Épidémiologie et Traitement des Pseudarthroses Diaphysaires des Os Longs à l’Hôpital de Sikasso

RESUME Introduction. le but de notre travail etait de decrire les aspects epidemiologiques et le therapeutiques des pseudarthroses diaphysaires dans notre service. Methodologie.Il s’agit d’une etude transversale retrospective de 4 ans realisee dans le service de chirurgie orthopedique et traumatologique de l’hopital de Sikasso. Les pseudarthroses etaient classees selon Cech et Weber. La decortication osteo-musculaire selon Judet etait realisee dans les pseudarthroses aseptiques. Les pseudarthroses septiques etaient traitees de maniere sequentielle. L’ evaluation a ete faite selon les criteres  modifies de Ketenjian. Resultats. Nous avons enregistre 74 cas de pseudarthrose (47 hommes, 27 femmes) d’âge moyen de 37,5 ans (3-75 ans). La pseudarthrose etait hypertrophique : 58 cas (78,4%), atrophique :12 cas (16,2%), oligo-trophique : 4 cas (5,4%) . Elle etait septique dans 5 cas (6,7%). La decortication osteo-musculaire a concerne 58 cas (78,4%). Elle etait associee a un apport de greffons cortico-spongieux dans 16 cas (21,6%) . La fixation osseuse etait interne : 69 cas (93,2%) et externe : 5 cas (6,8 %). Nous avons obtenu la consolidation chez 72 patients (97,3 %) dans un delai moyen de 3,2 mois (2- 9 mois). Le resultat etait excellent : 63 patients (85,1%), bon : 9 patients (12,2%) et mauvais : 2 patients (2,7%). Conclusion. La decortication osteo-musculaire associee a une fixation osseuse a ete la technique chirurgicale la plus utilisee. La consolidation a ete obtenue dans 97,3 % des cas. ABSTRACT Introduction: The objective of our work was to report the epidemiology and treatment modalities of diaphyseal nonunion in our practice.  Methodology. This was a cross sectional retrospective study of 4 years carried out at the department of orthopedic surgery and traumatology of the Hospital of Sikasso. Nonunions were classified according to Cech and Weber. Osteomuscular decortication (Judet’s technique) was done for aseptic nonunions cases. Septic nonunions were treated sequentially. Ketenjian modified criteria were used for the evaluation of treatment. Results. We registered 74 patients with nonunion (47 men and 27 women). Their average age of 37, 5 years old (3-75 years old). According to Weber and Cech, the distributions of nonunions were as follows: hypertrophic: 58 cases (78, 4%); atrophic: 12 cases (16, 2%) and eutrophic: 4 cases (5, 4%). Nonunion was septic in 5 cases (6, 7%). Osteomuscular decortication was performed in 58 cases (78, 4%). It was associated with injection of corticosteroid spongy graft in 16 cases (21, 6%). Bone fixation was internal in 69 cases (93, 2%) and external for 5 cases (6, 7%). Bone union was obtained in 72 patients (97, 3%) in an average delay of 3, 2 months (2 – 9 months). Over all, ours results were considered excellent for 63 patients (85, 1%), good for 9 patients (12, 2%) and poor for 2 patients (2, 7%).  Conclusion. Osteomuscular decortication associated with bone fixation is the most common surgical procedure for the treatment of diaphyseal non unions in our practice. Bone union is obtained more than 97% of cases.