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PRIMARY ARTHRODESIS AS FIRST-LINE TREATMENT OF OPEN INJURY OF THE KNEE
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GUIFO ML, BITANG MAFOK LJ, KOUAM KC, FARIKOU I, FOSSOH H,TAKONGMO S, ESSOMBA A.
OBJECTIF AND BACKGROUND
CASE PRESENTATION
The objective of this presentation is to report the case of a severe open trauma of the knee and highlight the difficulties and skills necessary to manage it successfully.
Mrs GS aged 20 years, victim of a road traffic accident and rushed to CHU Yaoundé in April 2013 on a motorcycle. On admission, she was conscious and well oriented. The primary exam showed a respiratory rate of 20/min, a blood pressure of 110/60 mmHg, a heart rate of 90/min at physical exam we noticed a tourniquet on the left thigh, a large anterior wound of the left knee (fig1) with active blood oozing. On secondary exam the plantar sensibility was conserved, and the Mangled Extremity Severity Score was estimated 5/10. We carried out an emergency debridment to achieve hemostasis and she underwent primary arthrodesis of the knee with screws and external fixator (fig2 and fig3). The post operative outcome was unevenful and a skin graft was done 3 weeks later (fig4).
DISCUSSION
Open joint injuries involve the knee most often and their incidence is going to increase, linked to rising motorcycle transport activities in many African cities [1]. Their management does not follow established protocols because of the variety of anatomic structures that can be involved with variable functional significance. These injuries are grossly categorize into three types: those associated with fracture, injuries without fracture and gunshot. Chronic infection and secondary arthritis are the late complications when coverage of bone and restoration of joint space has been successful. These late complications have led to evaluating the advantage of limb reconstruction versus early amputation or arthrodesis [2]. Although early amputation and arthrodesis can lead to rapid recovery of injured patients, long term acceptance is difficult especially for young patients. The lesions of our patient were too severe and we decided to do arthrodesis to increase the chances of limb salvage and avoid multiples procedures which could produce disappointing results with arthrofibrosis and painful motion. A split thickness skin graft was done to achieve healing. All hospitals receiving trauma cases should have the expertise of modern wound healing solutions. Despite these outcomes, each patient should be given full consideration according to the evolving technologies and personal resources as the case reported by Kenneth A et col on bilateral open dislocation of the knee joint treated successfully by reconstruction but that could also be managed by secondary arthroplasty [3].
Figure 1. Label in 24pt Arial.
CONCLUSIONS
CONCLUSION
Severe open fracture of the knee contrasts the conservative management which can be strenuous with a disappointing outcome and a primary arthrodesis that has a poor functional acceptance especially in young patients but can be limb sparing in difficult environment. There is a need of experience in wound healing at all the steps of the health pyramid .
CONTACT
REFERENCES
GUIFO MARC LEROY
CHU Yaoundé Cameroun
Tel:
Patzakis M J, Dorr LD, Ivler D, Moore Tillman D, Harvey JP. The early management of open joint injuries. A prospective study of hundred and forty patients.JBJS Vol 57.A, N°8 DECEMBER 1975.
MacKenzie E, Bosse MJ, Pollak AN, Webb LX, Swiontkowski MF, Kellan JF, Smith DG et col. Long-term persistance of disability following severe lower-limb trauma. Results of a seven year follow-up. JBJS VOL 87-A, N°8, AUGUST 2005.
Levistsky KA, Berger A, Nicholas GG, Vernick CG, Wilber JH, Scagliotti CJ. Bilateral open dislocation of the knee joint. JBJS VOL 70-A, N°9, OTOBER !998.