Traitement des fractures bimalleolaires chez l’adulte au chu Sylvanus Olympio de Lome

Objectifs : cette etude avait pour objectif de decrire les modalites therapeutiques des fractures bimalleolaires et les resultats obtenus. Patients et methode. Il s’agissait d’une cohorte retrospective de 92 patients dont 56 hommes (61%). L'âge moyen des patients etait de 39,3 ans. Il y avait 26 (28%, n=92) fractures ouvertes. Selon la classification de Danis-Weber il y avait les fractures de types : A (15%), B (50%) et C (35%). Le traitement etait orthopedique dans 54 cas (59%) par reduction fermee et plâtre cruro-pedieux d’une duree moyenne de 62 jours. Le traitement etait chirurgical pour 38 cas (41%) dont 26 etaient des fractures ouvertes. Celles-ci etaient traitees par debridement dans un premier temps sous couverture antibiotique prophylactique. Les resultats anatomiques etaient apprecies par les criteres de Lecestre et Ramadier, fonctionnel par les criteres de VIDAL. Les patients ont ete revus en controle ordinaire ou par convocation pour evaluer les resultats du traitement. Le recul moyen etait de 31 mois. Resultats. Le resultat anatomique etait bon (76%, n=70), passable (16%, n=15) et mauvais (8%, n=7). Le resultat fonctionnel etait bon (77%), acceptables 19%, mauvais 4%. Les complications observees etaient : deux suppurations de la plaie, six arthroses, trois raideurs, deux cal vicieux, quatre syndromes regionaux douloureux complexes Conclusion. Malgre une predominance du  traitement orthopedique dans les indications, les resultats a long terme sont satisfaisants. Mots cles : fracture de la cheville, traitement, resultats, Afrique   English title: Treatement of bimalleolar fractures in adults at Teaching Hospital Sylvanus Olympio of Lome   Objectives: The aim of this study was to describe the therapeutic modalities of bimalleolar fractures and the results obtained.Patients and method. This study involved a retrospective cohort of 92 patients, including 56 men (61%). The middle age was 39.3 years. There were 26 (28%, n = 92) open fractures. According to the Danis-Weber classification there were fractures of types: A (15%), B (50%) and C (35%). The treatment was non-operative in 54 cases (59%) by closed reduction and crurious-foot plaster with an average duration of 62 days. Treatment was surgical for 38 cases (41%) of which 26 were open fractures. These were treated by initial debridement associated to prophylactic antibiotic. Patients were reviewed in regular or refereed control to evaluate treatment outcomes. The anatomical results were appreciated by the criteria of Lecestre and Ramadier. The functional outcomes were appreciated by the criteria of VIDAL. The average decline was 31 months.Results. The anatomical result was good (76%, n = 70), fair (16%, n = 15) and poor (8%, n = 7). The functional result was good (77%), acceptable 19%, bad 4%. The complications observed were: two wounds infections, six osteoarthritis, three stiffness, two malunion, four complex regional pain syndrom.Conclusion. Despite a predominance of orthopedic treatment in indications, the final outcomes are satisfactory in this study. Keywords: ankle fracture, treatment, results, Africa.