Amniotic band syndrome is an acquired embryo-fetopathy. It is rare and is characterized by malformations mainly affecting the limbs but also the skull, face and thoraco-abdominal axis. Its etiopathogenesis remains poo...Amniotic band syndrome is an acquired embryo-fetopathy. It is rare and is characterized by malformations mainly affecting the limbs but also the skull, face and thoraco-abdominal axis. Its etiopathogenesis remains poorly understood. Its diagnosis is essentially clinical and is classically based on the existence of signs such as furrows, amputations and pseudosyndactyly. To show the importance of antenatal diagnosis in resource-limited countries, we report the case of two newborns, one premature at 31 weeks and the other at term, in whom amniotic band syndrome was discovered incidentally at birth. It involved an amputation of the right leg for both cases. The premature baby was born in a context of neonatal sepsis and will succumb to the latter while the 2nd case was released from the hospital alive. Imaging examinations to search for probable congenital malformations could only be carried out for the 2nd case and no accessible congenital malformation had been identified. And as management of the disease, only psychological support to the parents was provided for the 2 cases. The antenatal discovery of a case of amniotic band syndrome in countries with low technical capacity such as Burundi should push clinicians to think in time about treatment options.展开更多
<b><span style="font-family:Verdana;">Introduction</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verd...<b><span style="font-family:Verdana;">Introduction</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">Fractures of the femoral head are rare injuries which generally follow a traumatic dislocation of the hip or in a poly-trauma scenario. A fracture dislocation of the femoral head is an orthopedic emergency. The most frequent complications after a fracture of the femoral head are osteonecrosis, post traumatic arthritis and heterotopic ossification.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Objective</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">To focus on the therapeutic aspect of fracture-dislocations of femoral head and their short- and long-term prognoses.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Materials and Methods</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">This is a prospective study conducted at Kamenge teaching hospital and Rohero Christian medical and surgical clinic from January 2013 to August 2020. All patients diagnosed with fracture-dislocations of the femoral head were included in this study.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">Five patients were admitted for fracture dislocation of the femoral head. The mean age was 40.4 years and varied between 25 and 55 years. The dashboard injury was the most common mechanism and was found in four patients</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(80%). A standard x-ray was performed for the five patients as well as CT scans in two cases. All patients had posterior iliac dislocations with fractures of the femoral head classified as Pipkin I in three patients and Pipkin III in two patients.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Closed reduction under general anesthesia within six hours was possible in one among the five patients and within 12 hours in two patients. These three cases were managed with open reduction and internal fixation (ORIF) via anterior approach with screw fixation of the femoral head fragment. In the two remaining patients reduction was not possible and for one of them there was a femoral neck fracture following closed manipulation, making the fracture Pipkin III. The two patients with Pipkin III injuries were managed with total hip replacement.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">With an average follow up of five years, standard x-rays of the three patients who had ORIF showed fracture union without avascular necrosis, posttraumatic arthritis or heterotopic ossification. The functional results for the five patients with an average follow up of four years were very good (3/5) and good (2/5).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">The diagnosis of fracture dislocations of the femoral head was based on clinical, radiographic and computed tomography criteria. Early reduction and internal fixation can restore the natural anatomy of the hip joint, especially in young adults with a good long-term prognosis. Sometimes total hip replacement is necessary for management of fracture dislocations of the femoral head.</span>展开更多
<b><span>Background:</span></b><span> Necrotizing fasciitis is a rapidly spreading soft tissue infection involving the deep facial layers. It can cause secondary necrosis leading to signi...<b><span>Background:</span></b><span> Necrotizing fasciitis is a rapidly spreading soft tissue infection involving the deep facial layers. It can cause secondary necrosis leading to significant morbidity and mortality. The most important predictor of mortality is a delay in diagnosis. In low income countries, that delay must be high and other predictors of morbidity and mortality must be pointed out. </span><b><span>Objective: </span></b><span>To determine necrotizing fasciitis (NF) prognostic factors in a low income country. </span><b><span>Patients and Methods:</span></b><span> It is a prospective and descriptive study conducted over a one-year period from November 1, 2017 to November 1, 2018 about 23 cases of necrotizing fasciitis in two hospitals of Bujumbura. </span><b><span>Results:</span></b><span> The incidence of necrotizing fasciitis in these 2 hospitals (Kamenge Teaching Hospital and Prince Regent Charles Hospital) was 1%. The average age of patients was 41.76 years. Males were predominant with a sex ratio of 1.55. The risk factors for NF were: NSAIDs in 39%;HIV infection in 13%, diabetes mellitus in 4% and high blood pressure in 4%. The average time from symptoms onset to admission was 17.13 days. The mean time from admission to surgical treatment was 4 days with extremes of 1 to 22 days. The most affected site was the lower limb in 82% of cases. All patients (96%) were treated with necrotic tissue debridement. It was associated with skin grafting in 48% of cases. One patient (4%) with diabetes mellitus and HIV infection was amputated. The mortality rate was 22%</span><span> </span><span>(n = 5). Among those 5 patients, there was a combination of risk factors (diabetes mellitus, NSAID use and HIV infection) in 80% (n = 4), 60% (n = 3) were over 60 years of age and 60% (n = 3) were operated 10 days after the onset of symptoms. The average time of hospital stay was 101 days with extremes of 14 to 400 days. </span><b><span>Conclusion:</span></b><span> Necrotizing fasciitis is associated with a high mortality rate in low income countries. The use of NSAIDs;delayed treatment, elderly and immunosuppressive conditions such as diabetes mellitus and HIV are the most prognostic factors in Bujumbura hospitals.</span>展开更多
文摘Amniotic band syndrome is an acquired embryo-fetopathy. It is rare and is characterized by malformations mainly affecting the limbs but also the skull, face and thoraco-abdominal axis. Its etiopathogenesis remains poorly understood. Its diagnosis is essentially clinical and is classically based on the existence of signs such as furrows, amputations and pseudosyndactyly. To show the importance of antenatal diagnosis in resource-limited countries, we report the case of two newborns, one premature at 31 weeks and the other at term, in whom amniotic band syndrome was discovered incidentally at birth. It involved an amputation of the right leg for both cases. The premature baby was born in a context of neonatal sepsis and will succumb to the latter while the 2nd case was released from the hospital alive. Imaging examinations to search for probable congenital malformations could only be carried out for the 2nd case and no accessible congenital malformation had been identified. And as management of the disease, only psychological support to the parents was provided for the 2 cases. The antenatal discovery of a case of amniotic band syndrome in countries with low technical capacity such as Burundi should push clinicians to think in time about treatment options.
文摘<b><span style="font-family:Verdana;">Introduction</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">Fractures of the femoral head are rare injuries which generally follow a traumatic dislocation of the hip or in a poly-trauma scenario. A fracture dislocation of the femoral head is an orthopedic emergency. The most frequent complications after a fracture of the femoral head are osteonecrosis, post traumatic arthritis and heterotopic ossification.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Objective</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">To focus on the therapeutic aspect of fracture-dislocations of femoral head and their short- and long-term prognoses.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Materials and Methods</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">This is a prospective study conducted at Kamenge teaching hospital and Rohero Christian medical and surgical clinic from January 2013 to August 2020. All patients diagnosed with fracture-dislocations of the femoral head were included in this study.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">Five patients were admitted for fracture dislocation of the femoral head. The mean age was 40.4 years and varied between 25 and 55 years. The dashboard injury was the most common mechanism and was found in four patients</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(80%). A standard x-ray was performed for the five patients as well as CT scans in two cases. All patients had posterior iliac dislocations with fractures of the femoral head classified as Pipkin I in three patients and Pipkin III in two patients.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Closed reduction under general anesthesia within six hours was possible in one among the five patients and within 12 hours in two patients. These three cases were managed with open reduction and internal fixation (ORIF) via anterior approach with screw fixation of the femoral head fragment. In the two remaining patients reduction was not possible and for one of them there was a femoral neck fracture following closed manipulation, making the fracture Pipkin III. The two patients with Pipkin III injuries were managed with total hip replacement.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">With an average follow up of five years, standard x-rays of the three patients who had ORIF showed fracture union without avascular necrosis, posttraumatic arthritis or heterotopic ossification. The functional results for the five patients with an average follow up of four years were very good (3/5) and good (2/5).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">The diagnosis of fracture dislocations of the femoral head was based on clinical, radiographic and computed tomography criteria. Early reduction and internal fixation can restore the natural anatomy of the hip joint, especially in young adults with a good long-term prognosis. Sometimes total hip replacement is necessary for management of fracture dislocations of the femoral head.</span>
文摘<b><span>Background:</span></b><span> Necrotizing fasciitis is a rapidly spreading soft tissue infection involving the deep facial layers. It can cause secondary necrosis leading to significant morbidity and mortality. The most important predictor of mortality is a delay in diagnosis. In low income countries, that delay must be high and other predictors of morbidity and mortality must be pointed out. </span><b><span>Objective: </span></b><span>To determine necrotizing fasciitis (NF) prognostic factors in a low income country. </span><b><span>Patients and Methods:</span></b><span> It is a prospective and descriptive study conducted over a one-year period from November 1, 2017 to November 1, 2018 about 23 cases of necrotizing fasciitis in two hospitals of Bujumbura. </span><b><span>Results:</span></b><span> The incidence of necrotizing fasciitis in these 2 hospitals (Kamenge Teaching Hospital and Prince Regent Charles Hospital) was 1%. The average age of patients was 41.76 years. Males were predominant with a sex ratio of 1.55. The risk factors for NF were: NSAIDs in 39%;HIV infection in 13%, diabetes mellitus in 4% and high blood pressure in 4%. The average time from symptoms onset to admission was 17.13 days. The mean time from admission to surgical treatment was 4 days with extremes of 1 to 22 days. The most affected site was the lower limb in 82% of cases. All patients (96%) were treated with necrotic tissue debridement. It was associated with skin grafting in 48% of cases. One patient (4%) with diabetes mellitus and HIV infection was amputated. The mortality rate was 22%</span><span> </span><span>(n = 5). Among those 5 patients, there was a combination of risk factors (diabetes mellitus, NSAID use and HIV infection) in 80% (n = 4), 60% (n = 3) were over 60 years of age and 60% (n = 3) were operated 10 days after the onset of symptoms. The average time of hospital stay was 101 days with extremes of 14 to 400 days. </span><b><span>Conclusion:</span></b><span> Necrotizing fasciitis is associated with a high mortality rate in low income countries. The use of NSAIDs;delayed treatment, elderly and immunosuppressive conditions such as diabetes mellitus and HIV are the most prognostic factors in Bujumbura hospitals.</span>
