Réflexions sur la chirurgie orthopédique en milieu tropical

Management of neglected open extremity fractures in low-resource settings: Experience of the French Army Medical Service in Chad

“…The conditions of management of the open fractures and the "classic" complications observed in this series are no longer found in the developed countries, but are a reminder of the huge gap between the African and European healthcare systems [2,7]. In Chad, there are very few local medical clinics and healthcare personnel are sorely lacking.…”

“…In certain cases this can be converted to early internal fixation when deep tissue specimens have excluded bone infection. Stabilization with a plaster cast is a regular option in African countries because of the limited availability of hardware for internal fixation [2,5,[7][8][9]. Although this approach limits the risk of infectious complications, correction of alignment defects and maintaining stable reduction is not optimal [8,9].…”

“…In rural areas, this is mostly because local medical facilities are lacking and travelling conditions are difficult due to poor roads and limited means of transportation [1]. Access to healthcare is also a problem for the poor urban population, who may have difficulty paying hospital costs [2,3]. Thus, fractures are often first treated by traditional bone-setters and healers whose methods are not adapted to the management of open fractures [3][4][5][6].…”

“…Most patients only consult an orthopedic surgeon after a certain delay presenting with severe injuries or sequella that are difficult to cure with the diagnostic and therapeutic means available in local facilities [2,7]. Management of septic complications in open fractures is an especially complex problem.…”

Traitement des fractures ouvertes des membres négligées en situation précaire : expérience du Service de santé des armées français au Tchad

“…La plupart des patients n'accèdent que tardivement à un chirurgien orthopédiste, avec des lésions évoluées ou des séquelles difficilement curables avec les moyens diagnostiques et thérapeutiques disponibles dans les infrastructures locales [2,7]. Dans le cas des fractures ouvertes, la prise en charge des complications septiques est particulièrement problématique.…”