Osteochondroma also known as exostosis is one of the most common benign bone tumours, and are characterized by bone protuberances surrounded by a cartilage layer. They generally affect the extremities of the long bones in an immature skeleton and deform them. They are easily diagnosed at the level of the appendicular skeleton. However, atypical localization and malignancy are sometimes challenging to diagnose on clinical evaluation and plain radiography. Therefore, more refine diagnostic tools may be required. Scapula localization of solitary exostosis is relatively rare. We report the case of a 17 years old male patient reporting worsening shoulder pain since 3 years with right scapula winging. Computer tomography (CT) scan revealed an osteochondroma on the ventro-medial surface of the right scapula extending into the scapulo-thoracic space. Surgical excision was done and histopathological study confirmed osteochondroma of the scapula. We noted excellent post-operative pain alleviation after two weeks, full range of motion and a better self-esteem. The scapula is involved in 3.0-6.4% of all cases. Osteochondroma usually arises on the anterior surface of the scapula. Surgical excision is an excellent treatment option for symptomatic patients with scapula osteochondroma. In our case presentation we used a muscle sparing technique. No muscle detachment will ensure rapid and better postoperative recovery. Surgical removal is useful in eliminating painful symptoms and avoids possible malignant transformation. Good clinical outcome is expected with surgical excision of symptomatic scapula osteochondromas especially using muscle-sparing technique which offers a quick functional rehabilitation of patients.

Fracture-related infection (FRI) is a common and devastating complication of orthopedic trauma in all settings. Data on the microbiological profile and susceptibility of FRI to antibiotics in low-income countries are scarce. Therefore, this study aimed to investigate the microbial patterns and antimicrobial susceptibility of FRI in a sub-Saharan African setting in order to provide guidance for the formulation of evidence-based empirical antimicrobial regimens. We conducted a retrospective analysis of patients treated for FRI with deep tissue sampling for microbiological culture from January 2016 to August 2023 in four tertiary-level hospitals in Yaoundé, Cameroon. There were 246 infection episodes in 217 patients. Cultures were positive in 209 (84.9%) cases and polymicrobial in 109 (44.3%) cases. A total of 363 microorganisms from 71 different species were identified, of which 239 (65.8%) were Gram-negative. The most commonly isolated pathogens were Staphylococcus aureus (n = 69; 19%), Enterobacter cloacae (n = 43; 11.8%), Klebsiella pneumoniae (n = 35; 9.6%), Escherichia coli (n = 35; 9.6%), and Pseudomonas aeruginosa (n = 27; 7.4%). Coagulase-negative staphylococci (CoNS) were isolated in only 21 (5.9%) cases. Gram-negative bacteria accounted for the majority of the infections in early (70.9%) and delayed (73.2%) FRI, but Gram-positive bacteria were prevalent in late FRI (51.7%) (p < 0.001). Polymicrobial infections were more frequent in the early (55.9%) and delayed (41.9%) groups than in the late group (27.6%) (p < 0.001). Apart from Staphylococcus aureus, there was no significant difference in the proportions of causative pathogens between early, delayed, and late FRI. This study found striking resistance rates of bacteria to commonly used antibiotics. MRSA accounted for 63% of cases. The most effective antibiotics for all Gram-positive bacteria were linezolid (96.4%), vancomycin (92.5%), clindamycin (85.3%), and fucidic acid (89.4%). For Gram-negative bacteria, only three antibiotics displayed a sensitivity >50%: amikacin (80.4%), imipenem (74.4%), and piperacillin + tazobactam (57%). The most effective empirical antibiotic therapy (with local availability) was the combination of vancomycin and amikacin or vancomycin and imipenem. In contrast to the literature from high-resource settings, this study revealed that in a sub-Saharan African context, Gram-negative bacteria are the most common causative microorganisms of FRI. This study revealed striking resistance rates to commonly used antibiotics, which will require urgent action to prevent antimicrobial resistance in low and middle-income countries.

Incidentally discovered vaginal foreign body: Forensic implication - IJFMTS- Print ISSN No: - 2581-9844 Online ISSN No:- 2456-9615 Article DOI No:- 10.18231/j.ijfmts.2023.015, IP International Journal of Forensic Medicine and Toxicological Sciences-IP Int J Forensic Med Toxicol Sci

Discharge against medical advice (DAMA) is a term used in healthcare establishments when a patient leaves a hospital against the advice of their doctor.The aim of this study was to describe the epidemiological, clinical, evolutionary and medico-legal aspects of patients with long bone fractures discharged against medical advice at the Yaoundé Emergency Centre (YEC). This was a retrospective descriptive and analytical study conducted between January 2016 and December 2022 at the YEC. All patients aged 18 years or older with at least one long bone fracture and discharged against medical advice from our study site during the study period were included. Patients were then contacted to collect the reasons for DAMA, the therapeutic itinerary, the type of treatment undertaken, direct costs, and evolutionary data. Statistical analyses were performed using SPSS version 26 software. Six hundred and forty-seven patients were enrolled during the study period, representing a prevalence of DAMA of 45.7%. The mean age of the patients was 35.47 (± 13.86) years, and 475 (73.4%) were men. Socioeconomic status was low in 72.4% of cases. All religions and ethnic groups were represented. Road traffic accidents (RTA) were the cause of trauma in 83% of cases. The main site of injury was the tibia, in 253 (39.1%) cases. Open fractures accounted for 38.8% of cases. The median time to discharge against medical advice was 16 [6-26], , , hours, with 73.4% of DAMA within 24 hours. Lack of financial resources, the choice of traditional treatment and the preference for another hospital were the three main reasons. In our setting, 45.7% of patients with long bone fractures initially admitted to hospital were discharged against medical advice. The type of injury was varied, with 38.8% open fractures, some of which were complex.