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Pediatric Orthopaedics in Precarious Environment Possibilities and Limits of Humanitarian Surgery

Received: 8 May 2020     Accepted: 25 May 2020     Published: 4 June 2020
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Abstract

This is a retrospective study concerning a 35 years experience of pediatric orthopedic humanitarian surgery performed in precarious situation. This account may be useful to share with younger surgeons considering initiating such a surgery in developing countries. The data of 80 surgical missions held between 1983 and 2018 in Central African Republic have been collected and analyzed. The missions were planned with authorization of the local ministry of health. Their duration was usually two weeks, one week in the capital and one week in about fifteen villages in the country having small rehabilitation centers created when poliomyelitis was devastating. Surgery was performed in the local health center or hospital, with cooperation of the local medical team, sometimes without electricity, usually without radiograph, allowing only clinical diagnosis and not aggressive surgery. Postoperative care was given in the rehabilitation center. All in all 7500 children were seen in out-patients clinics and 2 200 underwent surgery. Sequelae of poliomyelitis which included 66% of out-patients between 1983 and 2000 turned down and became very rare, replaced by a more varied pathology with predominantly congenital malformations and sequelae of intramuscular injections, as well as sequelae of burns and sequelae of neurologic suffering (cerebral palsy, neuromalaria, sequelae of poisoning by toxic cassava). These pathologies are analyzed and the therapeutic options are discussed considering the local facilities. The families often neglected the given appointments, and due to this poor cooperation 25% only out of the operated patients were reviewed, making ineffective any statistical analysis. Nevertheless numerous pieces of information concerning the postoperative result and the late follow-up could be obtained from the local teams, allowing a global evaluation of the validity of this kind of humanitarian surgery.

Published in Journal of Surgery (Volume 8, Issue 3)
DOI 10.11648/j.js.20200803.14
Page(s) 97-103
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Poliomyelitis, Humanitarian Surgery, Sequelae of Intramuscular Injections, Orthopedic Surgery in Precarious Environment

References
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[2] Onimus M, Mandaba JL (1992) Les possibilités de verticalisation et de marche chez l’enfant porteur de séquelles de poliomyélite en milieu africain (Walking in Children after Poliomyelitis). Intern Orthop (SICOT) 16: 196-201.
[3] Ponseti IV (1992) Treatment of congenital club foot. J Bone Joint Surg (Am) 74: 448-454.
[4] Dobbs MD, Rudzki JR, Purcell DB, Walton T, Porter KE, Gurnett CA (2004) Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic club foot. J Bone Joint Surg (Am) 86-A: 22-27.
[5] Alves K, Penny N, Kobusingye O, Olupot R, Katz JN, Sabatini CS (2018) Paediatric Musculoskeletal Disease in Kumi District, Uganda: A Cross-Sectional Survey. Int Orthop. 42: 1967-1973.
[6] Onimus M, Brunet L, Gaudeuille F, Issa-mapouka A (2007) Le traitement des séquelles d’injections intramusculaires de sels de quinine en milieu africain. Med Trop 67: 267-273.
[7] Judet J, Judet R, Lagrange J (1956) Une technique de libération de l’appareil extenseur dans les raideurs du genou. Mem Acad Chir 82: 944-7.
[8] Gbenou A S, Kpadonou GT, Fiogbe A M, Zoumenou E, Alao MJ (2013) Iatrogenic Retractile Quadriceps Fibrosis Within Children in Benin: Epidemiological, Clinical, Therapeutical Aspects Afr J Paediatr Surg 10: 211-6.
[9] Sengupta S (1985) Pathogenesis of infantile quadriceps fibrosis ans its correction by proximal release. J Pediatr Orthop 5: 187-91.
[10] Soumah MT, Sylla AL, Toure MR et all (2003) Fibrose quadricipitale après injections intramusculaires dans la cuisse: à propos de 92 cas à l’Hôpital central universitaire Ignace Deen à Conakry. Med Trop 63: 49-52.
[11] Fiogbe AM, Gbenou AS, Magnidet ER,. Biaou O (2013). Distal quadricepsplasty in children: 88 cases of retractile fibrosis following intramuscular injections treated in Benin. Orthopaedics & Traumatology: Surgery & Research 99: 817-822.
[12] Hung NN (2011) Analysis of Two Different Techniques in the Treatment of Knee Stiffness in Swing Phase Due to Fibrous Rectus Femoris Muscle in Children. J Pediatr Orthop B 20: 164-72.
[13] Markus AF, Delaire J. (1993) Functional primary closure of the cleft lip. British Journal of oral and maxillofacial surgery 31: 281-291.
[14] Precious DS 2 (009) Primary bilateral cleft lip/nose repair using the "Delaire" technique. Atlas Oral Maxillofac Surg Clin North Am. 17: 137-46.
[15] Kuna SK, Srinath N, Naveen B S, Hasan K. (2016) Comparison of Outcome of Modified Millard's Incision and Delaire's Functional Method in Primary Repair of Unilateral Cleft Lip: A Prospective Study J Maxillofac Oral Surg 15: 221-8.
[16] Fufa DT, Chuang SS, Yang JY J (2014) Postburn Contractures of the Hand. Hand Surg Am 39: 1869-76.
[17] Brown M, Chung KC (2017) Postburn Contractures of the Hand. Hand Clin 33: 317-331.
[18] Tshala-Katumbay D, Eeg-Olofsson KE, Tylleskär T, Kazadi-Kayembe T. (2001) Impairments, disabilities and handicap pattern in konzo--a non-progressive spastic para/tetraparesis of acute onset. Disabil Rehabil. 23: 731-6.
[19] Boivin MJ, Okitundu D, Makila-Mabe Bumoko G, Sombo MT, Mumba D et all (2013) Neuropsychological effects of konzo: a neuromotor disease associated with poorly processed cassava. Pediatrics 131: 1231-9.
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Cite This Article
  • APA Style

    Michel Onimus. (2020). Pediatric Orthopaedics in Precarious Environment Possibilities and Limits of Humanitarian Surgery. Journal of Surgery, 8(3), 97-103. https://doi.org/10.11648/j.js.20200803.14

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    ACS Style

    Michel Onimus. Pediatric Orthopaedics in Precarious Environment Possibilities and Limits of Humanitarian Surgery. J. Surg. 2020, 8(3), 97-103. doi: 10.11648/j.js.20200803.14

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    AMA Style

    Michel Onimus. Pediatric Orthopaedics in Precarious Environment Possibilities and Limits of Humanitarian Surgery. J Surg. 2020;8(3):97-103. doi: 10.11648/j.js.20200803.14

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  • @article{10.11648/j.js.20200803.14,
      author = {Michel Onimus},
      title = {Pediatric Orthopaedics in Precarious Environment Possibilities and Limits of Humanitarian Surgery},
      journal = {Journal of Surgery},
      volume = {8},
      number = {3},
      pages = {97-103},
      doi = {10.11648/j.js.20200803.14},
      url = {https://doi.org/10.11648/j.js.20200803.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20200803.14},
      abstract = {This is a retrospective study concerning a 35 years experience of pediatric orthopedic humanitarian surgery performed in precarious situation. This account may be useful to share with younger surgeons considering initiating such a surgery in developing countries. The data of 80 surgical missions held between 1983 and 2018 in Central African Republic have been collected and analyzed. The missions were planned with authorization of the local ministry of health. Their duration was usually two weeks, one week in the capital and one week in about fifteen villages in the country having small rehabilitation centers created when poliomyelitis was devastating. Surgery was performed in the local health center or hospital, with cooperation of the local medical team, sometimes without electricity, usually without radiograph, allowing only clinical diagnosis and not aggressive surgery. Postoperative care was given in the rehabilitation center. All in all 7500 children were seen in out-patients clinics and 2 200 underwent surgery. Sequelae of poliomyelitis which included 66% of out-patients between 1983 and 2000 turned down and became very rare, replaced by a more varied pathology with predominantly congenital malformations and sequelae of intramuscular injections, as well as sequelae of burns and sequelae of neurologic suffering (cerebral palsy, neuromalaria, sequelae of poisoning by toxic cassava). These pathologies are analyzed and the therapeutic options are discussed considering the local facilities. The families often neglected the given appointments, and due to this poor cooperation 25% only out of the operated patients were reviewed, making ineffective any statistical analysis. Nevertheless numerous pieces of information concerning the postoperative result and the late follow-up could be obtained from the local teams, allowing a global evaluation of the validity of this kind of humanitarian surgery.},
     year = {2020}
    }
    

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    AB  - This is a retrospective study concerning a 35 years experience of pediatric orthopedic humanitarian surgery performed in precarious situation. This account may be useful to share with younger surgeons considering initiating such a surgery in developing countries. The data of 80 surgical missions held between 1983 and 2018 in Central African Republic have been collected and analyzed. The missions were planned with authorization of the local ministry of health. Their duration was usually two weeks, one week in the capital and one week in about fifteen villages in the country having small rehabilitation centers created when poliomyelitis was devastating. Surgery was performed in the local health center or hospital, with cooperation of the local medical team, sometimes without electricity, usually without radiograph, allowing only clinical diagnosis and not aggressive surgery. Postoperative care was given in the rehabilitation center. All in all 7500 children were seen in out-patients clinics and 2 200 underwent surgery. Sequelae of poliomyelitis which included 66% of out-patients between 1983 and 2000 turned down and became very rare, replaced by a more varied pathology with predominantly congenital malformations and sequelae of intramuscular injections, as well as sequelae of burns and sequelae of neurologic suffering (cerebral palsy, neuromalaria, sequelae of poisoning by toxic cassava). These pathologies are analyzed and the therapeutic options are discussed considering the local facilities. The families often neglected the given appointments, and due to this poor cooperation 25% only out of the operated patients were reviewed, making ineffective any statistical analysis. Nevertheless numerous pieces of information concerning the postoperative result and the late follow-up could be obtained from the local teams, allowing a global evaluation of the validity of this kind of humanitarian surgery.
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Author Information
  • Faculty of Medicine, Franch County University, Besan?on, France

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