Abstract Background: Serious trauma is the main cause of death for people under 40 years old. According to the WHO, in 2002, nearly 1.2 million people died worldwide from road traffic injuries. The vast majority (90%) are from low and middle-income countries. The diagnostic performance, the quality of the treatments offered, and the optimization of trauma care channels, make it possible to improve the management of serious trauma. This is not always the case in our context of a country with limited resources. Objectives: The ob jective is o describe the epidemiological, diagnostic and therapeutic aspects of premortal death in patients with traumatic injuries. Methods: This was a descriptive study with retrospective collection in the trauma emergency department of Yalgado Ouedraogo Teaching Hospital (Ouagadougou, Burkina Faso). All patients who died on the ward while in the hospital or on arrival were included. Results: 192 deaths were listed. The annual mortality was 1.6%, the sex ratio was 6.1 and the average age was 36 years. Road traffic accidents were the main etiology: 163 deaths (85%). Head injuries were the most common injuries: 45.3% of deceased patients had a Glasgow score ≤ 8. There was no pre-hospital care in 63% of the patients who died. The first six hours, on-call periods and the weekend were correlated with the death rate. Discussion: the high mortality in road traffic accident injuries in Africa is due to the weakness of pre-hospital care, the non-medicalization of the trans port of the injured and also the non-wearing of helmets by motorcyclists. The MGAP (Mechanism, Glasgow coma scale, Age, arterial Pressure) score is re liable in predicting the mortality of serious injuries.

Abstract Carpo-metacarpal dislocations are rare traumatic injuries resulting from vio lent trauma; they are mostly observed in young subjects. The spatular form is often accompanied by metacarpal fractures. We report a clinical case of complete dorsal carpo-metacarpal spatular dislocation. This was a 34-year-old patient, admitted for a closed trauma of the right hand, in whom the clinical examination noted edema of the hand. The radiological workup showed a complete dorsal spatular dislocation associated with a fracture of the base of the 2nd metacarpal. The reduction of these lesions in closed focus followed by stabilization by metacarpal broaching associated with an intermetacarpal transverse broach was done underscopic control in emergency. Functional rehabilitation was started in the 3rd week. The broaches were ablated at the 6th week. The functional result at 3 months was satisfying with good muscle strength. Resumption of work was effective at 8 weeks. Carpo-metacarpal dislocations are rare injuries, often unrecognized, especially in polytrauma patients, and have a good functional prognosis if they are managed correctly in an emergency.

Abstract Objectives: The objective is to determine whether there are differences in the position of the hyoid bone at rest in natural head position in subjects with mandibular hyperdivergence and to evaluate whether there are differences in hyoid position and antegonial notch depth in mandibular hyperdivergent males and females. Methods and Materials: This is a retrospective cohort study involving a review of lateral cephalometric radiographs of 45 adult men and women with mandibular hyperdivergency. Hyperdivergency was deter mined by cephalometric ranges of: SN-GoGn as least +2 SD from normal, Y-axis, PP-GoGN, and gonial angle greater than +1SD from normal. A group of 45 normodivergent adults served as a control, with cephalometric ranges of: SN-GoGn within ±1 SD of normal, with only one measurement of the other three between +1 and +1.5 standard deviations. A custom digital cephalometric analysis, the Hyoid Analysis, was designed, to measure the vertical and horizontal position and inclination of the hyoid and the antegonial notch depth. Results: In hyperdivergent subjects, the posterior aspect of the hyoid is located lower and more posterior, compared to the control group, while there is no difference in position of the anterior surface of the hyoid and the antegonial notch is 0.6 mm deeper. In males, the posterior aspect of hyoid is lower by 8.5 mm, while the anterior surface is located 9.0 mm lower. In males, the hyoid is inclined more steeply than in females by 4.4 degrees and the antegonial notch is deeper than in females by 0.6 mm. Conclusions: There are differences in hyoid bone position and mandibular morphology in hyperdivergent subjects compared to normodivergent subjects and in males compared to females.

Abstract Introduction: Binding retains an important place in Africa. Leaving a health facility to see a bonesetter is common there, but a source of complications. The purpose of this work was to analyze the results obtained by bonesetter after discharge against medical advice. Methodology: Analytical cross-sectional study over a period of one year, including all patients admitted for limb fracture, discharged against medical advice for treatment with a bonesetter. Results: Thirty-nine patients were selected. The average age was 36.9 years, and the sex ratio was 5.50. The fractures were open in 35.9%. At a mean follow-up of 19 months, the course was marked by pain in 34.4% and inequality in limb length in 62.5%. Thirteen fractures (40.6%) were consolidated with axis defect, and 11 were without axis defect (34.4%). There were eight non-union (25%), and eleven patients (34.4%) presented with stiffness in one or more joints. Seven patients had died. Discussion: The problem of discharge against medical advice is found in all hospitals but is particularly marked for fractures in our context. The absence of an X-ray and ignorance of the rules of asepsis lead to complications. Only the fractures of the two bones of the leg had progressed well (5/8 good results). The rate of vicious calluses (40.6%) and non-union (25%) is high. Conclusion: Although a few cases have progressed favorably, the results of patients traditionally treated after discharge against medical advice are generally poor.

Abstract Posterior hip dislocation with greater trochanter fracture is an uncommon injury pattern in the acute trauma patient. Frequently associated injury includes a combination of hip dislocation with posterior wall of acetabulum, head of femur fracture, intertrochanteric fracture and even the most severe type of combined acetabular fracture. We report a 42-year-old man post traumatic bilateral hip injuries with irreducible posterior hip dislocation and associated isolated greater trochanteric fracture successfully managed with open reduction and fixation of greater trochanter with universal locking trochanteric stabilization plate.

Abstract Myxoid liposarcoma is the most common form of myxoid sarcoma. Their primary and superficial localizations are very rare compared to the deeper forms. We report the case of myxoid liposarcoma in a 57-year-old patient. The clinical picture marked by painless swelling of the right thigh had evolved over a period of about ten years. The diagnosis was guided by ultrasound and magnetic resonance imaging. A pathological examination of the surgical specimen after removal of the tumor helped to clarify the diagnosis. We discuss the clinical presentation and therapeutic management.

Abstract Vitamin D deficiency is widespread in children and is associated with increased fracture severity. Previous studies have shown mixed results on the impact of vitamin D supplementation on bone health parameters measured on dual-energy x-ray absorptiometry (DEXA) scan. This is the first longitudinal DEXA study in a pediatric fracture population. Pediatric fracture patients with vitamin D levels below 20 ng/mL were counseled to take vitamin D and calcium per a serum-based protocol. Patients underwent baseline DEXA within the initial 12 weeks post fracture and had follow-up scans at 6 and 12 months. 48 patients were enrolled, 32 patients completed two DEXA scans, and 19 completed three DEXA scans. There was a significant increase in lumbar spine BMC, TBLH BMD, and TBLH BMC between DEXA 1 and 2 (p< 0.001). A positive trend in DEXA parameters is suggested between DEXA 1 and DEXA 3. Height adjusted z-scores (HAZ) were calculated which showed no statistical significance, p-values > 0.05. In this group, there are no significant changes in TBLH, BMC or BMD z-scores one year after fracturing despite vitamin D and calcium supplementation. This suggests that children returning to collision sports may be at continued risk for refracture and future studies are needed.

Abstract Purpose: Incidental bone lesions are a challenge for the specialist, who has to give recommendations for further management. This review of our cases will assist in the decision whether the lesion can be “neglected”, needs further active follow-up or direct initiation of treatment. Patients and Methods: 153 cases of incidental bone findings were presented to our musculoskeletal tumor service for evaluation from July 2008 through June 2021. 73 of them were cartilaginous tumors and 63 of these were diagnosed as enchondroma of a long bone based on X-Ray and MRI. Results: Follow-up imaging of the enchondroma patients was available for 35 patients at 1 to 13 years (mean 4.3 y), with no change in size except for one femoral diaphyseal enchondroma with increasing diameter from age 18 to 20 years. 14 additional patients answered written contact stating that they remained asymptomatic at 2 to 12 years (mean 5.6 y). None of the patients has been reported to the Swiss Confoederation Cancer Registry to have developed malignancy. Among the 10 other cartilaginous tumors were one chondrosarcoma grade II exhibiting different imaging, 3 non-long-bone localizations (pelvis, scapula and rib), 2 Ollier-type enchondromas, and 2 osteochondromas. Incidental findings other than cartilaginous tumors were fibrous dysplasia (n = 31), nonossifying fibroma (n = 31) and 18 other “sporadic” entities. Conclusions: Incidentally found enchondromas not exhibiting aggressive features need no systematic follow-up and patients can be “discharged” with the advice to present, if symptoms would develop. This also applies to fibrous dysplasia and the other sporadic lesions. 6 cases with other diagnoses needed specific treatment.

Abstract Multiple segmental fractures of the lower limbs, common in developing countries, are the prerogative of Road Traffic Accidents (RTA) involving two-wheeled vehicles. Their management is difficult, associated with complications, and is most often based on a two-stage strategy: Damage Control Orthopaedics,followed by delayed internal osteosynthesis. The aim is to allow early functional rehabilitation and rapid recovery of patients. We report the case of a 39-yearold man, bike rider, after his RTA, presented with segmental homolateral fractures of the femur and two bones of the left leg. Short-term evolution was marked by the appearance of significant lymphedema and bone infarctions of the lower left limb necessitating a transfemoral amputation. Through this observation, the authors highlight the problems related to the complexity of the management of multiple segmental fractures of the lower limb by emphasizing two posttraumatic complications rarely described but to be feared: chronic lymphedema and bone infarction.

Abstract Purpose: Bone marrow and muscle adiposity have been considered to correlate with osteoporosis and Sarcopenia. Proton Density Fat Fraction (PDFF)can be measured by Magnetic Resonance Imaging (MRI). The purpose of the present study was to measure PDFF in the lumbar spine, paraspinal muscle and subcutaneous fat tissue. Methods: Participants were comprised of 30 patients (18 males, 12 females; age range, 14 - 87 years) who underwent MRI due to low back symptoms. PDFFs for the body of the fourth lumbar vertebra (L4), paraspinal muscle, and subcutaneous fat were measured. Results: PDFFs of the vertebral body and subcutaneous fat were significantly higher than that of paraspinal muscle (p < 0.001). PDFF was significantly higher for subcutaneous fat than for the vertebral body (p < 0.001). Although no significant differences in PDFF of the vertebral body, paraspinal muscle, and subcutaneous fat between females and males, PDFFs of the vertebral body and paraspinal muscle were significantly higher in older subjects (>63 years) than in younger subjects (<63 years; p < 0.05). Conclusions: PDFF of the vertebral body was significantly higher than that of paraspinal muscle. PDFFs of the vertebral body and paraspinal muscle were significantly lower in younger subjects than in older subjects.

Abstract Background: Limb amputation is considered the last resort when the limb is no longer salvageable or when the limb is dead or dying, viable but nonfunctional or endangering the patient’s life. It is associated with profound economic, social, and psychological effects on the patients. The aim of this study is to evaluate the quality of life of major limb amputees in a rural setting in western Cameroon. Methods: This was a cross-sectional descriptive and analytical study carried out at the BATSENGLA-DSCHANG community in the West Region of Cameroon. Participants were interviewed and data collected using a pre-defined accredited questionnaire of the WHOQOL-BREF to assess the quality of life. Results: There were 63 participants, and a majority (60.32%) reported trauma as the cause of amputation. Participants with prostheses had a better quality of life. Conclusion: The age range of the study participants was 18 to 85 years with a mean of 46.73 ± 18.31 years. The majority were males (74.6%). Most of them (41.27%) had attained at least a secondary level of education, a majority (80.95%) were unemployed and more than half (55.56%) have less than the guaranteed inter-professional minimum wage. Major limb amputations were mostly due to traumatic causes (72%) and involved the lower limbs. Only a few (12.70%) used prostheses. Almost all of them (90.48%) had symptoms consistent with a phantom limb. The quality of life after major limb amputation in this study was generally fair according to the WHO quality of life tool.

Abstract Background: The olecranon fractures in children are relatively rare articular fractures. The aim of this work is to study the epidemiological, clinical and therapeutic particularities of this fracture in children at Owendo University Teaching Hospital. Patients and Methods: This was a retrospective analytical, monocentric study over 2 years from January 1, 2018 to January 1, 2020 at the Owendo University Hospital in Libreville and relating to the medical files of patients treated for a fracture of the olecranon in children in the service and regularly followed in outpatient consultation. Results: We collected 21 patients with an average age of 8.7 years. Falls dominated the etiologies. The Bracq classification was the one used in our series with the predominance of type D. The treatment was orthopedic in 33.3% of cases and surgical in 66.7% of cases. With an average follow-up of 12 months, the results were good in 71.5%, average in 19.0% and poor in 9.5%. Conclusion: The analysis of our results compared to those of the authors of the literature according to the precise parameters seems satisfactory.