678,8 Ariary. Conclusion: The age at the start of treatment and the duration of treatment influence the therapeutic outcome. The cost of orthosis treatment was affordable. If the treatment started earlier, the functional prognosis would be better.
Abstract The management of open fractures was a challenge from antiquity to the present day. The objective of this study is to report the difficulties of the management of open fractures of long bones in low-income countries. This was a retrospective cohort study of the files of patients admitted for open fracture of long bones in the Department of Orthopedic Surgery and Traumatology of the Anosiala University Hospital Center for four years. Forty-two open long bone fractures were collected. The average age of the patients was 36.3 years of which 73.8% were subject of working age in the age group of 20 to 60 years and 73.8% of the cases were following the accident of the road. Most of the wounded had arrived at the hospital by bush taxi. The tibia was the most affected bone (71.4%). Gustilo IIIA type open fractures were the most observed (38.1%). Only 26.3% of patients had received surgical debridement before the sixth hour. 76.2% had no care before arriving at the hospital, 14.3% had emergency care at the basic health center and 9.5% were already being treated by the traditional healer. Definitive treatment of the fracture was dominated by the external fixator (38.1%) and orthopedic treatment (26.2%). In low-income countries, the management of open fractures remains a daunting task. The main factors limiting the management of open fractures were the poverty of the population, the lack of health insurance coverage and the retard in arriving at the hospital. Keywords: open fractures, management, low-income, country
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