{"id":20190,"date":"2026-02-26T20:36:22","date_gmt":"2026-02-26T18:36:22","guid":{"rendered":"https:\/\/ao-alliance.org\/challenging-weight-bearing-practices-in-lower-extremity-fractures\/"},"modified":"2026-03-19T11:24:31","modified_gmt":"2026-03-19T09:24:31","slug":"challenging-weight-bearing-practices-in-lower-extremity-fractures","status":"publish","type":"post","link":"https:\/\/ao-alliance.org\/fr\/challenging-weight-bearing-practices-in-lower-extremity-fractures\/","title":{"rendered":"R\u00e9\u00e9valuation des pratiques de mise en charge pour les fractures des membres inf\u00e9rieurs"},"content":{"rendered":"

Un symposium se basant sur les donn\u00e9es probantes examine les protocoles classiques et une nouvelle terminologie lors de la conf\u00e9rence annuelle du Coll\u00e8ge des chirurgiens d\u2019Afrique de l\u2019Ouest<\/span><\/em><\/h3>\n

Lors d’un symposium qui a fait salle comble, organis\u00e9 dans le cadre de la conf\u00e9rence g\u00e9n\u00e9rale annuelle du Coll\u00e8ge des chirurgiens d\u2019Afrique de l\u2019Ouest (WACS – West Africa College of Surgeons) \u00e0 Accra, au Ghana, quatre intervenants ont discut\u00e9 de la pratique de longue date consistant \u00e0 prescrire plusieurs semaines sans mise en charge, apr\u00e8s la fixation d’une fracture des membres inf\u00e9rieurs.<\/p>\n

Michael Segbefia a ouvert la session en pr\u00e9sentant la biom\u00e9canique de la mise en charge pr\u00e9coce, affirmant que la gu\u00e9rison osseuse n’est pas passive, mais m\u00e9cano-adaptative, c’est-\u00e0-dire qu’elle est stimul\u00e9e par la mise en charge. Les ost\u00e9ocytes d\u00e9pendent des forces exerc\u00e9es par la mise en charge et la contraction musculaire, qui d\u00e9clenchent les cascades de signaux stimulant la formation de cal osseux. Il a fait remarquer qu’un patient \u00ab sans mise en charge \u00bb g\u00e9n\u00e8re toujours une contrainte importante au niveau du site de fracture par l’activation musculaire, rendant ainsi une v\u00e9ritable d\u00e9charge pratiquement impossible. \u00ab L’absence de charge n’est pas neutre, elle est n\u00e9faste \u00bb, a-t-il conclu.<\/p>\n

Jim Harrison, conseiller de l’AO Alliance pour l\u2019Afrique, a abord\u00e9 les incoh\u00e9rences de communication sur le sujet dans cette r\u00e9gion. Les instructions relatives \u00e0 la mise en charge dans la r\u00e9gion WACS vont de \u00ab appui l\u00e9ger sans mise en charge r\u00e9elle \u00bb \u00e0 \u00ab 20 % du poids corporel \u00bb, des termes qui ont des significations diff\u00e9rentes pour les cliniciens et les patients. M. Harrison a pr\u00e9sent\u00e9 la terminologie des normes de l’Association britannique d’orthop\u00e9die pour les traumatismes (BOASt – British Orthopaedic Association Standards for Trauma), qui r\u00e9sume les options en trois cat\u00e9gories: absence de mise en charge, mise en charge limit\u00e9e et mise en charge sans restriction. Les participants ont discut\u00e9 de la possibilit\u00e9 d’appliquer ces termes dans les contextes cliniques et les langues locales, et se sont demand\u00e9 si leur homog\u00e9n\u00e9isation ne risquerait pas d’\u00e9liminer les nuances pour les blessures complexes.<\/p>\n

Felix Oware Asomaning a apport\u00e9 le point de vue du physioth\u00e9rapeute, affirmant que la profession doit \u00e9voluer et passer d’une approche passive consistant \u00e0 suivre les recommandations du chirurgien, \u00e0 une collaboration active dans l’\u00e9laboration de protocoles individualis\u00e9s. Il a pr\u00e9sent\u00e9 un cadre d\u00e9cisionnel fond\u00e9 sur les caract\u00e9ristiques de la fracture, la stabilit\u00e9 de la fixation et les facteurs li\u00e9s au patient, avec un suivi continu pour guider la progression. Il a soulign\u00e9 que le co\u00fbt d’une protection excessive n\u2019\u00e9tait pas la s\u00e9curit\u00e9, mais des dommages: atrophie, raideur, thrombose veineuse profonde, perte osseuse et d\u00e9clin psychologique.<\/p>\n

Alex Trompeter, de l’h\u00f4pital St George’s, \u00e0 Londres, a pr\u00e9sent\u00e9 des essais contr\u00f4l\u00e9s randomis\u00e9s, portant sur des fractures de la hanche, de la cheville et de la diaphyse f\u00e9morale, montrant que la mise en charge pr\u00e9coce est \u00e9quivalente ou sup\u00e9rieure aux protocoles diff\u00e9r\u00e9s. Ses trois\u00a0 \u00abr\u00e8gles d’or \u00bb pour la mise en charge imm\u00e9diate (contact osseux, alignement acceptable et stabilit\u00e9 de la construction) ont fourni un cadre pratique. Il a d\u00e9clar\u00e9 que \u00ab le patient ne doit pas quitter la salle d’op\u00e9ration sans la construction d\u2019une mise en charge imm\u00e9diate sans restriction \u00bb.<\/p>\n

Ladipo Adewole a anim\u00e9 les discussions de la table ronde. Les participants ont d\u00e9battu de la question de savoir si la mise en charge pr\u00e9coce est plus pratique dans les contextes o\u00f9 l’acc\u00e8s aux soins de suivi et aux aides \u00e0 la mobilit\u00e9 est limit\u00e9 et o\u00f9 des recherches suppl\u00e9mentaires sont n\u00e9cessaires, comme pour les fractures du plateau tibial et du pilon. Des inqui\u00e9tudes subsistent quant \u00e0 la nouvelle terminologie et plusieurs d\u00e9l\u00e9gu\u00e9s ont sugg\u00e9r\u00e9 l’\u00e9laboration d’un guide de mise en \u0153uvre sp\u00e9cifique au WACS.<\/p>\n

Le symposium a mis en \u00e9vidence l’\u00e9volution des connaissances pour la prise en charge des fractures et a ouvert le d\u00e9bat sur la meilleure fa\u00e7on de les appliquer dans la pratique clinique de cette r\u00e9gion.<\/p>\n

Table ronde anim\u00e9e par Ladipo Adewole<\/figcaption><\/figure>\n
Plus de 100 participants ont assist\u00e9 \u00e0 cet \u00e9v\u00e9nement incitant \u00e0 la r\u00e9flexion \u00e0 Accra, au Ghana<\/figcaption><\/figure>\n
Alex Trompeter plaidant pour la simplification des directives li\u00e9es \u00e0 la mise en charge<\/figcaption><\/figure>\n","protected":false},"excerpt":{"rendered":"

Un symposium se basant sur les donn\u00e9es probantes examine les protocoles classiques et une nouvelle terminologie lors de la conf\u00e9rence annuelle du Coll\u00e8ge des chirurgiens d\u2019Afrique de l\u2019Ouest Lors d’un symposium qui a fait salle comble, organis\u00e9 dans le cadre de la conf\u00e9rence g\u00e9n\u00e9rale annuelle du Coll\u00e8ge des chirurgiens d\u2019Afrique de l\u2019Ouest (WACS – West […]<\/p>\n","protected":false},"author":2,"featured_media":20146,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"categories":[184],"tags":[317],"location":[144,153],"tax_year":[300],"class_list":["post-20190","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","tag-wacs","location-africa-fr","location-ghana-fr","tax_year-300"],"acf":[],"yoast_head":"\nR\u00e9\u00e9valuation des pratiques de mise en charge 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