Aspects Cliniques, Thérapeutiques et Évolutifs des Fractures-Luxations de Cheville à l’Hôpital Aristide Le Dantec (Dakar)

L Fonkoué, L Sarr, M Daffe, K Muluem, O Ngongang, A Gueye, C Dieme, A Sane

Abstract



RÉSUMÉ
Introduction. Les fracture-luxations de cheville (FLC) sont des lésions graves qui mettent en jeu le pronostic fonctionnel de l’articulation. Ce travail avait pour but d’étudier les formes anatomo-cliniques, les aspects thérapeutiques et évolutifs des FLC en contexte de ressources limitées. Patients et méthodes. Les données d’une cohorte rétrospective de tous les patients ayant été reçus et suivis CHU Aristide-Le-Dantec pour FLC sur une période de six ans (Janvier 2009 à Janvier 2015) ont été récoltées et analysées. Les variables d’intérêt étaient démographiques, radio-cliniques et thérapeutiques. Le délai de consolidation et les complications ont été rapportés, avec un recul moyen de 27,2 ± 18.3 mois. Résultats. Cinquante-deux patients âgés en moyenne de 37,2 ± 11,1 ans ont été inclus. Concernant les formes cliniques, les fractures étaient bimalléolaires, équivalent-bimalléolaires et trimalléolaires dans 26 (50%), 12 (23,10%) et 8 (15,3%) cas respectivement. La luxation talo-crurale associée était latérale dans 26 (50%) cas, postérieure dans 18 (34,6%) cas. La FLC était ouverte dans 16 (30,8%) cas. Le traitement était chirurgical chez 33 (63,4%) patients. La principale indication chirurgicale était l’embrochage de la malléole latérale associée à l’haubanage de la malléole médiale chez 15 (45,4%) patients. La réduction anatomique des fractures et le recentrage du talus étaient obtenus dans 26 (50%) et 34 (65,4%) cas respectivement. Le délai moyen de consolidation était de 76,7 ± 28,2 jours. La principale complication chronique était l’arthrose talo-crurale, retrouvée chez 22 (42.3%) patients. Conclusion. Les FLC constituent une urgence traumatologique grave, aux formes cliniques variées, avec 73% de complications chroniques dans notre milieu.
ABSTRACT
Introduction. Ankle fracture-dislocations (AFD) are serious injuries that affect the functional prognostic of the joint. The aim of our work was to report the clinical features, the therapeutic and evolutionary aspects of AFD in a resource-limited setting. Patients and Methods. Data from a retrospective cohort of consecutive patients admitted and followed for AFD at the Aristide-Le-Dantec teaching hospital for a six years period (January 2009 – January 2015) were collected and analyzed. We studied demographic, clinical and therapeutic data. The delay of consolidation and the occurrence of complications was also reported, at an average follow-up period of 27.2 ± 18.3 months. Results. Fifty-two patients, aged 37.2 ±11.1 years were included. Regarding the clinical features, bimalleolar fracture were observed in 26 (50%) cases, followed by equivalent-bimalleolar and trimalleolar fractures in 12(23.1%) and 8(15.3%) cases respectively. Associated tibio-tarsal dislocation was lateral in 26(50%) cases and posterior in 18(34.6%) cases. Open AFD was found in 16 (30.8%) cases. The treatment was surgical in 33 (63.4) patients. The main surgical modality was pinning of the lateral malleolus and tension band wiring of the medial malleolus in 15(45.4%) patients. Anatomical reduction of the fractures and centering of the talus were achieved in 26(50%) and 34(65.4%) patients respectively. The bone consolidation was achieved at an average delay of 76.7 ± 28.2 days. The main chronic complication was early posttraumatic ankle osteoarthritis, found in 22(42.3%) patients. Conclusion. AFD are severe trauma emergency with various clinical presentations, and 73% of chronic complications in our setting.


Keywords


Fracture-luxation cheville ; Formes cliniques ; Arthrose talo-crurale

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