Pub Date : 2023-11-07DOI: 10.17159/2309-8309/2022/v21n1a5
Sandile M Mwelase, P. Mare, D. Thompson, L. Marais
ABSTRACT BACKGROUND: Children with osteogenesis imperfecta frequently present with coxa vara. Skeletal fragility, severe deformity and limited fixation options make this a challenging condition to correct surgically. Our study aimed to determine the efficacy of the Fassier technique to correct coxa vara and determine the complication rate METHODS: We retrospectively reviewed the records of a cohort of eight children (four females, 12 hips) with osteogenesis imperfecta (6/8 Sillence type III, 2/8 type IV) who had surgical treatment with the Fassier technique for proximal femoral deformity between 2014 and 2020 RESULTS: The mean age at operation was 5.8 years (range 2-10). The mean neck-shaft angle (NSA) was corrected from 96.8° preoperatively to 137° postoperatively. At a mean follow-up of 38.6 months, the mean NSA was maintained at 133°, and 83% (10/12) of hips had an NSA that remained greater than 120°. There was a 42% (5/12) complication rate: three Fassier-Duval rods failed to expand after distal epiphyseal fixation was lost during growth; one Rush rod migrated through the lateral proximal femur cortex with recurrent coxa vara; and one Rush rod migrated proximally and required rod revision CONCLUSION: The Fassier technique effectively corrected coxa vara in children with moderate and progressively deforming osteogenesis imperfecta. The deformity correction was maintained in the short term. The complication rate was high, but mainly related to the failed expansion of the Fassier-Duval rods. Further studies are required to determine the long-term outcome of this technique Level of evidence: Level 4 Keywords: osteogenesis imperfecta, coxa vara, Fassier-Duval, neck-shaft angle, deformity
{"title":"The Fassier technique for correction of proximal femoral deformity in children with osteogenesis imperfecta","authors":"Sandile M Mwelase, P. Mare, D. Thompson, L. Marais","doi":"10.17159/2309-8309/2022/v21n1a5","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n1a5","url":null,"abstract":"ABSTRACT BACKGROUND: Children with osteogenesis imperfecta frequently present with coxa vara. Skeletal fragility, severe deformity and limited fixation options make this a challenging condition to correct surgically. Our study aimed to determine the efficacy of the Fassier technique to correct coxa vara and determine the complication rate METHODS: We retrospectively reviewed the records of a cohort of eight children (four females, 12 hips) with osteogenesis imperfecta (6/8 Sillence type III, 2/8 type IV) who had surgical treatment with the Fassier technique for proximal femoral deformity between 2014 and 2020 RESULTS: The mean age at operation was 5.8 years (range 2-10). The mean neck-shaft angle (NSA) was corrected from 96.8° preoperatively to 137° postoperatively. At a mean follow-up of 38.6 months, the mean NSA was maintained at 133°, and 83% (10/12) of hips had an NSA that remained greater than 120°. There was a 42% (5/12) complication rate: three Fassier-Duval rods failed to expand after distal epiphyseal fixation was lost during growth; one Rush rod migrated through the lateral proximal femur cortex with recurrent coxa vara; and one Rush rod migrated proximally and required rod revision CONCLUSION: The Fassier technique effectively corrected coxa vara in children with moderate and progressively deforming osteogenesis imperfecta. The deformity correction was maintained in the short term. The complication rate was high, but mainly related to the failed expansion of the Fassier-Duval rods. Further studies are required to determine the long-term outcome of this technique Level of evidence: Level 4 Keywords: osteogenesis imperfecta, coxa vara, Fassier-Duval, neck-shaft angle, deformity","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-07DOI: 10.17159/2309-8309/2023/v22n1a5
Vuyisa S Mdingi, P. Mare, ². Leonard, C. Marais¹
BACKGROUND: Paediatric bone and joint infections remain common in low- and middle-income countries (LMICs) and may have devastating long-term sequelae. There is a paucity of data from LMICs where the true incidence might be underreported, and delayed presentation is common. Our study aimed to determine the complication rate and incidence of disseminated infection in paediatric bone and joint infections in an LMIC setting. Secondly, we aimed to elucidate factors associated with complications and disseminated disease METHODS: We retrospectively reviewed our paediatric orthopaedic database for children that presented with bone and joint infections between September 2015 and March 2019. Data were extracted from medical records, laboratory results and radiological investigations to identify factors that were associated with the development of complications and disseminated infection at a median follow-up of four months RESULTS: We analysed 49 children. The median age at presentation was 6 years (range 1 month to 12 years). Locally advanced disease, with combined acute haematogenous osteomyelitis (AHOM) and septic arthritis (SA), was present in 13 children (27%). The remaining 36 children were evenly divided (18/49 each, 37%) between isolated AHOM and SA, respectively. Disseminated disease was present in 16 children (33%) and was associated with locally advanced disease, an increase in the number of surgeries and an increased length of stay. Twenty-six complications were documented in 22 (45%) children. Chronic osteomyelitis developed in 15/49 (31%) cases, growth arrest in 5/49 (10%), and pathological fracture, DVT and septic shock in 2/49 (4%) each. Complicated disease was associated with locally advanced disease, a higher number of surgeries, disseminated disease and an increased length of stay. Staphylococcus aureus was the infecting pathogen in 65% of cases (31 MSSA, 1 MRSA), while 25% (12/49) were culture-negative infections. While the median time from admission to surgery was one day, the median time from onset of symptoms to surgery was seven days CONCLUSION: We found a high complication rate despite a short follow-up period. More than a quarter of patients had locally advanced disease, and this was associated with the development of complications and disseminated disease. Further studies are needed to be able to predict which children will have poor outcomes Level of evidence: Level 4
{"title":"Factors associated with dissemination and complications of acute bone and joint infections in children","authors":"Vuyisa S Mdingi, P. Mare, ². Leonard, C. Marais¹","doi":"10.17159/2309-8309/2023/v22n1a5","DOIUrl":"https://doi.org/10.17159/2309-8309/2023/v22n1a5","url":null,"abstract":"BACKGROUND: Paediatric bone and joint infections remain common in low- and middle-income countries (LMICs) and may have devastating long-term sequelae. There is a paucity of data from LMICs where the true incidence might be underreported, and delayed presentation is common. Our study aimed to determine the complication rate and incidence of disseminated infection in paediatric bone and joint infections in an LMIC setting. Secondly, we aimed to elucidate factors associated with complications and disseminated disease METHODS: We retrospectively reviewed our paediatric orthopaedic database for children that presented with bone and joint infections between September 2015 and March 2019. Data were extracted from medical records, laboratory results and radiological investigations to identify factors that were associated with the development of complications and disseminated infection at a median follow-up of four months RESULTS: We analysed 49 children. The median age at presentation was 6 years (range 1 month to 12 years). Locally advanced disease, with combined acute haematogenous osteomyelitis (AHOM) and septic arthritis (SA), was present in 13 children (27%). The remaining 36 children were evenly divided (18/49 each, 37%) between isolated AHOM and SA, respectively. Disseminated disease was present in 16 children (33%) and was associated with locally advanced disease, an increase in the number of surgeries and an increased length of stay. Twenty-six complications were documented in 22 (45%) children. Chronic osteomyelitis developed in 15/49 (31%) cases, growth arrest in 5/49 (10%), and pathological fracture, DVT and septic shock in 2/49 (4%) each. Complicated disease was associated with locally advanced disease, a higher number of surgeries, disseminated disease and an increased length of stay. Staphylococcus aureus was the infecting pathogen in 65% of cases (31 MSSA, 1 MRSA), while 25% (12/49) were culture-negative infections. While the median time from admission to surgery was one day, the median time from onset of symptoms to surgery was seven days CONCLUSION: We found a high complication rate despite a short follow-up period. More than a quarter of patients had locally advanced disease, and this was associated with the development of complications and disseminated disease. Further studies are needed to be able to predict which children will have poor outcomes Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.17159/2309-8309/2023/v22n1a3
Ntambue Kauta, E. Owolabi, B. Salence, Stefan Swanepoel, S. Roche, K. Chu
BACKGROUND: A WhatsApp orthopaedic referral group (ORG) was created in 2017 by orthopaedic specialists at a district hospital to provide support to primary healthcare doctors in order to manage traumatic fractures and dislocations. This study assessed the educational value and user satisfaction of the ORG platform METHODS: An online, cross-sectional survey was conducted among ORG users from May to June 2021. Demographic information, user satisfaction, the educational value of ORG, and perceived improvement in managing closed fractures and dislocations were captured using descriptive and inferential statistics RESULTS: There were 80 respondents, with 50% females. The median age was 30 (interquartile range [IQR] 28-35) years, duration of practice was 5 (IQR 3-10) years, and length of ORG use was 10 (IQR 5-24) months. Seventy-two (90%) reported that ORG enabled them to receive timely advice for orthopaedic case management and 75 (93.8%) considered it an easy referral facilitation tool. Most (76.3%) felt that the advice, pictures, and videos shared on ORG helped novice doctors successfully complete fracture reduction. The percentage of participants who felt very capable in managing the following fractures increased after ORG membership: extra-articular distal radius fracture (12.5% to 45.0%, p < 0.001); bimalleolar ankle fractures (16.3% to 43.8%, p < 0.001) and shoulder dislocation (35.0% to 61.3%, p = 0.001 CONCLUSION: ORG is an easy-to-use and well-accepted platform for the management, referral facilitation and teaching of acute orthopaedic conditions. Similar platforms can be introduced in other settings where surgical specialists are scarce. Additional studies should measure the feasibility and effectiveness of these mHealth platforms Level of evidence: Level 3
{"title":"A survey on the educational value of an mHealth referral app for orthopaedics in South Africa","authors":"Ntambue Kauta, E. Owolabi, B. Salence, Stefan Swanepoel, S. Roche, K. Chu","doi":"10.17159/2309-8309/2023/v22n1a3","DOIUrl":"https://doi.org/10.17159/2309-8309/2023/v22n1a3","url":null,"abstract":"BACKGROUND: A WhatsApp orthopaedic referral group (ORG) was created in 2017 by orthopaedic specialists at a district hospital to provide support to primary healthcare doctors in order to manage traumatic fractures and dislocations. This study assessed the educational value and user satisfaction of the ORG platform METHODS: An online, cross-sectional survey was conducted among ORG users from May to June 2021. Demographic information, user satisfaction, the educational value of ORG, and perceived improvement in managing closed fractures and dislocations were captured using descriptive and inferential statistics RESULTS: There were 80 respondents, with 50% females. The median age was 30 (interquartile range [IQR] 28-35) years, duration of practice was 5 (IQR 3-10) years, and length of ORG use was 10 (IQR 5-24) months. Seventy-two (90%) reported that ORG enabled them to receive timely advice for orthopaedic case management and 75 (93.8%) considered it an easy referral facilitation tool. Most (76.3%) felt that the advice, pictures, and videos shared on ORG helped novice doctors successfully complete fracture reduction. The percentage of participants who felt very capable in managing the following fractures increased after ORG membership: extra-articular distal radius fracture (12.5% to 45.0%, p < 0.001); bimalleolar ankle fractures (16.3% to 43.8%, p < 0.001) and shoulder dislocation (35.0% to 61.3%, p = 0.001 CONCLUSION: ORG is an easy-to-use and well-accepted platform for the management, referral facilitation and teaching of acute orthopaedic conditions. Similar platforms can be introduced in other settings where surgical specialists are scarce. Additional studies should measure the feasibility and effectiveness of these mHealth platforms Level of evidence: Level 3","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.17159/2309-8309/2023/v22n2a0
L. Rajah
Orthopaedic surgery is an innovative and demanding speciality covering a broad anatomy and complex pathologies treated with a wide range of procedures.1 Orthopaedic surgeons typically have heavy workloads and work long hours. The registrar training programme in Orthopaedic Surgery is arduous. Specialist orthopaedic practice, in both the private and public sectors, is associated with specific and increasing demands and difficulties. On the one hand, we have an enduring professional obligation to advocate for surgery that improves quality of life and outcome. On the other, we practise in an era of relentless increase in our understanding of surgical pathology and surgical techniques; and treat patients in an environment of heightened and increasing patient expectations. Surgery is interventional, and complications will occur even with the very highest level of skill. The only way to avoid this is for a surgeon not to operate. Surgical complications are not uncommon, and estimates of their frequency range from 8–12% across the world.2 While in clinical practice, complications are most often recognised quickly and intuitively, defining a surgical complication is surprisingly elusive. There remains no standard definition.3,4 Complications will arise in regular practice and, therefore, will be part and parcel of an orthopaedic surgeon’s working life. However, dealing with one is always difficult. In responding, the focus is on patients and their families. For the patient, apart from having to deal with the immediate physical sequelae, surgical complications have been identified as an independent predictor of impaired postoperative psychosocial wellbeing for a very long time after surgery.5 The care and the outcome of the patient is the primary responsibility. A key factor in the first intervention is what the United Kingdom General Medical Council refers to as the ‘duty of candour’ – tell the patient exactly what happened, what went wrong, and if appropriate, apologise. Patients will always want to know that they are cared for as a person and that their treating team continues to offer hope for a remedy and a reasonable outcome.6 The other side to surgical complications is less appreciated. This is because the impact on the surgeon can be devastating. Surgeons can be overwhelmed by guilt, self-doubt, depression, anxiety, and possibly, post-traumatic disorder. This has been referred to as a ‘second victim syndrome’.7 The term is better avoided today as patient advocacy groups have argued that such terminology may contribute to decreasing levels of accountability. This may distract from the very serious issues raised.6,8 Surgeons typically live pressurised lives. In a large study of more than 7 500 members, the American College of Surgeons identified that 40% of their respondents were burnt out, 30% screened positive for symptoms of depression, and their quality of life was well below the population norm.9 We may be worse off: a recent South African Orth
骨科手术是一门具有创新性和高要求的专业，涵盖了广泛的解剖和复杂的病理，并采用多种手术方法进行治疗骨科医生通常工作量大，工作时间长。骨科外科注册医师的培训项目是艰巨的。无论是在私营部门还是在公共部门，专业的骨科实践都伴随着特定的和不断增加的需求和困难。一方面，我们有一个持久的职业义务，倡导手术改善生活质量和结果。另一方面，我们在一个对外科病理和外科技术的理解不断增加的时代进行实践;在病人期望不断提高的环境中治疗病人。手术是介入性的，即使技术水平再高，也会出现并发症。避免这种情况的唯一方法就是不做手术。手术并发症并不罕见，在世界范围内，其发生率估计在8-12%之间虽然在临床实践中，并发症通常是快速和直观地识别出来的，但手术并发症的定义却令人惊讶地难以捉摸。现在还没有标准的定义。在常规手术中会出现并发症，因此，并发症是骨科医生工作生活中不可缺少的一部分。然而，与一个人打交道总是很困难的。在应对时，重点是患者及其家属。对于患者来说，除了必须处理直接的身体后遗症外，手术并发症已被确定为术后很长一段时间内术后心理健康受损的独立预测因素病人的护理和结果是首要责任。第一次干预的一个关键因素是英国总医学委员会所说的“坦率的责任”——告诉病人到底发生了什么，哪里出了问题，如果合适的话，道歉。病人总是想知道他们被当作一个人来照顾，他们的治疗团队继续给他们提供治疗和合理结果的希望手术并发症的另一方面却很少被重视。这是因为对外科医生的影响可能是毁灭性的。外科医生可能会被内疚、自我怀疑、抑郁、焦虑，甚至可能是创伤后精神障碍所淹没。这被称为“第二受害者综合症”今天最好避免使用这个术语，因为患者权益团体认为，这样的术语可能会降低问责制的水平。这可能会分散人们对所提出的非常严重的问题的注意力。外科医生通常过着压力很大的生活。美国外科医师学会(American College of Surgeons)对7500多名会员进行了一项大型研究，发现40%的受访者身心疲惫，30%的人有抑郁症状，他们的生活质量远低于人口标准我们的情况可能更糟:最近南非骨科杂志发表的一篇报道称，南非骨科社区的倦怠率为72%外科医生可能有一定程度的应激免疫。根据专业对性格差异进行的研究发现，外科医生在坚强意志方面得分更高，在解决问题时不太可能被情绪分散注意力，而且在压力免疫方面得分更高。11,12目睹手术并发症对病人造成的伤害仍然是一种痛苦的经历。这种经历的后果可能会产生情绪和心理症状，并导致对专业能力的恐惧和不确定这种发病率并非微不足道，研究表明10-43%的外科医生存在一系列不良反应在评估发生了什么时，区分错误和复杂情况是有用的。一个错误可能被认为是一个可以避免的遗漏，有潜在的负面后果，由同行当时评估。另一方面，并发症是外科护理中公认的危险的不良事件外科医生对并发症的反应可分为建设性(积极)和抑制性(消极)两种。建设性的回应应包括承认并发症，与患者沟通，制定纠正干预计划，并确定可以吸取的教训。在适当的情况下，外科医生会通过锻炼、幽默、爱好、休假和/或宗教来寻求积极主动的方式来应对压力。不可避免地，这也与采取防御措施有关，据报道，高达63%的外科医生在并发症发生后变得更加谨慎。此外，医疗法律问题可能会对声誉产生负面影响，而且，在当前充满敌意的环境下，存在着对外科医生定罪威胁的幽灵。9,13压抑行为也可能发生。 骨科手术是一门具有创新性和高要求的专业，涵盖了广泛的解剖和复杂的病理，并采用多种手术方法进行治疗骨科医生通常工作量大，工作时间长。骨科外科注册医师的培训项目是艰巨的。无论是在私营部门还是在公共部门，专业的骨科实践都伴随着特定的和不断增加的需求和困难。一方面，我们有一个持久的职业义务，倡导手术改善生活质量和结果。另一方面，我们在一个对外科病理和外科技术的理解不断增加的时代进行实践;在病人期望不断提高的环境中治疗病人。手术是介入性的，即使技术水平再高，也会出现并发症。避免这种情况的唯一方法就是不做手术。手术并发症并不罕见，在世界范围内，其发生率估计在8-12%之间虽然在临床实践中，并发症通常是快速和直观地识别出来的，但手术并发症的定义却令人惊讶地难以捉摸。现在还没有标准的定义。在常规手术中会出现并发症，因此，并发症是骨科医生工作生活中不可缺少的一部分。然而，与一个人打交道总是很困难的。在应对时，重点是患者及其家属。对于患者来说，除了必须处理直接的身体后遗症外，手术并发症已被确定为术后很长一段时间内术后心理健康受损的独立预测因素病人的护理和结果是首要责任。第一次干预的一个关键因素是英国总医学委员会所说的“坦率的责任”——告诉病人到底发生了什么，哪里出了问题，如果合适的话，道歉。病人总是想知道他们被当作一个人来照顾，他们的治疗团队继续给他们提供治疗和合理结果的希望手术并发症的另一方面却很少被重视。这是因为对外科医生的影响可能是毁灭性的。外科医生可能会被内疚、自我怀疑、抑郁、焦虑，甚至可能是创伤后精神障碍所淹没。这被称为“第二受害者综合症”今天最好避免使用这个术语，因为患者权益团体认为，这样的术语可能会降低问责制的水平。这可能会分散人们对所提出的非常严重的问题的注意力。外科医生通常过着压力很大的生活。美国外科医师学会(American College of Surgeons)对7500多名会员进行了一项大型研究，发现40%的受访者身心疲惫，30%的人有抑郁症状，他们的生活质量远低于人口标准我们的情况可能更糟:最近南非骨科杂志发表的一篇报道称，南非骨科社区的倦怠率为72%外科医生可能有一定程度的应激免疫。根据专业对性格差异进行的研究发现，外科医生在坚强意志方面得分更高，在解决问题时不太可能被情绪分散注意力，而且在压力免疫方面得分更高。11,12目睹手术并发症对病人造成的伤害仍然是一种痛苦的经历。这种经历的后果可能会产生情绪和心理症状，并导致对专业能力的恐惧和不确定这种发病率并非微不足道，研究表明10-43%的外科医生存在一系列不良反应在评估发生了什么时，区分错误和复杂情况是有用的。一个错误可能被认为是一个可以避免的遗漏，有潜在的负面后果，由同行当时评估。另一方面，并发症是外科护理中公认的危险的不良事件外科医生对并发症的反应可分为建设性(积极)和抑制性(消极)两种。建设性的回应应包括承认并发症，与患者沟通，制定纠正干预计划，并确定可以吸取的教训。在适当的情况下，外科医生会通过锻炼、幽默、爱好、休假和/或宗教来寻求积极主动的方式来应对压力。不可避免地，这也与采取防御措施有关，据报道，高达63%的外科医生在并发症发生后变得更加谨慎。此外，医疗法律问题可能会对声誉产生负面影响，而且，在当前充满敌意的环境下，存在着对外科医生定罪威胁的幽灵。9,13压抑行为也可能发生。 最坏的情况是药物滥用;这种情况只发生在少数外科医生身上。其他不太为人所知的压抑行为包括倾向于脱离社会，如尽量减少社会交往、内化、自我分心和否认。一个特别显著的负面反应是长时间的反刍，可发生在高达43%的外科医生并发症后外科医生在并发症后的行为随时间而改变，尽管不是线性的或顺序的典型的第一反应是困惑、否认、强烈的情绪和生理反应。情况很混乱，此时大多数注意力都集中在管理病人和寻求安慰上。在这个阶段，最有益
{"title":"Navigating adversity: the orthopaedic surgeon and complications","authors":"L. Rajah","doi":"10.17159/2309-8309/2023/v22n2a0","DOIUrl":"https://doi.org/10.17159/2309-8309/2023/v22n2a0","url":null,"abstract":"Orthopaedic surgery is an innovative and demanding speciality covering a broad anatomy and complex pathologies treated with a wide range of procedures.1 Orthopaedic surgeons typically have heavy workloads and work long hours. The registrar training programme in Orthopaedic Surgery is arduous. Specialist orthopaedic practice, in both the private and public sectors, is associated with specific and increasing demands and difficulties. On the one hand, we have an enduring professional obligation to advocate for surgery that improves quality of life and outcome. On the other, we practise in an era of relentless increase in our understanding of surgical pathology and surgical techniques; and treat patients in an environment of heightened and increasing patient expectations. Surgery is interventional, and complications will occur even with the very highest level of skill. The only way to avoid this is for a surgeon not to operate. Surgical complications are not uncommon, and estimates of their frequency range from 8–12% across the world.2 While in clinical practice, complications are most often recognised quickly and intuitively, defining a surgical complication is surprisingly elusive. There remains no standard definition.3,4 Complications will arise in regular practice and, therefore, will be part and parcel of an orthopaedic surgeon’s working life. However, dealing with one is always difficult. In responding, the focus is on patients and their families. For the patient, apart from having to deal with the immediate physical sequelae, surgical complications have been identified as an independent predictor of impaired postoperative psychosocial wellbeing for a very long time after surgery.5 The care and the outcome of the patient is the primary responsibility. A key factor in the first intervention is what the United Kingdom General Medical Council refers to as the ‘duty of candour’ – tell the patient exactly what happened, what went wrong, and if appropriate, apologise. Patients will always want to know that they are cared for as a person and that their treating team continues to offer hope for a remedy and a reasonable outcome.6 The other side to surgical complications is less appreciated. This is because the impact on the surgeon can be devastating. Surgeons can be overwhelmed by guilt, self-doubt, depression, anxiety, and possibly, post-traumatic disorder. This has been referred to as a ‘second victim syndrome’.7 The term is better avoided today as patient advocacy groups have argued that such terminology may contribute to decreasing levels of accountability. This may distract from the very serious issues raised.6,8 Surgeons typically live pressurised lives. In a large study of more than 7 500 members, the American College of Surgeons identified that 40% of their respondents were burnt out, 30% screened positive for symptoms of depression, and their quality of life was well below the population norm.9 We may be worse off: a recent South African Orth","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.17159/2309-8309/2023/v22n1a2
M. Shah, Shah
BACKGROUND: Bone tumours involving hands are usually benign but can be locally aggressive. Several treatments have been described. Usual modalities of treatment include curettage and bone grafting. In more advanced stages when short bones of the hand are involved with more than 70% cortical destruction, or when such treatment option is not possible (as with non-contained tumours with cortical breaches, pathological fracture), only the resection or amputation of the affected segment can offer an effective cure. We studied the role of the free fibula graft (non-vascularised) in such types of benign non-reconstructable (by conventional methods) hand tumours. The aims and objectives were to study the functional outcome of free fibula grafting in benign non-reconstructable bone tumours involving the hand and to analyse the complications, if any, and assess the causes and solutions for them METHODS: We prospectively studied 15 patients with different types of benign, non-reconstructable bone tumours involving the hand operated by free fibula grafting. The study period ranged from January 2014 to December 2021. Follow-up ranged from 2 to 8 years (average of 4.26 years RESULTS: Results were analysed by the QuidkDASH-9 score system. There was no recurrence. One case of superficial infection was treated with antibiotics and dressing. All patients were happy with the treatment and resumed their normal duties and functional movements CONCLUSION: Use of the free fibula graft can be a good option for benign non-reconstructable bone tumours involving the hand to avoid amputation. The free fibula graft gives better results due to total excision of the lesion and strut graft support for good functional outcomes Level of evidence: Level 3
{"title":"Functional outcome of free fibula grafting in benign non-reconstructable bone tumours involving the hand","authors":"M. Shah, Shah","doi":"10.17159/2309-8309/2023/v22n1a2","DOIUrl":"https://doi.org/10.17159/2309-8309/2023/v22n1a2","url":null,"abstract":"BACKGROUND: Bone tumours involving hands are usually benign but can be locally aggressive. Several treatments have been described. Usual modalities of treatment include curettage and bone grafting. In more advanced stages when short bones of the hand are involved with more than 70% cortical destruction, or when such treatment option is not possible (as with non-contained tumours with cortical breaches, pathological fracture), only the resection or amputation of the affected segment can offer an effective cure. We studied the role of the free fibula graft (non-vascularised) in such types of benign non-reconstructable (by conventional methods) hand tumours. The aims and objectives were to study the functional outcome of free fibula grafting in benign non-reconstructable bone tumours involving the hand and to analyse the complications, if any, and assess the causes and solutions for them METHODS: We prospectively studied 15 patients with different types of benign, non-reconstructable bone tumours involving the hand operated by free fibula grafting. The study period ranged from January 2014 to December 2021. Follow-up ranged from 2 to 8 years (average of 4.26 years RESULTS: Results were analysed by the QuidkDASH-9 score system. There was no recurrence. One case of superficial infection was treated with antibiotics and dressing. All patients were happy with the treatment and resumed their normal duties and functional movements CONCLUSION: Use of the free fibula graft can be a good option for benign non-reconstructable bone tumours involving the hand to avoid amputation. The free fibula graft gives better results due to total excision of the lesion and strut graft support for good functional outcomes Level of evidence: Level 3","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.17159/2309-8309/2023/v22n1a4
MF Maseeha, Ansermeah, C. G. Proches, Robert Snyders¹
BACKGROUND: The high burden of trauma in Durban results in longer elective surgery waiting periods, which exacerbates the in-patient hospital days and increases the average length of stay. Quantitative analyses of the data clearly demonstrate a growing list of elective patients awaiting surgery while the rate of acute trauma admissions continues to escalate. It has been demonstrated that interactions of patients between the various stages of care should be carefully studied in order for policymakers to identify limiting factors and leverage points Many public health interventions run aground and fail to actualise their initial objectives since the system is deconstructed and reduced to simplified autonomous components. A restorative undertaking to remedy this syndrome is to reconstitute the normative conventions of framing, mapping out and scrutinising deficiencies within healthcare systems. This paper explores a model of total patient flow through the orthopaedic service to test alternative major new structural options for relieving pressure on health services. METHODS: Qualitative data was collected using purposeful sampling to conduct 20 semi-structured interviews as well as including discourse analysis and ethnographic research. Participatory action research (PAR) was the main epistemological method driving the study under the auspices of a system dynamics framework RESULTS: Areas of potential improvements have been identified which can ameliorate the flow of patients between the different departments together with the challenges and uncertainties that are present in achieving this CONCLUSION: Efficient patient flow management is a cornerstone in optimising healthcare services; the failure of such a system burdens the entire health system Level of evidence: Level 5
{"title":"Enhancing healthcare services in an orthopaedic department utilising a system dynamics and participatory action research perspective to optimise patient flow","authors":"MF Maseeha, Ansermeah, C. G. Proches, Robert Snyders¹","doi":"10.17159/2309-8309/2023/v22n1a4","DOIUrl":"https://doi.org/10.17159/2309-8309/2023/v22n1a4","url":null,"abstract":"BACKGROUND: The high burden of trauma in Durban results in longer elective surgery waiting periods, which exacerbates the in-patient hospital days and increases the average length of stay. Quantitative analyses of the data clearly demonstrate a growing list of elective patients awaiting surgery while the rate of acute trauma admissions continues to escalate. It has been demonstrated that interactions of patients between the various stages of care should be carefully studied in order for policymakers to identify limiting factors and leverage points Many public health interventions run aground and fail to actualise their initial objectives since the system is deconstructed and reduced to simplified autonomous components. A restorative undertaking to remedy this syndrome is to reconstitute the normative conventions of framing, mapping out and scrutinising deficiencies within healthcare systems. This paper explores a model of total patient flow through the orthopaedic service to test alternative major new structural options for relieving pressure on health services. METHODS: Qualitative data was collected using purposeful sampling to conduct 20 semi-structured interviews as well as including discourse analysis and ethnographic research. Participatory action research (PAR) was the main epistemological method driving the study under the auspices of a system dynamics framework RESULTS: Areas of potential improvements have been identified which can ameliorate the flow of patients between the different departments together with the challenges and uncertainties that are present in achieving this CONCLUSION: Efficient patient flow management is a cornerstone in optimising healthcare services; the failure of such a system burdens the entire health system Level of evidence: Level 5","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.17159/2309-8309/2023/v22n2a4
M. Jordaan, J. D. Plessis, Dorcas M Rakumakoe, Liané Mostert
BACKGROUND: The correct use of surgical antibiotic prophylaxis (SAP), as stipulated in evidence-based guidelines, is essential to prevent surgical site infections (SSIs) following orthopaedic procedures and consequently the impact thereof on the patient and healthcare system. Orthopaedic SSIs are associated with devastating complications with a great burden of disease on patients. METHODS: A cross-sectional study was performed in a 186-bed private hospital, located in North West province, South Africa. Retrospective data of adult patients who underwent orthopaedic surgery from 1 January 2020 to 31 December 2020 were included. Data were obtained from the study hospital's theatre registers, anaesthetic notes, patient medical records and patient antimicrobial prescription charts. Descriptive statistical analysis was used to determine the compliance (indication, choice, route of administration, dose, administration time, re-dosing and duration) of orthopaedic SAP administration with prescribing guidelines. RESULTS: Of the 942 orthopaedic procedures, SAP was correctly administered or omitted in 742 cases (78.8%). The total choice of SAP was correct in 738 cases (78.3%). SAP was administered intravenously 100% of the time and was prescribed at the correct dose in 632 cases (77.5%). However, SAP re-dosing occurred only in one of the three prolonged procedures, and the preoperative SAP administration time was only indicated in 34.4% of the cases. The correct duration of SAP was 75.9%. The overall compliance rate to SAP guidelines regarding indication, choice, dose and duration was 57.5%. SSIs developed in 0.9% of the patients, resulting in the death of one. CONCLUSION: Orthopaedic SAP practices moderately deviated from current SAP guidelines. Apparent overuse, incorrect dosing and prolonged duration were identified as burdens to overcome. Special attention should be paid to dosing adjustments for patients weighing more than 120 kg. However, certain components such as route of administration, administration time, SAP indication and SAP correct choice showed greater compliance percentages. The low prevalence of SSIs supports a positive reporting of the findings Level of evidence: Level 4.
{"title":"Orthopaedic surgical antibiotic prophylaxis administration compliance with prescribing guidelines in a private hospital in North West province, South Africa","authors":"M. Jordaan, J. D. Plessis, Dorcas M Rakumakoe, Liané Mostert","doi":"10.17159/2309-8309/2023/v22n2a4","DOIUrl":"https://doi.org/10.17159/2309-8309/2023/v22n2a4","url":null,"abstract":"BACKGROUND: The correct use of surgical antibiotic prophylaxis (SAP), as stipulated in evidence-based guidelines, is essential to prevent surgical site infections (SSIs) following orthopaedic procedures and consequently the impact thereof on the patient and healthcare system. Orthopaedic SSIs are associated with devastating complications with a great burden of disease on patients. METHODS: A cross-sectional study was performed in a 186-bed private hospital, located in North West province, South Africa. Retrospective data of adult patients who underwent orthopaedic surgery from 1 January 2020 to 31 December 2020 were included. Data were obtained from the study hospital's theatre registers, anaesthetic notes, patient medical records and patient antimicrobial prescription charts. Descriptive statistical analysis was used to determine the compliance (indication, choice, route of administration, dose, administration time, re-dosing and duration) of orthopaedic SAP administration with prescribing guidelines. RESULTS: Of the 942 orthopaedic procedures, SAP was correctly administered or omitted in 742 cases (78.8%). The total choice of SAP was correct in 738 cases (78.3%). SAP was administered intravenously 100% of the time and was prescribed at the correct dose in 632 cases (77.5%). However, SAP re-dosing occurred only in one of the three prolonged procedures, and the preoperative SAP administration time was only indicated in 34.4% of the cases. The correct duration of SAP was 75.9%. The overall compliance rate to SAP guidelines regarding indication, choice, dose and duration was 57.5%. SSIs developed in 0.9% of the patients, resulting in the death of one. CONCLUSION: Orthopaedic SAP practices moderately deviated from current SAP guidelines. Apparent overuse, incorrect dosing and prolonged duration were identified as burdens to overcome. Special attention should be paid to dosing adjustments for patients weighing more than 120 kg. However, certain components such as route of administration, administration time, SAP indication and SAP correct choice showed greater compliance percentages. The low prevalence of SSIs supports a positive reporting of the findings Level of evidence: Level 4.","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.17159/2309-8309/2023/v22n2a1
S. Mbatha, M. Duma, S. Maqungo, L. Marais
BACKGROUND: High energy pelvic and acetabular fractures frequently occur in conjunction with multiple system injuries and have been associated with morbidity and mortality. We aimed to identify the risk factors associated with complications in patients with pelvic and/or acetabular fractures treated surgically in a resource-constrained clinical setting. METHODS: We performed a retrospective review of adult patients younger than 65 years treated surgically over a three-year period at a tertiary and regional hospitals in South Africa. Epidemiological data as well as trauma-, fracture- and treatment-related factors were compared in patients who developed complications and those who did not, at a mean follow-up of ten months (interquartile range 4-14 months; range 0-31. RESULTS: Eighty-eight patients were included. Complications were encountered in 41% of the cohort. Factors associated with adverse events were age above 35 years (p = 0.008); transverse sacral fractures (p = 0.008); partial articular acetabular fractures with isolated column and/or wall involvement (p = 0.014); Kocher-Langenbeck approach (p = 0.001); posterior acetabular wall fixation (p = 0.002); fixation with plate and screws (p = 0.012); and follow-up period more than 6 months (p = 0.025). Complications encountered were heterotopic ossification, postoperative sepsis, unplanned reoperation, implant failure, postoperative neurological deficit, venous thromboembolism, femoral head osteonecrosis, osteoarthritis and limb length discrepancy. No association was found between adverse events and injury severity score, comorbidities or other associated injuries. CONCLUSION: Complications were common within three years in patients with pelvic and acetabular fractures treated surgically in a developing setting. While an increased Injury Severity Score was not associated with complications, certain fracture- and surgery-related factors may be associated with an increased risk. Heterotopic ossification was the most common adverse event despite formal gluteus minimus debridement and the use of NSAIDs. Further studies are needed to determine the medium- to long-term complications as well as the functional outcome of surgery and the complications of surgery. Level of evidence: Level 4.
{"title":"Complications of surgically managed pelvic and acetabular fractures","authors":"S. Mbatha, M. Duma, S. Maqungo, L. Marais","doi":"10.17159/2309-8309/2023/v22n2a1","DOIUrl":"https://doi.org/10.17159/2309-8309/2023/v22n2a1","url":null,"abstract":"BACKGROUND: High energy pelvic and acetabular fractures frequently occur in conjunction with multiple system injuries and have been associated with morbidity and mortality. We aimed to identify the risk factors associated with complications in patients with pelvic and/or acetabular fractures treated surgically in a resource-constrained clinical setting. METHODS: We performed a retrospective review of adult patients younger than 65 years treated surgically over a three-year period at a tertiary and regional hospitals in South Africa. Epidemiological data as well as trauma-, fracture- and treatment-related factors were compared in patients who developed complications and those who did not, at a mean follow-up of ten months (interquartile range 4-14 months; range 0-31. RESULTS: Eighty-eight patients were included. Complications were encountered in 41% of the cohort. Factors associated with adverse events were age above 35 years (p = 0.008); transverse sacral fractures (p = 0.008); partial articular acetabular fractures with isolated column and/or wall involvement (p = 0.014); Kocher-Langenbeck approach (p = 0.001); posterior acetabular wall fixation (p = 0.002); fixation with plate and screws (p = 0.012); and follow-up period more than 6 months (p = 0.025). Complications encountered were heterotopic ossification, postoperative sepsis, unplanned reoperation, implant failure, postoperative neurological deficit, venous thromboembolism, femoral head osteonecrosis, osteoarthritis and limb length discrepancy. No association was found between adverse events and injury severity score, comorbidities or other associated injuries. CONCLUSION: Complications were common within three years in patients with pelvic and acetabular fractures treated surgically in a developing setting. While an increased Injury Severity Score was not associated with complications, certain fracture- and surgery-related factors may be associated with an increased risk. Heterotopic ossification was the most common adverse event despite formal gluteus minimus debridement and the use of NSAIDs. Further studies are needed to determine the medium- to long-term complications as well as the functional outcome of surgery and the complications of surgery. Level of evidence: Level 4.","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67482066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.17159/2309-8309/2023/v22n2a3
Sven Strydom, Christian H Snyckers²
Various methods for anterior pelvic ring fixation have been described in the literature, each with specific advantages and disadvantages. We describe a modified minimally invasive subcutaneous technique for anterior fixation: the Bridging Infix. It combines the benefits of internal plate fixation with external fixator principles. We merged and modified features of the existing INFIX and Pelvic Bridge techniques during the design. Similar to these techniques, we use plate-rods typically used during occipitocervical fusions. The design changes allow for less discomfort due to prominent hardware in thin patients and eliminate the need for an intact medial pubic rami for fixation. There is also no risk of bladder injury due to accidental screw perforation through the pubic rami. The Bridging Infix is ideal for patients who are physiologically too frail for extensive open reduction and plate osteosynthesis, such as elderly patients with pelvic fragility fractures who are failing to mobilise due to pain. It can also be used for patients in whom external fixators may be impractical or poorly tolerated, such as obese patients or those with increased nursing demands. This technique does not provide adequate posterior pelvic ring stability, thus it requires an intact posterior tension band or the addition of separate posterior fixation. Patients can commence in-bed mobilisation the same day as the procedure, with weight-bearing as tolerated allowed for most cases, and toe-touching reserved for highly unstable injury patterns only. The implants are not routinely removed unless requested by the patient, especially in the elderly to avoid additional anaesthetic exposure. Potential complaints include lateral thigh pain, due to lateral femoral nerve compression, and mechanical discomfort during exercise activities. Level of evidence: Level 5
{"title":"The Bridging Infix: a modified, minimally invasive subcutaneous anterior pelvic fixation technique","authors":"Sven Strydom, Christian H Snyckers²","doi":"10.17159/2309-8309/2023/v22n2a3","DOIUrl":"https://doi.org/10.17159/2309-8309/2023/v22n2a3","url":null,"abstract":"Various methods for anterior pelvic ring fixation have been described in the literature, each with specific advantages and disadvantages. We describe a modified minimally invasive subcutaneous technique for anterior fixation: the Bridging Infix. It combines the benefits of internal plate fixation with external fixator principles. We merged and modified features of the existing INFIX and Pelvic Bridge techniques during the design. Similar to these techniques, we use plate-rods typically used during occipitocervical fusions. The design changes allow for less discomfort due to prominent hardware in thin patients and eliminate the need for an intact medial pubic rami for fixation. There is also no risk of bladder injury due to accidental screw perforation through the pubic rami. The Bridging Infix is ideal for patients who are physiologically too frail for extensive open reduction and plate osteosynthesis, such as elderly patients with pelvic fragility fractures who are failing to mobilise due to pain. It can also be used for patients in whom external fixators may be impractical or poorly tolerated, such as obese patients or those with increased nursing demands. This technique does not provide adequate posterior pelvic ring stability, thus it requires an intact posterior tension band or the addition of separate posterior fixation. Patients can commence in-bed mobilisation the same day as the procedure, with weight-bearing as tolerated allowed for most cases, and toe-touching reserved for highly unstable injury patterns only. The implants are not routinely removed unless requested by the patient, especially in the elderly to avoid additional anaesthetic exposure. Potential complaints include lateral thigh pain, due to lateral femoral nerve compression, and mechanical discomfort during exercise activities. Level of evidence: Level 5","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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