Pub Date : 2020-05-29DOI: 10.17159/2309-8309/2020/v19n2a2
Lourens JC Erasmus, F. F. Fourie, J. V. D. Merwe
Background: Total hip replacements done for intracapsular neck of femur fractures (NOF) have a dislocation rate of up to 14%. This is seven times higher than in total hip arthroplasty (THA) done for osteoarthritis. Using a dual mobility cup (DMC) has been shown to be effective in addressing dislocation in elective THA. Our hypothesis is that the use of DMC in NOF will do the same. This study aims to determine the incidence proportion of dislocation of DMCs one year after surgery in patients who received THA for NOF and to compare it to dislocation rates as documented in existing studies. Methods: A retrospective study was done on 86 patients treated with DMC THA for an intracapsular NOF fracture from 2012 until 2016. A minimum one-year follow-up period was required for inclusion into the study. The number of dislocations at one year after surgery was noted. Results: Forty-one patients with a mean age of 60.7 years were included (26 females and 15 males). All patients were operated via the posterior approach. None of the patients had dislocated after one year. Conclusion: Low dislocation rates can be achieved using DMC THA in the management of intracapsular NOF fractures. Our one-year dislocation rate of 0% compares favourably to conventional THA and is comparable to similar DMC studies done outside of South Africa. Level of evidence: Level 4
{"title":"Low dislocation rates achieved when using dual mobility cup hip implants for femur neck fractures","authors":"Lourens JC Erasmus, F. F. Fourie, J. V. D. Merwe","doi":"10.17159/2309-8309/2020/v19n2a2","DOIUrl":"https://doi.org/10.17159/2309-8309/2020/v19n2a2","url":null,"abstract":"Background: Total hip replacements done for intracapsular neck of femur fractures (NOF) have a dislocation rate of up to 14%. This is seven times higher than in total hip arthroplasty (THA) done for osteoarthritis. Using a dual mobility cup (DMC) has been shown to be effective in addressing dislocation in elective THA. Our hypothesis is that the use of DMC in NOF will do the same. This study aims to determine the incidence proportion of dislocation of DMCs one year after surgery in patients who received THA for NOF and to compare it to dislocation rates as documented in existing studies. \u0000Methods: A retrospective study was done on 86 patients treated with DMC THA for an intracapsular NOF fracture from 2012 until 2016. A minimum one-year follow-up period was required for inclusion into the study. The number of dislocations at one year after surgery was noted. \u0000Results: Forty-one patients with a mean age of 60.7 years were included (26 females and 15 males). All patients were operated via the posterior approach. None of the patients had dislocated after one year. \u0000Conclusion: Low dislocation rates can be achieved using DMC THA in the management of intracapsular NOF fractures. Our one-year dislocation rate of 0% compares favourably to conventional THA and is comparable to similar DMC studies done outside of South Africa. \u0000Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"19 1","pages":"70-73"},"PeriodicalIF":0.0,"publicationDate":"2020-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44572823","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 : 2020-05-29DOI: 10.17159/2309-8309/2020/v19n2a3
E. Gericke, J. F. Beer, M. Deacon, L. Marais
Background: Administration of tranexamic acid (TXA) peri-operatively is a well-recognised strategy used by orthopaedic surgeons to reduce blood loss during total knee arthroplasty (TKA). Furthermore, not using a drain has been advocated to be a safe and effective way to further reduce blood loss. The main aim of this study is to assess the effect of a combination of these two strategies on total blood loss associated with TKA. Methods: This is a retrospective study conducted on a single surgeon’s data gathered over a two-year period. This study compares the blood loss in two groups of patients. The control group received no antifibrinolytic agents and a drain was inserted, while the study group received TXA and the drain was omitted. Results: A total of 109 patients were included in the analysis, with 86 patients in the study group and 23 patients in the control group. The two groups were compared in terms of pre-operative haemoglobin, American Society of Anesthesiologists (ASA) score and body mass index (BMI). The mean age of the study group was lower than that of the control group (64±8 years vs 68±9 years; p=0.03). The mean total blood loss was lower in the study group compared to the control group (mean difference 171.8 ml; 95% CI 31.2–312.2; p=0.01). Duration of hospital stay was also reduced in the study group (2.4 days vs 3.1 days; p=0.003). There was, however, no difference in the functional outcome according to the Knee injury and Osteoarthritis Outcome Score (KOOS). Conclusion: These findings are in accordance with previous studies, indicating that intra-articular administration of TXA and omission of negative pressure drainage may be associated with a reduction in blood loss following TKA. Larger, well-designed studies are required to determine the optimal TXA administration strategy. Level of evidence: Level 4
{"title":"Percutaneous intra-articular tranexamic acid following total knee arthroplasty without drainage to reduce blood loss","authors":"E. Gericke, J. F. Beer, M. Deacon, L. Marais","doi":"10.17159/2309-8309/2020/v19n2a3","DOIUrl":"https://doi.org/10.17159/2309-8309/2020/v19n2a3","url":null,"abstract":"Background: Administration of tranexamic acid (TXA) peri-operatively is a well-recognised strategy used by orthopaedic surgeons to reduce blood loss during total knee arthroplasty (TKA). Furthermore, not using a drain has been advocated to be a safe and effective way to further reduce blood loss. The main aim of this study is to assess the effect of a combination of these two strategies on total blood loss associated with TKA. \u0000Methods: This is a retrospective study conducted on a single surgeon’s data gathered over a two-year period. This study compares the blood loss in two groups of patients. The control group received no antifibrinolytic agents and a drain was inserted, while the study group received TXA and the drain was omitted. \u0000Results: A total of 109 patients were included in the analysis, with 86 patients in the study group and 23 patients in the control group. The two groups were compared in terms of pre-operative haemoglobin, American Society of Anesthesiologists (ASA) score and body mass index (BMI). The mean age of the study group was lower than that of the control group (64±8 years vs 68±9 years; p=0.03). The mean total blood loss was lower in the study group compared to the control group (mean difference 171.8 ml; 95% CI 31.2–312.2; p=0.01). Duration of hospital stay was also reduced in the study group (2.4 days vs 3.1 days; p=0.003). There was, however, no difference in the functional outcome according to the Knee injury and Osteoarthritis Outcome Score (KOOS). \u0000Conclusion: These findings are in accordance with previous studies, indicating that intra-articular administration of TXA and omission of negative pressure drainage may be associated with a reduction in blood loss following TKA. Larger, well-designed studies are required to determine the optimal TXA administration strategy. \u0000Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"19 1","pages":"74-78"},"PeriodicalIF":0.0,"publicationDate":"2020-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43647018","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 : 2020-05-29DOI: 10.17159/2309-8309/2020/v19n2a6
S. Strydom, C. Hattingh, M. Ngcelwane, N. Ngcoya
Background: There are limited studies available that examine the epidemiology of children and adolescents admitted with orthopaedic injuries in developing countries. Several unique factors in South Africa, such as a large socio-economic divide and a public health sector with limited resources, are suggested to influence injury patterns and fracture management. The data emanating from this study may play a role in identifying potential preventative measures. The aims of the study were to determine the age, sex, duration of admission, aetiology and management regimen of paediatric and adolescent patients admitted with fractures in a South African provincial hospital. Patients and methods: We did a cross-sectional review of medical records for the period 1 January 2016 to 31 December 2017 at a South African provincial hospital. Convenience sampling was done, and demographic and clinical data was collected from patient records. All patients younger than 18 years at the time of injury who were admitted with fractures of the limbs, pelvis or spine were included. Patients with incomplete clinical records were excluded. Results: A total of 731 patients were admitted during this period. After excluding patients with incomplete records, 526 (72%) were included in the study. From these records we found a higher percentage of males admitted (73%) and the average age was 7.72 years. The average duration of admission was 8.59 days. A fall on ground level was the most common mechanism of injury (70.0%), followed by pedestrian vehicle accidents (12.2%). The most frequently fractured regions were the forearm (36.4%), humerus (26.5%) and femur (18.9%). Multiple fractures were sustained by 2.4% and additional non-skeletal injuries were sustained by 2.9%. There was one fatality: a patient who presented with gunshot trauma. Conclusion: Despite fall-related injuries being the most common cause for admission, pedestrian vehicle accident prevention can have the greatest effect on admissions. They require significantly longer hospitalisation and present more frequently with additional injuries. By implementing safety strategies and improving road infrastructure, we can theoretically decrease the number of serious paediatric admissions. Level of evidence: Level 4
{"title":"Epidemiology of paediatric and adolescent fractures admitted to a South African provincial hospital","authors":"S. Strydom, C. Hattingh, M. Ngcelwane, N. Ngcoya","doi":"10.17159/2309-8309/2020/v19n2a6","DOIUrl":"https://doi.org/10.17159/2309-8309/2020/v19n2a6","url":null,"abstract":"Background: There are limited studies available that examine the epidemiology of children and adolescents admitted with orthopaedic injuries in developing countries. Several unique factors in South Africa, such as a large socio-economic divide and a public health sector with limited resources, are suggested to influence injury patterns and fracture management. The data emanating from this study may play a role in identifying potential preventative measures. The aims of the study were to determine the age, sex, duration of admission, aetiology and management regimen of paediatric and adolescent patients admitted with fractures in a South African provincial hospital. \u0000Patients and methods: We did a cross-sectional review of medical records for the period 1 January 2016 to 31 December 2017 at a South African provincial hospital. Convenience sampling was done, and demographic and clinical data was collected from patient records. All patients younger than 18 years at the time of injury who were admitted with fractures of the limbs, pelvis or spine were included. Patients with incomplete clinical records were excluded. \u0000Results: A total of 731 patients were admitted during this period. After excluding patients with incomplete records, 526 (72%) were included in the study. From these records we found a higher percentage of males admitted (73%) and the average age was 7.72 years. The average duration of admission was 8.59 days. A fall on ground level was the most common mechanism of injury (70.0%), followed by pedestrian vehicle accidents (12.2%). The most frequently fractured regions were the forearm (36.4%), humerus (26.5%) and femur (18.9%). Multiple fractures were sustained by 2.4% and additional non-skeletal injuries were sustained by 2.9%. There was one fatality: a patient who presented with gunshot trauma. \u0000Conclusion: Despite fall-related injuries being the most common cause for admission, pedestrian vehicle accident prevention can have the greatest effect on admissions. They require significantly longer hospitalisation and present more frequently with additional injuries. By implementing safety strategies and improving road infrastructure, we can theoretically decrease the number of serious paediatric admissions. \u0000Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"19 1","pages":"92-96"},"PeriodicalIF":0.0,"publicationDate":"2020-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43195202","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 : 2020-05-29DOI: 10.17159/2309-8309/2020/v19n2a1
J. D. Plessis, R. Greeff, V. Singh, N. Fang, C. Frey
Background: Hip and knee arthroplasty procedures are successful surgical procedures, with total hip arthroplasty being named the operation of the 20th century. With there being an estimated rate globally of periprosthetic joint infection of 1% for hips and 2% for knees, this minimal infection rate represents a large global concern. The successful management of periprosthetic joint infection remains controversial with multiple proposed strategies. Our aim is to present our short-term data for a two-stage revision protocol. Methods: A single centre retrospective review of an existing database starting from January 2013 and including April 2019 was conducted looking at patients having undergone two-stage revision for periprosthetic joint infection. The unit utilised a standard approach to two-stage revisions. Data was collected from the existing database to ascertain short-term success based on the Delphibased international multidisciplinary consensus criteria. Results: A total of 2 125 entries were reviewed from the database comprising 1 912 primary arthroplasty procedures. From all revision cases 19 patients were identified to have undergone a two-stage revision by our unit. Of these patients we managed to collect sufficient data to gauge treatment success in 12 patients. Of these 12 patients with a mean follow-up of 25.6 months, ten reported complete wound healing, pain improvement and no subsequent surgery. One patient demised from septic complications and one required subsequent arthrodesis which controlled the sepsis. Conclusion: Our results showed a high infection eradication rate following our two-staged revision protocol despite frequent delays between first and second stages as a result of resource constraints and limitations. Level of evidence: Level 4
{"title":"Short-term results following two-stage revision for periprosthetic joint infection","authors":"J. D. Plessis, R. Greeff, V. Singh, N. Fang, C. Frey","doi":"10.17159/2309-8309/2020/v19n2a1","DOIUrl":"https://doi.org/10.17159/2309-8309/2020/v19n2a1","url":null,"abstract":"Background: Hip and knee arthroplasty procedures are successful surgical procedures, with total hip arthroplasty being named the operation of the 20th century. With there being an estimated rate globally of periprosthetic joint infection of 1% for hips and 2% for knees, this minimal infection rate represents a large global concern. The successful management of periprosthetic joint infection remains controversial with multiple proposed strategies. Our aim is to present our short-term data for a two-stage revision protocol. \u0000Methods: A single centre retrospective review of an existing database starting from January 2013 and including April 2019 was conducted looking at patients having undergone two-stage revision for periprosthetic joint infection. The unit utilised a standard approach to two-stage revisions. Data was collected from the existing database to ascertain short-term success based on the Delphibased international multidisciplinary consensus criteria. \u0000Results: A total of 2 125 entries were reviewed from the database comprising 1 912 primary arthroplasty procedures. From all revision cases 19 patients were identified to have undergone a two-stage revision by our unit. Of these patients we managed to collect sufficient data to gauge treatment success in 12 patients. Of these 12 patients with a mean follow-up of 25.6 months, ten reported complete wound healing, pain improvement and no subsequent surgery. One patient demised from septic complications and one required subsequent arthrodesis which controlled the sepsis. \u0000Conclusion: Our results showed a high infection eradication rate following our two-staged revision protocol despite frequent delays between first and second stages as a result of resource constraints and limitations. \u0000Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"19 1","pages":"64-69"},"PeriodicalIF":0.0,"publicationDate":"2020-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47858766","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 : 2020-05-29DOI: 10.17159/2309-8309/2020/v19n2a4
J. Joubert, S. Matshidza, E. D'Alton
Background: To compare three-dimensional (3D) printed models with 3D computed tomography (CT) images in terms of the reliability of the classification of tibial plateau fractures using the Hohl and Moore and the Schatzker classification systems, and whether there was any influence on surgical management. Method: The sample comprised the 20 CT scans of patients with tibial plateau fractures available in the radiology archive of Dr George Mukhari Academic Hospital (Ga-Rankuwa). Standardised illustrated guides to the Schatzker and the Hohl and Moore classification systems were used by six observers of varying orthopaedic experience. They completed questionnaires individually in three different sessions. In session one the observers had access to the 3D CT images only. On average two to five days later, in session two the observers assessed only the 3D models. In the third session, another two-to-five days later, the observers assessed the 3D CT images while handling and inspecting the corresponding 3D model. Results: The inter-observer reliability of the Schatzker system (moderate reliability) was superior to the Hohl and Moore system (fair reliability) when comparing the assessment using the images and models separately. When all observations were combined, there was no difference between the systems. For the six possible surgical management options given to the observers, there was an overall difference in agreement based on assessing only the CT images compared with assessing only the models, of 19% (23 of the possible 120 procedures). Of these 23 differing procedures, 15 were more invasive. The 3D models were considered superior to 3D CT imaging in terms of spatial awareness and the observers’ ability to assess intra-articular fracture patterns. The models were assessed as being superior to the imaging when considering the ability to estimate the quantity of bone graft required. Conclusion: Although the inter-rater reliability of classification was not significantly improved, there were several advantages to using the 3D-printed models both separately from the CT images and together with the images. The effect of 3D models on patient outcome remains untested. The clinical impact of the use of 3D models (including cost, manufacturing time and radiation exposure) should be weighed against the potential benefits. Level of evidence: Level 4
背景:比较三维(3D)打印模型与三维计算机断层扫描(CT)图像在Hohl和Moore以及Schatzker分类系统对胫骨平台骨折分类的可靠性，以及是否对手术处理有影响。方法:样本包括Dr George Mukhari学术医院(Ga-Rankuwa)放射学档案中提供的20例胫骨平台骨折患者的CT扫描。标准化的图解指南Schatzker和Hohl和Moore分类系统被6名不同骨科经验的观察员使用。他们在三个不同的阶段分别完成问卷调查。在第一阶段，观察者只能看到3D CT图像。平均两到五天后，在第二阶段，观察员只评估3D模型。在第三阶段，也就是两到五天后，观察人员在处理和检查相应的3D模型的同时评估3D CT图像。结果:分别使用图像和模型进行评估时，Schatzker系统的观察者间信度(中等信度)优于Hohl和Moore系统(公平信度)。当所有的观测结果结合在一起时，系统之间没有差异。对于给予观察者的六种可能的手术处理方案，仅基于评估CT图像与仅评估模型的总体差异为19%(可能的120种手术中的23种)。在这23种不同的手术中，有15种更具侵入性。3D模型被认为在空间意识和观察者评估关节内骨折模式的能力方面优于3D CT成像。当考虑到估计所需骨移植数量的能力时，评估模型优于影像学。结论:虽然分类的间信度没有明显提高，但3d打印模型与CT图像分开使用或与CT图像结合使用都有几个优势。3D模型对患者预后的影响尚未得到验证。使用3D模型的临床影响(包括成本、制造时间和辐射暴露)应该与潜在的好处进行权衡。证据等级:四级
{"title":"The use of three-dimensional models in tibial plateau fractures","authors":"J. Joubert, S. Matshidza, E. D'Alton","doi":"10.17159/2309-8309/2020/v19n2a4","DOIUrl":"https://doi.org/10.17159/2309-8309/2020/v19n2a4","url":null,"abstract":"Background: To compare three-dimensional (3D) printed models with 3D computed tomography (CT) images in terms of the reliability of the classification of tibial plateau fractures using the Hohl and Moore and the Schatzker classification systems, and whether there was any influence on surgical management. \u0000Method: The sample comprised the 20 CT scans of patients with tibial plateau fractures available in the radiology archive of Dr George Mukhari Academic Hospital (Ga-Rankuwa). Standardised illustrated guides to the Schatzker and the Hohl and Moore classification systems were used by six observers of varying orthopaedic experience. They completed questionnaires individually in three different sessions. In session one the observers had access to the 3D CT images only. On average two to five days later, in session two the observers assessed only the 3D models. In the third session, another two-to-five days later, the observers assessed the 3D CT images while handling and inspecting the corresponding 3D model. \u0000Results: The inter-observer reliability of the Schatzker system (moderate reliability) was superior to the Hohl and Moore system (fair reliability) when comparing the assessment using the images and models separately. When all observations were combined, there was no difference between the systems. For the six possible surgical management options given to the observers, there was an overall difference in agreement based on assessing only the CT images compared with assessing only the models, of 19% (23 of the possible 120 procedures). Of these 23 differing procedures, 15 were more invasive. The 3D models were considered superior to 3D CT imaging in terms of spatial awareness and the observers’ ability to assess intra-articular fracture patterns. The models were assessed as being superior to the imaging when considering the ability to estimate the quantity of bone graft required. \u0000Conclusion: Although the inter-rater reliability of classification was not significantly improved, there were several advantages to using the 3D-printed models both separately from the CT images and together with the images. The effect of 3D models on patient outcome remains untested. The clinical impact of the use of 3D models (including cost, manufacturing time and radiation exposure) should be weighed against the potential benefits. \u0000Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"19 1","pages":"79-83"},"PeriodicalIF":0.0,"publicationDate":"2020-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67480138","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 : 2020-05-29DOI: 10.17159/2309-8309/2020/v19n2a7
H. Verhoef, L. Marais, PV Ryan, PD Rollinson
Background: The aim of this study was to identify the risk factors associated with the development of early complications in patients with hand infections. A secondary objective was to describe the bacteriology and resistance profile in our study population. Methods: This retrospective observational descriptive study was performed at a regional referral centre in South Africa. All primary hand infection cases treated over a period of one year were reviewed. Children under 18 years, cases with incomplete primary outcome data and post-operative infections were excluded. Clinical and demographic data was extracted from clinical records. Amputation, re-debridement and tissue loss requiring skin grafting were regarded as early complications. Bacteriological analysis comprised identification of causative organisms as well as evaluation of their resistance profiles. Risk factors that were found to be significant for development of early complications were entered into a multivariate regression analysis. Results: After inclusion and exclusion criteria were applied, 78 patients were deemed eligible for inclusion to the study. The patientassociated risk factors that were found to be associated with the development of early complications after univariate analysis were increasing age and poorly controlled diabetes mellitus. Human bites and polymicrobial infections were the only aetiological factors that were identified to be significant on a univariate level. Initial presentation to a private sector general practitioner (GP) was the only management factor to reach significance on univariate analysis. Human immunodeficiency virus (HIV) infection, CD4 count, viral load and duration of ARV treatment were not found to be significantly associated with the development of early infections. On multivariate logistic regression analysis, poorly controlled diabetes mellitus, human bites and first presentation to a private GP were the only risk factors that remained significant for the development of early complications. The culture yield was 68%. Staphylococcus aureus (S. aureus) was the most frequently isolated organism (37%), followed by polymicrobial infections (10%). S. aureus encountered in our study population remained mostly sensitive to cloxacillin; however, high levels of resistance (50%) to ampicillin were observed. Klebsiella sp. and Acinetobacter sp. were the most frequently observed Gram-negative organisms. Conclusion: After multivariate regression analysis, hand infections in poorly controlled diabetic patients, infections occurring after human bites as well as those affected by polymicrobial infections were identified as independent risk factors for development of early complications in patients with hand infections. HIV infection was not found to be a significant risk factor. Our bacteriological profile is in keeping with trends demonstrated in the literature where S. aureus infections seem to be declining in frequency while polymicrobial infections
{"title":"The risk of early complications in patients with hand infections","authors":"H. Verhoef, L. Marais, PV Ryan, PD Rollinson","doi":"10.17159/2309-8309/2020/v19n2a7","DOIUrl":"https://doi.org/10.17159/2309-8309/2020/v19n2a7","url":null,"abstract":"Background: The aim of this study was to identify the risk factors associated with the development of early complications in patients with hand infections. A secondary objective was to describe the bacteriology and resistance profile in our study population. \u0000Methods: This retrospective observational descriptive study was performed at a regional referral centre in South Africa. All primary hand infection cases treated over a period of one year were reviewed. Children under 18 years, cases with incomplete primary outcome data and post-operative infections were excluded. Clinical and demographic data was extracted from clinical records. Amputation, re-debridement and tissue loss requiring skin grafting were regarded as early complications. Bacteriological analysis comprised identification of causative organisms as well as evaluation of their resistance profiles. Risk factors that were found to be significant for development of early complications were entered into a multivariate regression analysis. \u0000Results: After inclusion and exclusion criteria were applied, 78 patients were deemed eligible for inclusion to the study. The patientassociated risk factors that were found to be associated with the development of early complications after univariate analysis were increasing age and poorly controlled diabetes mellitus. Human bites and polymicrobial infections were the only aetiological factors that were identified to be significant on a univariate level. Initial presentation to a private sector general practitioner (GP) was the only management factor to reach significance on univariate analysis. Human immunodeficiency virus (HIV) infection, CD4 count, viral load and duration of ARV treatment were not found to be significantly associated with the development of early infections. On multivariate logistic regression analysis, poorly controlled diabetes mellitus, human bites and first presentation to a private GP were the only risk factors that remained significant for the development of early complications. The culture yield was 68%. Staphylococcus aureus (S. aureus) was the most frequently isolated organism (37%), followed by polymicrobial infections (10%). S. aureus encountered in our study population remained mostly sensitive to cloxacillin; however, high levels of resistance (50%) to ampicillin were observed. Klebsiella sp. and Acinetobacter sp. were the most frequently observed Gram-negative organisms. \u0000Conclusion: After multivariate regression analysis, hand infections in poorly controlled diabetic patients, infections occurring after human bites as well as those affected by polymicrobial infections were identified as independent risk factors for development of early complications in patients with hand infections. HIV infection was not found to be a significant risk factor. Our bacteriological profile is in keeping with trends demonstrated in the literature where S. aureus infections seem to be declining in frequency while polymicrobial infections ","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"19 1","pages":"97-102"},"PeriodicalIF":0.0,"publicationDate":"2020-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49577727","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 : 2020-03-16DOI: 10.17159/2309-8309/2020/v19n1a5
T. Asmall, G. Gunston, R. Venter, B. Henry, K. Keet
Aims: Variation of the sciatic nerve may increase the risk of iatrogenic injury during total hip arthroplasty or arthroscopy, result in failure of peripheral blocks, or be associated with piriformis syndrome. Studies from Africa are scarce, with none to date from South Africa. Thus, the aims were to document the relationship between the sciatic nerve and piriformis muscle, variation in the bifurcation level and in the length of the nerve. Any significant differences between sexes and sides were also investigated. Methods: The lower limbs of 42 cadavers (84 limbs) were dissected and the relationship between the sciatic nerve and piriformis classified according to the patterns described by Beaton and Anson. The region of sciatic nerve bifurcation was documented, and the length of the nerve was measured in individuals with bifurcation in the thigh. Results: The normal relationship between the sciatic nerve and piriformis muscle was present in 64 limbs (76.2%). The bifurcation level of the nerve was variable in more than half the sample. No significant differences occurred in any of the variant patterns or bifurcation regions between side or sex; however, variations were more common in females than in males. The mean length of the sciatic nerve was 133.30±19.33 mm, with no differences in length between sex or side. Conclusion: Variations in the anatomy of the sciatic nerve occurred in up to half of the sample, which may have implications for increased risk of iatrogenic injury in total hip arthroplasty and arthroscopy, piriformis syndrome or sciatic block failure. Level of evidence: Level 4
{"title":"Surgical anatomy of the sciatic nerve and its relationship to the piriformis muscle with a description of a rare variant","authors":"T. Asmall, G. Gunston, R. Venter, B. Henry, K. Keet","doi":"10.17159/2309-8309/2020/v19n1a5","DOIUrl":"https://doi.org/10.17159/2309-8309/2020/v19n1a5","url":null,"abstract":"Aims: Variation of the sciatic nerve may increase the risk of iatrogenic injury during total hip arthroplasty or arthroscopy, result in failure of peripheral blocks, or be associated with piriformis syndrome. Studies from Africa are scarce, with none to date from South Africa. Thus, the aims were to document the relationship between the sciatic nerve and piriformis muscle, variation in the bifurcation level and in the length of the nerve. Any significant differences between sexes and sides were also investigated. \u0000Methods: The lower limbs of 42 cadavers (84 limbs) were dissected and the relationship between the sciatic nerve and piriformis classified according to the patterns described by Beaton and Anson. The region of sciatic nerve bifurcation was documented, and the length of the nerve was measured in individuals with bifurcation in the thigh. \u0000Results: The normal relationship between the sciatic nerve and piriformis muscle was present in 64 limbs (76.2%). The bifurcation level of the nerve was variable in more than half the sample. No significant differences occurred in any of the variant patterns or bifurcation regions between side or sex; however, variations were more common in females than in males. The mean length of the sciatic nerve was 133.30±19.33 mm, with no differences in length between sex or side. \u0000Conclusion: Variations in the anatomy of the sciatic nerve occurred in up to half of the sample, which may have implications for increased risk of iatrogenic injury in total hip arthroplasty and arthroscopy, piriformis syndrome or sciatic block failure. \u0000Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"19 1","pages":"33-39"},"PeriodicalIF":0.0,"publicationDate":"2020-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47794270","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 : 2020-03-16DOI: 10.17159/2309-8309/2020/v19n1a1
A. Horn, M. Sipilä
Background: We evaluated the outcomes following femoral lengthening by distraction osteogenesis in children. Additionally, we determined the incidence and nature of complications, the management thereof and factors associated with the development of complications. Method: A retrospective review was performed of all patients who underwent femoral lengthening as an isolated procedure at our institution. Data regarding presenting details and clinical course were collected and X rays analysed. The healing index (HI) and the percentage lengthened were calculated. Complications were defined as deep sepsis, joint contracture, fracture and neurological injury. Results: Fifteen patients underwent 16 femoral lengthenings from 2008–2018. Nine patients had congenital short femur or proximal focal femoral deficiency, three patients had sequelae of meningococcaemia and four had various other pathologies. The median age at time of surgery was 9 years (6–13). Median follow-up was 1.6 years (0.5–6.6). The median HI was 32 days/cm (20–60). Leg lengths were equalised to ≤2.5 cm in 11 patients; length achieved was as planned in all but three patients. Eight patients sustained fractures on average six days (2–57) after frame removal, five through the regenerate. Four required surgery. Thirteen patients developed joint contractures of which six required additional procedures to address this. Two deep infections required surgery. Two patients developed neurological symptoms of which one recovered fully. Higher percentage length gained (>20%) was associated with increased fracture and joint contracture rate. Diaphyseal osteotomy, as opposed to metaphyseal, was associated with increased risk of fracture (71% vs 25%). A diagnosis of congenital short femur was associated with increased fracture rate. Spanning the knee did not prevent joint stiffness in 4/5 patients but did prevent subluxation. Conclusion: Femoral lengthening using external fixation can be successful in achieving leg length equality, but complications are common and often require additional surgery. Limiting lengthening to less than 20% of the original bone length and performing the osteotomy through the metaphysis decreases the risk of fracture and joint contracture. Level of evidence: Level 4
背景:我们评估了儿童牵张成骨股骨延长术后的结果。此外，我们还确定了并发症的发生率和性质，并发症的处理方法以及与并发症发生相关的因素。方法:对我院所有单独行股骨延长术的患者进行回顾性分析。收集了有关表现细节和临床过程的数据，并分析了X光片。计算愈合指数(HI)和延长百分比。并发症定义为深度脓毒症、关节挛缩、骨折和神经损伤。结果:2008-2018年，15例患者接受了16次股骨延长术。9例患者有先天性股骨短或股骨近端局灶性缺陷，3例患者有脑膜炎球菌血症后遗症，4例患者有各种其他病理。手术时的中位年龄为9岁(6-13岁)。中位随访时间为1.6年(0.5-6.6年)。中位HI为32天/厘米(20-60)。11例患者腿长均为≤2.5 cm;除3例患者外，其余患者均达到计划长度。8例患者在框架取出后平均6天(2-57天)持续骨折，5例通过再生。四人需要手术。13例患者出现关节挛缩，其中6例需要额外的手术来解决这个问题。两处深部感染需要手术。两名患者出现神经系统症状，其中一名完全康复。增加的长度百分比(bbb20 %)与骨折和关节挛缩率增加有关。干骺端截骨术与干骺端截骨术相比，骨折风险增加(71% vs 25%)。先天性短股骨的诊断与骨折率增加有关。在4/5的患者中，跨膝不能防止关节僵硬，但可以防止半脱位。结论:采用外固定支架延长股骨可以成功地达到腿长相等，但并发症很常见，通常需要额外的手术。将延长限制在原骨长度的20%以内并通过干骺端行截骨术可降低骨折和关节挛缩的风险。证据等级:四级
{"title":"Femoral lengthening in children","authors":"A. Horn, M. Sipilä","doi":"10.17159/2309-8309/2020/v19n1a1","DOIUrl":"https://doi.org/10.17159/2309-8309/2020/v19n1a1","url":null,"abstract":"Background: We evaluated the outcomes following femoral lengthening by distraction osteogenesis in children. Additionally, we determined the incidence and nature of complications, the management thereof and factors associated with the development of complications. \u0000Method: A retrospective review was performed of all patients who underwent femoral lengthening as an isolated procedure at our institution. Data regarding presenting details and clinical course were collected and X rays analysed. The healing index (HI) and the percentage lengthened were calculated. Complications were defined as deep sepsis, joint contracture, fracture and neurological injury. \u0000Results: Fifteen patients underwent 16 femoral lengthenings from 2008–2018. Nine patients had congenital short femur or proximal focal femoral deficiency, three patients had sequelae of meningococcaemia and four had various other pathologies. The median age at time of surgery was 9 years (6–13). Median follow-up was 1.6 years (0.5–6.6). The median HI was 32 days/cm (20–60). Leg lengths were equalised to ≤2.5 cm in 11 patients; length achieved was as planned in all but three patients. Eight patients sustained fractures on average six days (2–57) after frame removal, five through the regenerate. Four required surgery. Thirteen patients developed joint contractures of which six required additional procedures to address this. Two deep infections required surgery. Two patients developed neurological symptoms of which one recovered fully. Higher percentage length gained (>20%) was associated with increased fracture and joint contracture rate. Diaphyseal osteotomy, as opposed to metaphyseal, was associated with increased risk of fracture (71% vs 25%). A diagnosis of congenital short femur was associated with increased fracture rate. Spanning the knee did not prevent joint stiffness in 4/5 patients but did prevent subluxation. \u0000Conclusion: Femoral lengthening using external fixation can be successful in achieving leg length equality, but complications are common and often require additional surgery. Limiting lengthening to less than 20% of the original bone length and performing the osteotomy through the metaphysis decreases the risk of fracture and joint contracture. \u0000Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44048676","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 : 2020-03-16DOI: 10.17159/2309-8309/2020/v19n1a4
K. Wiese, F. Kock, C. Blake, T. Franken, J. Jordaan
Aims: Total hip arthroplasty (THA) is considered one of the most successful surgical procedures in modern medicine. The success of THA is well documented, and includes high patient satisfaction rates, low morbidity rates and cost-effective surgery. Most publications come from THA performed in high-volume arthroplasty units, done in high-income countries. Limited data is available on THA performed in low-volume, low-income countries. The aim of this study was to evaluate the accuracy of digital templating in a low-volume, resource constrained orthopaedic unit from 2016 to 2017. We introduced a standardised hip radiography programme, followed by a stepwise pre-operative templating method. We compared the implant sizes inserted during THA with the templated sizes determined pre-operatively. This was to deduct whether digital templating in a low volume arthroplasty unit is accurate and of the same value as digital templating done in a high-volume unit. Methods: A descriptive retrospective study was conducted on all patients who received elective primary uncemented THA in a low-volume, resource-constrained orthopaedic unit. Pre-operative radiographs were done according to guidelines published by Scheerlinck followed by pre-operative templating using the Impax Orthopaedic tools® software and a stepwise technique described by Bono. Implanted prosthesis sizes, as recorded in operation notes, were retrospectively compared to pre-operative templating. Results: A total of 56 participants were included (30 females, 26 males), with a mean age of 55.5 (32–78) years. On the acetabular side, in 71% (n=40; p<0.001) there was a cumulative difference of one implant size between the templated cup size and the actual cup size used. On the femoral side, in 79% (n=44; p<0.001) there was a cumulative difference of one implant size between the templated stem size and the actual stem size used. Oversizing of the implants was more prevalent, with 20% (n=11) of the acetabular components oversized by two or more sizes and 13% (n=7) of the femoral components oversized by two or more sizes. Conclusion: With the introduction of a standardised radiology programme and a stepwise templating technique, the benefits and accuracy of pre-operative templating done in a low-volume, resource-constrained orthopaedic unit is comparable to published data done in high-volume arthroplasty units. Level of evidence: Level 4
{"title":"The accuracy of pre-operative digital templating in total hip arthroplasty performed in a low-volume, resource-constrained orthopaedic unit","authors":"K. Wiese, F. Kock, C. Blake, T. Franken, J. Jordaan","doi":"10.17159/2309-8309/2020/v19n1a4","DOIUrl":"https://doi.org/10.17159/2309-8309/2020/v19n1a4","url":null,"abstract":"Aims: Total hip arthroplasty (THA) is considered one of the most successful surgical procedures in modern medicine. The success of THA is well documented, and includes high patient satisfaction rates, low morbidity rates and cost-effective surgery. Most publications come from THA performed in high-volume arthroplasty units, done in high-income countries. Limited data is available on THA performed in low-volume, low-income countries. The aim of this study was to evaluate the accuracy of digital templating in a low-volume, resource constrained orthopaedic unit from 2016 to 2017. We introduced a standardised hip radiography programme, followed by a stepwise pre-operative templating method. We compared the implant sizes inserted during THA with the templated sizes determined pre-operatively. This was to deduct whether digital templating in a low volume arthroplasty unit is accurate and of the same value as digital templating done in a high-volume unit. \u0000Methods: A descriptive retrospective study was conducted on all patients who received elective primary uncemented THA in a low-volume, resource-constrained orthopaedic unit. Pre-operative radiographs were done according to guidelines published by Scheerlinck followed by pre-operative templating using the Impax Orthopaedic tools® software and a stepwise technique described by Bono. Implanted prosthesis sizes, as recorded in operation notes, were retrospectively compared to pre-operative templating. \u0000Results: A total of 56 participants were included (30 females, 26 males), with a mean age of 55.5 (32–78) years. On the acetabular side, in 71% (n=40; p<0.001) there was a cumulative difference of one implant size between the templated cup size and the actual cup size used. On the femoral side, in 79% (n=44; p<0.001) there was a cumulative difference of one implant size between the templated stem size and the actual stem size used. Oversizing of the implants was more prevalent, with 20% (n=11) of the acetabular components oversized by two or more sizes and 13% (n=7) of the femoral components oversized by two or more sizes. \u0000Conclusion: With the introduction of a standardised radiology programme and a stepwise templating technique, the benefits and accuracy of pre-operative templating done in a low-volume, resource-constrained orthopaedic unit is comparable to published data done in high-volume arthroplasty units. \u0000Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"19 1","pages":"28-32"},"PeriodicalIF":0.0,"publicationDate":"2020-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42988534","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 : 2020-03-16DOI: 10.17159/2309-8309/2020/v19n1a3
J. Davis, M. Burger, G. Pienaar, R. Lamberts
Aims: The aim of the study was to investigate the differences in participant characteristics between positive and negative, positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) activity at the spinal tuberculosis (TB) site following 12 months of the appropriate chemotherapy therapy for spinal TB. A secondary aim of the study was to determine whether erythrocyte sedimentation rate (ESR) levels could be used as a reliable marker of TB activity and/or treatment success of spinal TB, especially in a high HIV-positive population. Patients and methods: All patients who were treated for spinal TB and underwent an 18F-FDG PET/CT scan were considered for inclusion. PET/CT positive patients underwent a spinal biopsy which was sent for microscopy, Gram staining, Gene Xpert (GXP) polymerase chain reaction (PCR) and histology. Patients in the PET/CT positive group underwent a repeat MRI scan and biopsy at the completion of treatment to investigate the potential presence of resistance or ongoing active spinal TB. Results: A total of 18 patients were included in the study: five patients were allocated to the PET/CT positive group and 13 to the PET/CT negative group. The PET/CT negative group was significantly older (p=0.016) and had significantly fewer TB-infected vertebrae (p=0.010) than the PET/CT positive group. Two patients, one in each group, were found to have drug-resistant spinal TB. At the 12-month follow-up visit, two patients (40%) in the PET/CT positive group and three patients (30%) in the PET/CT negative group were still complaining of back pain. All smear microscopy results of the PET/CT positive patients who underwent a repeat biopsy were negative after the conclusion of treatment; culture results (n=4/4) were also negative. GXP PCR results were positive in four and negative in one case. Only one of four samples showed classic TB signs on histology. Conclusion: This study is the first to report on biopsies done from a PET/CT positive site, after 12 months of anti-tubercular treatment. It is not unlikely that PET/CT is over-sensitive and can show metabolic activity in areas of sterile inflammation, and future studies are necessary to evaluate this. Level of evidence: Level 3
{"title":"18F-FDG PET/CT as a modality for the evaluation of persisting raised infective markers in patients with spinal tuberculosis","authors":"J. Davis, M. Burger, G. Pienaar, R. Lamberts","doi":"10.17159/2309-8309/2020/v19n1a3","DOIUrl":"https://doi.org/10.17159/2309-8309/2020/v19n1a3","url":null,"abstract":"Aims: The aim of the study was to investigate the differences in participant characteristics between positive and negative, positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) activity at the spinal tuberculosis (TB) site following 12 months of the appropriate chemotherapy therapy for spinal TB. A secondary aim of the study was to determine whether erythrocyte sedimentation rate (ESR) levels could be used as a reliable marker of TB activity and/or treatment success of spinal TB, especially in a high HIV-positive population. \u0000Patients and methods: All patients who were treated for spinal TB and underwent an 18F-FDG PET/CT scan were considered for inclusion. PET/CT positive patients underwent a spinal biopsy which was sent for microscopy, Gram staining, Gene Xpert (GXP) polymerase chain reaction (PCR) and histology. Patients in the PET/CT positive group underwent a repeat MRI scan and biopsy at the completion of treatment to investigate the potential presence of resistance or ongoing active spinal TB. \u0000Results: A total of 18 patients were included in the study: five patients were allocated to the PET/CT positive group and 13 to the PET/CT negative group. The PET/CT negative group was significantly older (p=0.016) and had significantly fewer TB-infected vertebrae (p=0.010) than the PET/CT positive group. Two patients, one in each group, were found to have drug-resistant spinal TB. At the 12-month follow-up visit, two patients (40%) in the PET/CT positive group and three patients (30%) in the PET/CT negative group were still complaining of back pain. All smear microscopy results of the PET/CT positive patients who underwent a repeat biopsy were negative after the conclusion of treatment; culture results (n=4/4) were also negative. GXP PCR results were positive in four and negative in one case. Only one of four samples showed classic TB signs on histology. \u0000Conclusion: This study is the first to report on biopsies done from a PET/CT positive site, after 12 months of anti-tubercular treatment. It is not unlikely that PET/CT is over-sensitive and can show metabolic activity in areas of sterile inflammation, and future studies are necessary to evaluate this. \u0000Level of evidence: Level 3","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"19 1","pages":"23-27"},"PeriodicalIF":0.0,"publicationDate":"2020-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41921047","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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