Vol 8 | Issue 2 | July-December 2022 | page: 21-25 | Daniel Mossalbaye Adendjingue, S. Pascal Chigblo, Oswald Goukodadja, Adebola Padonou, Iréti Fiacre Tidjani, Aristote Hans-Moevi Akue
Authors: Daniel Mossalbaye Adendjingue , S. Pascal Chigblo , Oswald Goukodadja , Adebola Padonou , Iréti Fiacre Tidjani , Aristote Hans-Moevi Akue 
 Department of Orthopedic-Traumatology, National Teaching Hospital CHU-RN, N’Djamena-Chad.  Department of Orthopedic-Traumatology, National Teaching Hospital CNHU-HKM, Cotonou, Benin.
Address of Correspondence
Dr. Daniel Mossalbaye Adendjingue,
Department of Orthopedic-Traumatology, National Teaching Hospital CHU-RN, N’Djamena-Chad.
E-mail: firstname.lastname@example.org / email@example.com
Introduction: The management of polytrauma patient should be beforehand and always in keeping in mind the damage control. the surgical treatment is secondary to the stabilization of the patient.
Clinical Case: we are reporting a 34 years old polytrauma patient from a motor vehicle accident. On physical examination, we noted : a severe brain injury, a closed articular fracture of right distal radius associated to a dislocation of distal radius and ulna distal joint, a closed bilateral fracture of both trochanters, an open communitive tibial fracture of proximal epiphysis methaphysis and diaphysis. The last one was classified as type IIIB of Gustilo and Anderson and associated to a closed fracture of the head and the neck of right fibula, a closed fracture of the right lateral malleolus. After patient stabilization, the head injury improves to normal Glasgow score on 8th day of admission. Necrosis of soft tissus and exposition of the tibia was noted. The surgical treatment was done on 2 stages due to financial issues. A bone synthesis of the trochanteric fracture was done only on the left and external frame as well as a muscle flap was done for the right tibial fracture on the 18th day. On the 42nd day a PAPINEAU technic associated to a proximal inter tibiofibular graft was done. The functional outcome of the orthopaedic treatment of the wrist was bad (malunion). That last complication was managed by a SAUVE KAPANDJI surgery (at 6 months) and the contracture (pronation and supination) at 12 months post trauma. The outcome was fair good despite patient financial issue and local complications that compromise an optimal surgical management and a delay. He resumes normal professional activities at about 2 years. At 5 years follow up, functional and anatomical results were satisfactory.
Conclusion: In a limited ressources’ setting, the management of lesions including a multiple fractures is a challenge for the practitioner and the injuried patient. A management taking into account social and economic ressources is mandatory to minimise sequelae. Keywords: Management, Polytrauma, Limited ressources.
1. Taeger G, Ruchholtz S, Waydhas C, Lewan U, Schmidt B, Nast-Kolb D. Damage control orthopedics in patients with multiple injuries is effective, time saving, and safe. J Trauma. 2005 ; 59(2):409-16.
2. Roberts CS, Pape HC, Jones AL, Malkani AL, Rodriguez JL, Giannoudis PV. Damage Control Orthopaedics-Evolving concepts in the treatment of patients who have sustained orthopaedic trauma. J Bone Joint Surg Am. 2005;87(2):434-49.
3. Dubert T, Voche P, Dumontier C, Dinh A. Le questionnaire DASH. Adaptation française d’un outil d’évaluation international. Chirurgie de la Main. 2001 ;20:294-302. 4. Meary. Correction des désordres post-traumatiques de l’articulation radio-ulnaire distale par intervention de Sauvé-Kapandji. Revue de ChirurgieOrthopédique et Traumatologie.1993;6:79:464
5. Mansat P. Traitement des fractures anciennes de l’extrémité distale des deux os de l’avant-bras. Technique chirurgicales Orthopédie-Traumatologie. 2017 ;44:346
6. Carter PB, Stuart PR. The Sauve-Kapandji procedure for post-traumatic disorders of the distal radio-ulnar joint. J Bone Joint Surg [Br]. 2000;82(B):1013-8.
7. Kacou AD1, Sié EJB1, Bamba I1, Lambin Y1. Résultats de la technique de Sauvé Kapandji dans les séquelles post-traumatiques du poignet. Afr J Orthop Trauma. 2016;1(1):57-63.
8. Baciu C. L’opération de Sauvé Kapandji dans le traitement des cals-vicieux de l’extrémité inférieure du radius. Ann Chir. 1997; 31 :323-9.
9. Pethapara Y, Singh V, Patel R. Radiological Assessment and Functional Outcomes of Hand and Wrist in Patients with Distal End Radius Fractures ; Trauma international. 2021; 7(2): 04-08.
10. Gartland JJ, Jr, Werley CW. Evaluation of healed Colles’ fracture. J Bone Joint Surg Am. 1951; 33(4) :895–907.
11. Jupiter JB. Fractures of the distal end of the radius. J Bone Joint Surg [Am]. 1991 ;73-A:461-9.
12. Jacobsen TW, Leicht P. The Sauvé-Kapandji procedure for posttraumatic disorders of the distal radioulnar joint. Acta Orthop Belg. 2004;70:226-30,
13. Zachee B, De Smet L, Roosen P, Fabry G. The Sauvé-Kapandji procedure for non rheumatic disorders of the distal radioulnar joint. Acta Orthop Belg. 1994;60:225-30.
14. Kasotya D, Bhatia N, Yadav R, Sabat D. Side Swipe Injury to the Leg. A Hefty Price for an Autorickshaw Ride: A Case Report. Trauma international. 2021; 7(2): 12-4.
15. Devender Kasotya , Nishant Bhatia , Rajeev Yadav , Dhananjay Sabat. Trauma International. 2021; 7(2): 12-4 .
16. Panda M, Ntungila N , Kalunda M, Hinsenkamp M. Treatment of chronic osteomyelitis using the Papineau technique. International Orthopaedics (SICOT). 1998 ;22: 37-40.
|How to Cite this article: Adendjingue DM, Chigblo SP, Goukodadja O, Padonou A, Tidjani IF, Akue AHM | Management of a Polytrauma Case In a Resource-Constrained Hospital | July-December 2022; 8(2): 21-25 | https://doi.org/10.13107/ti.2022.v08i02.030|