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La nécrose de la hanche : Une complication grave de l'injection intrafessière de sels de quinine à Bangui, République centrafricaine

INTRODUCTION: Intramuscular injection of quinine has been for long the most common treatment for malaria in children in endemic areas of Africa, especially sub-Saharan Africa, and remains too often used. However, it is frequently wrongly performed by unqualified people. When administered in a poorly...

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Autores principales: Onimus, M., Ouaimon, D.S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MTSI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9128448/
https://www.ncbi.nlm.nih.gov/pubmed/35686167
http://dx.doi.org/10.48327/mtsibulletin.2021.120
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author Onimus, M.
Ouaimon, D.S
author_facet Onimus, M.
Ouaimon, D.S
author_sort Onimus, M.
collection PubMed
description INTRODUCTION: Intramuscular injection of quinine has been for long the most common treatment for malaria in children in endemic areas of Africa, especially sub-Saharan Africa, and remains too often used. However, it is frequently wrongly performed by unqualified people. When administered in a poorly developed or malnourished child, the injection can be done too deeply in the hip joint instead of the gluteus muscle area. MATERIALS AND METHODS: The files of 3012 children examined in out-patient clinics in Bangui, Central African Republic, between 2011 and 2020 were reviewed. Sequelae of intramuscular injections were observed in 307 cases, including intraquadricipital injection in 170 cases (56%) and intragluteal injection in 137 cases (44%). The latter included 115 sciatic paralysis and 22 hip sequelae with stiffness, shortening of the limb, limping and pain at walking. In these 22 cases, an intragluteal injection was incriminated by the families. However, 16 files were considered as insufficient because of imprecise history or because poor quality or no radiograph was available. Although suspected of being hip necrosis, these files were excluded. Six cases presented specific clinical pictures and interpretable radiographs and were included in this study. RESULTS: The clinical and the radiographic aspects of this severe complication apparently not documented in the literature are analyzed. The well-known toxicity of quinine may be responsible of a necrosis involving both the femoral head and the acetabular roof, resulting in a painful joint, stiff in adduction, with limping and with an apparent marked shortening of the lower limb. Radiographs show a subtotal femoral head necrosis associated to an acetabular roof necrosis with an upward displacement of the epiphyseo-metaphysal femoral stump, the latter keeping a roughly spherical aspect and remaining well-covered and fitted in a relatively deep neo-acetabulum. DISCUSSION: In the African background, this picture of coxopathy occurring in childhood may suggest an avascular necrosis of the femoral head complicating a sickle-cells disease, or above all sequelae of septic osteoarthritis. Treatments are limited to the prescription of a partial weight bearing of the hip. CONCLUSION: Although no irrefutable arguments are existing, the observed clinical and radiographic pictures are sufficiently clear and typical to individualize this severe iatrogenic complication which should be avoided by a good technic or by using the intravenous way when necessary.
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spelling pubmed-91284482022-06-08 La nécrose de la hanche : Une complication grave de l'injection intrafessière de sels de quinine à Bangui, République centrafricaine Onimus, M. Ouaimon, D.S Med Trop Sante Int Clinique INTRODUCTION: Intramuscular injection of quinine has been for long the most common treatment for malaria in children in endemic areas of Africa, especially sub-Saharan Africa, and remains too often used. However, it is frequently wrongly performed by unqualified people. When administered in a poorly developed or malnourished child, the injection can be done too deeply in the hip joint instead of the gluteus muscle area. MATERIALS AND METHODS: The files of 3012 children examined in out-patient clinics in Bangui, Central African Republic, between 2011 and 2020 were reviewed. Sequelae of intramuscular injections were observed in 307 cases, including intraquadricipital injection in 170 cases (56%) and intragluteal injection in 137 cases (44%). The latter included 115 sciatic paralysis and 22 hip sequelae with stiffness, shortening of the limb, limping and pain at walking. In these 22 cases, an intragluteal injection was incriminated by the families. However, 16 files were considered as insufficient because of imprecise history or because poor quality or no radiograph was available. Although suspected of being hip necrosis, these files were excluded. Six cases presented specific clinical pictures and interpretable radiographs and were included in this study. RESULTS: The clinical and the radiographic aspects of this severe complication apparently not documented in the literature are analyzed. The well-known toxicity of quinine may be responsible of a necrosis involving both the femoral head and the acetabular roof, resulting in a painful joint, stiff in adduction, with limping and with an apparent marked shortening of the lower limb. Radiographs show a subtotal femoral head necrosis associated to an acetabular roof necrosis with an upward displacement of the epiphyseo-metaphysal femoral stump, the latter keeping a roughly spherical aspect and remaining well-covered and fitted in a relatively deep neo-acetabulum. DISCUSSION: In the African background, this picture of coxopathy occurring in childhood may suggest an avascular necrosis of the femoral head complicating a sickle-cells disease, or above all sequelae of septic osteoarthritis. Treatments are limited to the prescription of a partial weight bearing of the hip. CONCLUSION: Although no irrefutable arguments are existing, the observed clinical and radiographic pictures are sufficiently clear and typical to individualize this severe iatrogenic complication which should be avoided by a good technic or by using the intravenous way when necessary. MTSI 2021-08-13 /pmc/articles/PMC9128448/ /pubmed/35686167 http://dx.doi.org/10.48327/mtsibulletin.2021.120 Text en Copyright © 2021 SFMTSI https://creativecommons.org/licenses/by/4.0/Cet article en libre accès est distribué selon les termes de la licence Creative Commons CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Clinique
Onimus, M.
Ouaimon, D.S
La nécrose de la hanche : Une complication grave de l'injection intrafessière de sels de quinine à Bangui, République centrafricaine
title La nécrose de la hanche : Une complication grave de l'injection intrafessière de sels de quinine à Bangui, République centrafricaine
title_full La nécrose de la hanche : Une complication grave de l'injection intrafessière de sels de quinine à Bangui, République centrafricaine
title_fullStr La nécrose de la hanche : Une complication grave de l'injection intrafessière de sels de quinine à Bangui, République centrafricaine
title_full_unstemmed La nécrose de la hanche : Une complication grave de l'injection intrafessière de sels de quinine à Bangui, République centrafricaine
title_short La nécrose de la hanche : Une complication grave de l'injection intrafessière de sels de quinine à Bangui, République centrafricaine
title_sort la nécrose de la hanche : une complication grave de l'injection intrafessière de sels de quinine à bangui, république centrafricaine
topic Clinique
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9128448/
https://www.ncbi.nlm.nih.gov/pubmed/35686167
http://dx.doi.org/10.48327/mtsibulletin.2021.120
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