Pediatric Orthopaedics in Precarious Environment Possibilities and Limits of Humanitarian Surgery

Michel Onimus

doi:doi:10.11648/j.js.20200803.14

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Pediatric Orthopaedics in Precarious Environment Possibilities and Limits of Humanitarian Surgery

Michel Onimus

Published in Journal of Surgery (Volume 8, Issue 3)

Received: 8 May 2020 Accepted: 25 May 2020 Published: 4 June 2020

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Abstract

This is a retrospective study concerning a 35 years experience of pediatric orthopedic humanitarian surgery performed in precarious situation. This account may be useful to share with younger surgeons considering initiating such a surgery in developing countries. The data of 80 surgical missions held between 1983 and 2018 in Central African Republic have been collected and analyzed. The missions were planned with authorization of the local ministry of health. Their duration was usually two weeks, one week in the capital and one week in about fifteen villages in the country having small rehabilitation centers created when poliomyelitis was devastating. Surgery was performed in the local health center or hospital, with cooperation of the local medical team, sometimes without electricity, usually without radiograph, allowing only clinical diagnosis and not aggressive surgery. Postoperative care was given in the rehabilitation center. All in all 7500 children were seen in out-patients clinics and 2 200 underwent surgery. Sequelae of poliomyelitis which included 66% of out-patients between 1983 and 2000 turned down and became very rare, replaced by a more varied pathology with predominantly congenital malformations and sequelae of intramuscular injections, as well as sequelae of burns and sequelae of neurologic suffering (cerebral palsy, neuromalaria, sequelae of poisoning by toxic cassava). These pathologies are analyzed and the therapeutic options are discussed considering the local facilities. The families often neglected the given appointments, and due to this poor cooperation 25% only out of the operated patients were reviewed, making ineffective any statistical analysis. Nevertheless numerous pieces of information concerning the postoperative result and the late follow-up could be obtained from the local teams, allowing a global evaluation of the validity of this kind of humanitarian surgery.

Published in	Journal of Surgery (Volume 8, Issue 3)
DOI	10.11648/j.js.20200803.14
Page(s)	97-103
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Poliomyelitis, Humanitarian Surgery, Sequelae of Intramuscular Injections, Orthopedic Surgery in Precarious Environment

References

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[5]	Alves K, Penny N, Kobusingye O, Olupot R, Katz JN, Sabatini CS (2018) Paediatric Musculoskeletal Disease in Kumi District, Uganda: A Cross-Sectional Survey. Int Orthop. 42: 1967-1973.
[6]	Onimus M, Brunet L, Gaudeuille F, Issa-mapouka A (2007) Le traitement des séquelles d’injections intramusculaires de sels de quinine en milieu africain. Med Trop 67: 267-273.
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[8]	Gbenou A S, Kpadonou GT, Fiogbe A M, Zoumenou E, Alao MJ (2013) Iatrogenic Retractile Quadriceps Fibrosis Within Children in Benin: Epidemiological, Clinical, Therapeutical Aspects Afr J Paediatr Surg 10: 211-6.
[9]	Sengupta S (1985) Pathogenesis of infantile quadriceps fibrosis ans its correction by proximal release. J Pediatr Orthop 5: 187-91.
[10]	Soumah MT, Sylla AL, Toure MR et all (2003) Fibrose quadricipitale après injections intramusculaires dans la cuisse: à propos de 92 cas à l’Hôpital central universitaire Ignace Deen à Conakry. Med Trop 63: 49-52.
[11]	Fiogbe AM, Gbenou AS, Magnidet ER,. Biaou O (2013). Distal quadricepsplasty in children: 88 cases of retractile fibrosis following intramuscular injections treated in Benin. Orthopaedics & Traumatology: Surgery & Research 99: 817-822.
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APA Style

Michel Onimus. (2020). Pediatric Orthopaedics in Precarious Environment Possibilities and Limits of Humanitarian Surgery. Journal of Surgery, 8(3), 97-103. https://doi.org/10.11648/j.js.20200803.14

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ACS Style

Michel Onimus. Pediatric Orthopaedics in Precarious Environment Possibilities and Limits of Humanitarian Surgery. J. Surg. 2020, 8(3), 97-103. doi: 10.11648/j.js.20200803.14

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AMA Style

Michel Onimus. Pediatric Orthopaedics in Precarious Environment Possibilities and Limits of Humanitarian Surgery. J Surg. 2020;8(3):97-103. doi: 10.11648/j.js.20200803.14

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@article{10.11648/j.js.20200803.14,
  author = {Michel Onimus},
  title = {Pediatric Orthopaedics in Precarious Environment Possibilities and Limits of Humanitarian Surgery},
  journal = {Journal of Surgery},
  volume = {8},
  number = {3},
  pages = {97-103},
  doi = {10.11648/j.js.20200803.14},
  url = {https://doi.org/10.11648/j.js.20200803.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20200803.14},
  abstract = {This is a retrospective study concerning a 35 years experience of pediatric orthopedic humanitarian surgery performed in precarious situation. This account may be useful to share with younger surgeons considering initiating such a surgery in developing countries. The data of 80 surgical missions held between 1983 and 2018 in Central African Republic have been collected and analyzed. The missions were planned with authorization of the local ministry of health. Their duration was usually two weeks, one week in the capital and one week in about fifteen villages in the country having small rehabilitation centers created when poliomyelitis was devastating. Surgery was performed in the local health center or hospital, with cooperation of the local medical team, sometimes without electricity, usually without radiograph, allowing only clinical diagnosis and not aggressive surgery. Postoperative care was given in the rehabilitation center. All in all 7500 children were seen in out-patients clinics and 2 200 underwent surgery. Sequelae of poliomyelitis which included 66% of out-patients between 1983 and 2000 turned down and became very rare, replaced by a more varied pathology with predominantly congenital malformations and sequelae of intramuscular injections, as well as sequelae of burns and sequelae of neurologic suffering (cerebral palsy, neuromalaria, sequelae of poisoning by toxic cassava). These pathologies are analyzed and the therapeutic options are discussed considering the local facilities. The families often neglected the given appointments, and due to this poor cooperation 25% only out of the operated patients were reviewed, making ineffective any statistical analysis. Nevertheless numerous pieces of information concerning the postoperative result and the late follow-up could be obtained from the local teams, allowing a global evaluation of the validity of this kind of humanitarian surgery.},
 year = {2020}
}

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TY - JOUR
T1 - Pediatric Orthopaedics in Precarious Environment Possibilities and Limits of Humanitarian Surgery
AU - Michel Onimus
Y1 - 2020/06/04
PY - 2020
N1 - https://doi.org/10.11648/j.js.20200803.14
DO - 10.11648/j.js.20200803.14
T2 - Journal of Surgery
JF - Journal of Surgery
JO - Journal of Surgery
SP - 97
EP - 103
PB - Science Publishing Group
SN - 2330-0930
UR - https://doi.org/10.11648/j.js.20200803.14
AB - This is a retrospective study concerning a 35 years experience of pediatric orthopedic humanitarian surgery performed in precarious situation. This account may be useful to share with younger surgeons considering initiating such a surgery in developing countries. The data of 80 surgical missions held between 1983 and 2018 in Central African Republic have been collected and analyzed. The missions were planned with authorization of the local ministry of health. Their duration was usually two weeks, one week in the capital and one week in about fifteen villages in the country having small rehabilitation centers created when poliomyelitis was devastating. Surgery was performed in the local health center or hospital, with cooperation of the local medical team, sometimes without electricity, usually without radiograph, allowing only clinical diagnosis and not aggressive surgery. Postoperative care was given in the rehabilitation center. All in all 7500 children were seen in out-patients clinics and 2 200 underwent surgery. Sequelae of poliomyelitis which included 66% of out-patients between 1983 and 2000 turned down and became very rare, replaced by a more varied pathology with predominantly congenital malformations and sequelae of intramuscular injections, as well as sequelae of burns and sequelae of neurologic suffering (cerebral palsy, neuromalaria, sequelae of poisoning by toxic cassava). These pathologies are analyzed and the therapeutic options are discussed considering the local facilities. The families often neglected the given appointments, and due to this poor cooperation 25% only out of the operated patients were reviewed, making ineffective any statistical analysis. Nevertheless numerous pieces of information concerning the postoperative result and the late follow-up could be obtained from the local teams, allowing a global evaluation of the validity of this kind of humanitarian surgery.
VL - 8
IS - 3
ER -

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Author Information

Michel Onimus

Faculty of Medicine, Franch County University, Besan?on, France

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Plain Text BibTeX RIS

APA Style

Michel Onimus. (2020). Pediatric Orthopaedics in Precarious Environment Possibilities and Limits of Humanitarian Surgery. Journal of Surgery, 8(3), 97-103. https://doi.org/10.11648/j.js.20200803.14

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ACS Style

Michel Onimus. Pediatric Orthopaedics in Precarious Environment Possibilities and Limits of Humanitarian Surgery. J. Surg. 2020, 8(3), 97-103. doi: 10.11648/j.js.20200803.14

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AMA Style

Michel Onimus. Pediatric Orthopaedics in Precarious Environment Possibilities and Limits of Humanitarian Surgery. J Surg. 2020;8(3):97-103. doi: 10.11648/j.js.20200803.14

Copy | Download

@article{10.11648/j.js.20200803.14,
  author = {Michel Onimus},
  title = {Pediatric Orthopaedics in Precarious Environment Possibilities and Limits of Humanitarian Surgery},
  journal = {Journal of Surgery},
  volume = {8},
  number = {3},
  pages = {97-103},
  doi = {10.11648/j.js.20200803.14},
  url = {https://doi.org/10.11648/j.js.20200803.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20200803.14},
  abstract = {This is a retrospective study concerning a 35 years experience of pediatric orthopedic humanitarian surgery performed in precarious situation. This account may be useful to share with younger surgeons considering initiating such a surgery in developing countries. The data of 80 surgical missions held between 1983 and 2018 in Central African Republic have been collected and analyzed. The missions were planned with authorization of the local ministry of health. Their duration was usually two weeks, one week in the capital and one week in about fifteen villages in the country having small rehabilitation centers created when poliomyelitis was devastating. Surgery was performed in the local health center or hospital, with cooperation of the local medical team, sometimes without electricity, usually without radiograph, allowing only clinical diagnosis and not aggressive surgery. Postoperative care was given in the rehabilitation center. All in all 7500 children were seen in out-patients clinics and 2 200 underwent surgery. Sequelae of poliomyelitis which included 66% of out-patients between 1983 and 2000 turned down and became very rare, replaced by a more varied pathology with predominantly congenital malformations and sequelae of intramuscular injections, as well as sequelae of burns and sequelae of neurologic suffering (cerebral palsy, neuromalaria, sequelae of poisoning by toxic cassava). These pathologies are analyzed and the therapeutic options are discussed considering the local facilities. The families often neglected the given appointments, and due to this poor cooperation 25% only out of the operated patients were reviewed, making ineffective any statistical analysis. Nevertheless numerous pieces of information concerning the postoperative result and the late follow-up could be obtained from the local teams, allowing a global evaluation of the validity of this kind of humanitarian surgery.},
 year = {2020}
}

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