[Difficulties in the management of supracondylar fractures of the humerus in children living in Central African Republic].

Like many developing countries, the Central African Republic lacks the technology and skills to perform certain medical procedures. One example of this situation can be found in the Pediatric Surgery Department of Bangui with regard to first intention management of supracondylar fractures of the humerus (SCF). Due to a lack of proper technological facilities (e.g. absence of brightness enhancement) and to insufficient staff training, management of SCF must be limited to orthopedic reduction followed cast application and brachio-anti-brachio-palmar traction such problems. This retrospective study describes management of 119 cases of SCF involving children between the ages of 0 and 15 years. Special emphasis was placed on factors impairing outcome, namely, inadequate staff training, availability of brightness enhancement, and poor awareness on the part of the parents concerning the seriousness of SCF. The quality of reduction was compared according to whether reduction was done with or without brightness enhancement (reduction without brightness enhancement was imperfect in most cases: 78/119) and according to fracture grade (high number of imperfect reductions in grade 3 and 4:69%). Assessment of outcome at one month showed a high incidence of poor results due to severe fracture or imperfect reduction. A prospective study including 35 cases with a follow-up of three years showed poor results for the same reasons. Comparison of these results with those reported by previous authors showed a large gap which must be filled by upgrading technical facilities and training staff.