Kouassi, Kouame Jean Eric
[UCL]
Open tibia fractures (OTF) can cause significant morbidity. These injuries justify early antibiotic therapy, adequate debridement, stable osteosynthesis, and early coverage of the fracture. The mostly poor infrastructural conditions concerning the provision of health services in developing countries (DCs) likely render adequate treatment of problematic fractures practically impossible. The hygienic conditions required for surgical treatment involving techniques of internal osteosynthesis may be insufficient; for cost reasons, the necessary devices including image intensifier and implants may be lacking in places where such treatment could indeed be offered. Thus, casting with plaster of Paris (POP) is still the commonly used restraint method due to its availability and low-cost. However, this method may cause many complications. In this context, the external fixator (EF) is still the implant of choice, which is also suitable for precarious areas. The EF has proven its usefulness in the treatment of open fractures. This alternative could be employed to circumvent the difficulties of implementing a classic osteosynthesis. There are many sophisticated external fixators on the market, but they are too expensive, which limits their usefulness in our country. This doctoral thesis investigated the locally-developed external fixator (LDEF) manufactured from available and easily accessible materials for treating shaft fractures of long bones, including the tibia. The first part of this thesis investigated the treatment of open fractures in DCs in sub-Saharan Africa. A prospective clinical study on the management of OTF in a reference health facility in Ivory Coast was carried out, as was a systematic review of literature concerning the treatment of OTF. This was meant to establish an inventory concerning the treatment of open tibia fractures. The second part of this thesis investigated the design and biomechanical aspects of different LDEFs. Design of the LDEF was made from materials locally available in developing country like the Ivory Coast. These fixators are suitable for simple and comminuted pattern fractures. A static biomechanical study revealed a rigidity that was comparable to reference external fixator. After applying 1 million loading cycles, the overall stiffness characteristics of the frame remained unchanged. Based on these test results, the LDEF could be re-used, but certain fixator components had to be inspected and eventually replaced, especially pins. The third part of this thesis sought to evaluate the LDEF effectiveness as definitive treatment for open tibia fractures. A prospective clinical study was conducted, revealing a consolidation rate exceeding 70%, with an 80% functional recovery in LDEF-treated patients.
| Bibliographic reference |
Kouassi, Kouame Jean Eric. Locally-developed external fixators and their impact on the stability of long bone diaphyseal fractures after osteosynthesis. Prom. : Cornu, Olivier |
| Permanent URL |
http://hdl.handle.net/2078.1/249145 |
