Jornal de Trauma e Tratamento

Introduction: Hip dislocation is frequent in our context. It becomes old if the reduction is not made after 28 days. The aim of the work is to assess their frequency and the difficulty of their management, then to assess functionally the fate of this hip after arthroplasty.

Materials and Methods: We carried out a prospective and descriptive study from January 2016 to December 2020 at the Laquintinie hospital in Douala and the Garoua Regional Hospital. We collected a total of 25 cases (22 patients with an old dislocation and 3 cases of neglected hip dislocation) including 15 men and 10 women; we performed uncemented total hip arthroplasty in 9 patients. With an average follow-up of 26 months, we evaluated these 9 patients by the numerical PMA evaluation score (Postel Merle d'Aubigné).

Results: Men were the most numerous (15/10). The left hip was the most injured (13/12). All patients presented with a high posterior dislocation. The average score is 15 out of 18. 2 operated patients had a very good result and 7 a good result.

Discussion: If hip dislocations are not reduced on time, their management becomes complex and can lead to total hip arthroplasty straight away. This is complicated by osteonecrosis of the femoral head or paralysis of the sciatic nerve. Some authors suggest the realization of a total hip replacement regardless of the patient's age. The low rate of operated patients may constitute a limitation for our study. The major part of our patients could not be operated due to lack of financial means, the health insurance not being effective. The results of the 9 operated patients were satisfactory after hip arthroplasty, we believe that we made the best choice by immediately proposing a hip arthroplasty.

Conclusion: Old hip dislocations exist in our environment and are frequent. First-line total hip arthroplasty is the best indication to restore autonomy to the patient.

Background: Distal radius fractures are one of the most common fractures. Plaster casting remains the common treatment of choice for simple distal radius +/- ulna fractures. Casting has been noted by patients to be heavy, itchy, cumbersome, restrictive of work and leisure activity, and presents a hygiene risk. To alleviate the difficulties noted with casting, an evaluation of a novel adjustable wrist orthosis in the non-operative management of distal radius fractures was performed.

Methods: All patients presenting to the participating clinic and who met the inclusion criteria were invited to participate in the study. The Zero- Cast™ device was applied by a trained healthcare professional. All patients were followed-up at 1, 2, and 4-6 weeks. Participants completed the Patient Questionnaire and the Patient Rated Wrist Evaluation (PRWE) at their final clinic visit. X-rays examinations were undertaken. The healthcare professionals who applied the orthosis also completed the Healthcare professional questionnaire. Complications from the treatment were recorded.

Results: This trial took place at a single clinic; 5 clinicians participated in the trial. 32 patients were included in this study. Radiologically all fracture were stable with no loss of position. There were no reported complications. Patients provided an overall rating for orthosis comfort scoring of 2.2 out of 10 (10 being least comfortable). Most patients felt the orthosis was convenient for hygiene scored 2.7. On ease of activity to daily living the orthosis was scored at an average of 2.7. An overall average PRWE score of 2.5 (scoring 1=best – 10=worst). Clinician feedback was generally positive. Average time taken to apply the orthosis was 5.2 mins.

Discussion: This study was limited by the lack of a ‘control’ group and by the limited number of patients in the cohort. This study was performed as a new-technology, early evaluation of patient experience and the outcomes were found to be positive. This study should encourage other investigators to design studies that will further test the potential benefits offered by new treatment devices.

Conclusion: We recommend using this new device for simple and stable fracture however more research is warranted prior to its utilisation in complex distal radius fractures.