We report a fatal case due to a massive attack by a swarm of bees in a nine-year-old child. The accident was fatal because of two aggravating factors: the cephalic location and the large number of stings (about 300). Complications were coagulopathy, anemia, hemorrhage, coma, and oligoanuria. Support was symptomatic at a facility second level. The outcome was fatal within 14 days. In view of the encountered difficulties, we recommend to build written protocols for the management of envenomation in any health training reference.

174 Open Journal of Orthopedics terior tibial tuberosity was performed for 15 days in all patients. The hip was flexed to 45˚ and the knee to 35˚. Fixation was performed with one or two screws. No contralateral preventive fixation was performed. Minimum follow-up was one year. Functional outcome was assessed by the Postel Merle d'Aubigné score. Anatomical outcome was assessed by the quality of reduction, the occurrence or non-occurrence of femoral head necrosis, and chondrolysis. Results: We identified nine patients with a mean age of 12.8 years and extremes of 9 and 17 years. There were three boys and six girls. Trauma was mentioned in four cases. The cause was idiopathic in five cases. Functional impotence was complete in all patients. The slippage was acute on a chronic background in all patients. The left side was affected in 7 cases and the right side in 2 cases. The patients were overweight in 7 cases. The patient's weight was within the normal range in two cases. At final follow-up, all nine patients were asymptomatic. Anatomically, all nine patients had a femoral head free of avascular necrosis. In eight patients, the posterior tilt was absent, identical to that obtained after the traction period. Only one patient had a moderate posterior tilt with a neck uncovering of less than 25%. Functionally, the PMA score was very good in eight cases and good in one case. Conclusion: This study shows that the treatment of acute and unstable forms of upper femoral epiphysiolysis by progressive reduction with transtibial traction can lead to satisfactory results. Reduction in large displacement forms should be gentle, progressive and limited to the minimum necessary for osteosynthesis. Magnetic resonance imaging examination is an essential and indispensable prognostic element. Indications for preventive fixation should be selectively reserved for specific cases.

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