Pub Date : 2023-01-01DOI: 10.17159/2309-8309/2023/v22n1a7
C. Nkosi, T. Sefeane
Abstract
摘要
{"title":"A subungual glomus tumour of the finger with five reappearances: a rare case report","authors":"C. Nkosi, T. Sefeane","doi":"10.17159/2309-8309/2023/v22n1a7","DOIUrl":"https://doi.org/10.17159/2309-8309/2023/v22n1a7","url":null,"abstract":"Abstract","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"422 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481984","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/v22n2a5
M. Thiart, A. Nansook
Acute haematogenous osteomyelitis (AHOM) is a bacterial infection localised in bone that usually occurs after an episode of bacteraemia. This infection is commonly encountered by doctors in low- and middle-income countries (LMICs) and, if not recognised early and managed appropriately, can harbour significant early and late complications, including death. This narrative review aims to summarise the current management of AHOM, highlight the controversies and report on new advances in diagnosis and treatment. AHOM is typically a monomicrobial disease. Staphylococcus aureus remains the most common pathogen globally, accounting for 70-90% of all cases. Diagnostic work-up includes complete blood cell count, serum C-reactive protein, erythrocyte sedimentation rate, imaging and blood culture. Management of AHOM includes empiric intravenous (IV) antibiotics based on the most likely causative agents; source control entailing surgery to drain any abscesses and obtain specimens for microscopy, culture and sensitivity (MCS), as well as debridement of any necrotic bone; and subsequent targeted antibiotic therapy effective against the identified pathogen with the narrowest spectrum. Treatment response is monitored with repeat CRP every 48-72 hours. The decision to switch from IV to oral antibiotics is made if there is clinical improvement and the CRP is < 20 mg/L. The total duration of antibiotics is six weeks. Treatment of paediatric AHOM is multidisciplinary and includes orthopaedic surgeons, paediatricians, infectious diseases specialists, physiotherapists, dieticians, nurses and social workers. AHOM can cause devastating destruction of the bone due to tissue necrosis, leading to late sequelae. These complications are more common in children in LMICs. Level of evidence: Level 5
{"title":"Acute haematogenous osteomyelitis in the paediatric population: a current concepts review","authors":"M. Thiart, A. Nansook","doi":"10.17159/2309-8309/2023/v22n2a5","DOIUrl":"https://doi.org/10.17159/2309-8309/2023/v22n2a5","url":null,"abstract":"Acute haematogenous osteomyelitis (AHOM) is a bacterial infection localised in bone that usually occurs after an episode of bacteraemia. This infection is commonly encountered by doctors in low- and middle-income countries (LMICs) and, if not recognised early and managed appropriately, can harbour significant early and late complications, including death. This narrative review aims to summarise the current management of AHOM, highlight the controversies and report on new advances in diagnosis and treatment. AHOM is typically a monomicrobial disease. Staphylococcus aureus remains the most common pathogen globally, accounting for 70-90% of all cases. Diagnostic work-up includes complete blood cell count, serum C-reactive protein, erythrocyte sedimentation rate, imaging and blood culture. Management of AHOM includes empiric intravenous (IV) antibiotics based on the most likely causative agents; source control entailing surgery to drain any abscesses and obtain specimens for microscopy, culture and sensitivity (MCS), as well as debridement of any necrotic bone; and subsequent targeted antibiotic therapy effective against the identified pathogen with the narrowest spectrum. Treatment response is monitored with repeat CRP every 48-72 hours. The decision to switch from IV to oral antibiotics is made if there is clinical improvement and the CRP is < 20 mg/L. The total duration of antibiotics is six weeks. Treatment of paediatric AHOM is multidisciplinary and includes orthopaedic surgeons, paediatricians, infectious diseases specialists, physiotherapists, dieticians, nurses and social workers. AHOM can cause devastating destruction of the bone due to tissue necrosis, leading to late sequelae. These complications are more common in children in LMICs. 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":"67481643","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/v22n1a6
Falethu M. Sukati, J. Viljoen, Alwich Alexander³
Intertrochanteric fractures are common injuries around the hip, especially among the elderly. With the rising incidence of these injuries, they are expected to double by 2050. Incidence rates are higher in females than males and in white patients than black African patients. Osteoporosis weakens the local trochanteric anatomic support leading to an increased susceptibility to fractures. Disruption of the posteromedial calcar region results in fracture instability. Optimal lag screw position and fracture reduction are significant determinants for postoperative outcomes. The tip apex distance and reduction criteria determine lag screw cut-out risk and fracture reduction quality, respectively. A calcar-referenced tip apex distance is comparable if not better than the tip apex distance in predicting cut-out risk. Optimal reduction is in slight valgus, a positive medial cortex apposition and smooth anterior cortex apposition. High mortality rates are observed with non-surgical treatment. Surgical management is therefore the gold standard for intertrochanteric fractures. Treatment options are categorised into extramedullary fixation, intramedullary fixation and proximal femur replacement. They include the dynamic hip screw (DHS), cephalomedullary nails (CMN) and arthroplasty. Although still in use, the proximal femur locking plate is falling out of favour due to high complication rates. Fracture stability and pattern influence the treatment choice. There is, however, a growing use of CMNs which has been attributed to surgical training background. Modification of older CMN designs has improved treatment outcomes. Systematic meta-analyses of randomised controlled trials (RCTs) do not show superiority of one treatment option over another; therefore, there is no consensus on the best treatment choice. The proximal femur nail antirotation (PFNA) has better outcomes compared to other fixation options with respect to intraoperative blood loss and Harris hip scores. As a group, CMNs have a better 120-day postoperative quality of life compared to the DHS. No significant difference in complications has been found between treatment options. In light of the anticipated increased incidence of intertrochanteric fracture, more work is needed in planning national resource allocation, devising preventative methods and improving clinical interventions in South Africa. Level of evidence: Level 5
{"title":"Intertrochanteric femur fractures: a current concepts review","authors":"Falethu M. Sukati, J. Viljoen, Alwich Alexander³","doi":"10.17159/2309-8309/2023/v22n1a6","DOIUrl":"https://doi.org/10.17159/2309-8309/2023/v22n1a6","url":null,"abstract":"Intertrochanteric fractures are common injuries around the hip, especially among the elderly. With the rising incidence of these injuries, they are expected to double by 2050. Incidence rates are higher in females than males and in white patients than black African patients. Osteoporosis weakens the local trochanteric anatomic support leading to an increased susceptibility to fractures. Disruption of the posteromedial calcar region results in fracture instability. Optimal lag screw position and fracture reduction are significant determinants for postoperative outcomes. The tip apex distance and reduction criteria determine lag screw cut-out risk and fracture reduction quality, respectively. A calcar-referenced tip apex distance is comparable if not better than the tip apex distance in predicting cut-out risk. Optimal reduction is in slight valgus, a positive medial cortex apposition and smooth anterior cortex apposition. High mortality rates are observed with non-surgical treatment. Surgical management is therefore the gold standard for intertrochanteric fractures. Treatment options are categorised into extramedullary fixation, intramedullary fixation and proximal femur replacement. They include the dynamic hip screw (DHS), cephalomedullary nails (CMN) and arthroplasty. Although still in use, the proximal femur locking plate is falling out of favour due to high complication rates. Fracture stability and pattern influence the treatment choice. There is, however, a growing use of CMNs which has been attributed to surgical training background. Modification of older CMN designs has improved treatment outcomes. Systematic meta-analyses of randomised controlled trials (RCTs) do not show superiority of one treatment option over another; therefore, there is no consensus on the best treatment choice. The proximal femur nail antirotation (PFNA) has better outcomes compared to other fixation options with respect to intraoperative blood loss and Harris hip scores. As a group, CMNs have a better 120-day postoperative quality of life compared to the DHS. No significant difference in complications has been found between treatment options. In light of the anticipated increased incidence of intertrochanteric fracture, more work is needed in planning national resource allocation, devising preventative methods and improving clinical interventions in South Africa. 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":"67481342","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/v22n2a2
W. Laney, Dharshen Naicker, Brenda Milner, Shahed Omar³
BACKGROUND: In South Africa, doctors commonly treat patients suffering major trauma, often with multiple injuries, which necessitates the demand for a rapid diagnostic assessment. Whole body computed tomography (CT pan scan) allows for a rapid multisystem injury diagnosis. There is a scarcity of literature evaluating the extent of orthopaedic injuries in CT pan scan of polytrauma patients. The aim of the study was to evaluate the local epidemiology of orthopaedic injuries in polytrauma patients who underwent a CT pan scan. METHODS: A retrospective, observational analysis, based at an academic hospital, was done of polytrauma patients who underwent a CT pan scan during a two-year period. A database was compiled by accessing the picture archiving and communication system. RESULTS: A total of 296 polytrauma patients had a reported CT pan scan; 85% were male and 15% were female with a median age of 33 years. The most common mechanism of injury was motor vehicle accidents (33.1%). A total of 1 012 injuries were identified; 196 were spinal fractures (mostly cervical), 137 were pelvic/sacral fractures, and 101 were long bone fractures of the upper and lower limbs. The most frequent non-orthopaedic injury sustained was a chest injury. In a pedestrian-vehicle accident, the most common combination of injuries was a chest injury with an associated pelvic/sacral injury. Interpersonal and intentional injuries were significantly associated with a higher risk of thoracic spine fractures (relative risk [RR] 1.8, CI 1.1-2.9), whereas road traffic accidents were significantly associated with a higher risk of scapula/clavicula fractures (RR 2.0, CI 1.2-3.5) and a higher risk of tibia/fibula fractures (RR 3.5, CI 1.2-10.3). CONCLUSION: The majority of polytrauma patients were young males involved in road traffic accidents. A patient involved in a road traffic accident is 3.5 times more likely to sustain a tibia/fibula fracture as opposed to any other fracture. One in four patients who sustained a chest injury had an associated cervical spine injury, and one in three patients had a pelvic/sacral injury, and similarly with head injuries. The findings of this study highlight injury patterns that should be anticipated in polytrauma patients. Level of evidence: Level 3
背景:在南非，医生通常治疗患有严重创伤的患者，通常伴有多处损伤，这就需要快速诊断评估。全身计算机断层扫描(CT泛扫描)允许快速多系统损伤诊断。评估多发创伤患者CT平扫的骨科损伤程度的文献很少。本研究的目的是评估接受CT平扫的多发创伤患者骨科损伤的局部流行病学。方法:在一家学术医院对两年内接受CT平扫的多发创伤患者进行回顾性观察分析。通过访问图片存档和通信系统，建立了数据库。结果:共有296例多发外伤患者进行了CT平扫;85%为男性，15%为女性，中位年龄为33岁。最常见的伤害机制是机动车事故(33.1%)。共发现1 012人受伤;196例为脊柱骨折(以颈椎为主)，137例为骨盆/骶骨骨折，101例为上肢和下肢长骨骨折。最常见的非骨科损伤是胸部损伤。在行人-车辆事故中，最常见的损伤组合是胸部损伤并伴有盆腔/骶骨损伤。人际伤害和故意伤害与胸椎骨折的高风险显著相关(相对危险度[RR] 1.8, CI 1.1-2.9)，而道路交通事故与肩胛骨/锁骨骨折的高风险(RR 2.0, CI 1.2-3.5)和胫骨/腓骨骨折的高风险(RR 3.5, CI 1.2-10.3)显著相关。结论:道路交通事故多发伤患者以年轻男性为主。在道路交通事故中，患者发生胫骨/腓骨骨折的可能性是其他骨折的3.5倍。四分之一的胸部损伤患者伴有颈椎损伤，三分之一的患者伴有骨盆/骶骨损伤，头部损伤也有类似情况。本研究的发现强调了多发创伤患者应该预料到的损伤模式。证据等级:三级
{"title":"Analysis of orthopaedic injuries in CT pan scans of polytrauma patients at a quaternary academic hospital","authors":"W. Laney, Dharshen Naicker, Brenda Milner, Shahed Omar³","doi":"10.17159/2309-8309/2023/v22n2a2","DOIUrl":"https://doi.org/10.17159/2309-8309/2023/v22n2a2","url":null,"abstract":"BACKGROUND: In South Africa, doctors commonly treat patients suffering major trauma, often with multiple injuries, which necessitates the demand for a rapid diagnostic assessment. Whole body computed tomography (CT pan scan) allows for a rapid multisystem injury diagnosis. There is a scarcity of literature evaluating the extent of orthopaedic injuries in CT pan scan of polytrauma patients. The aim of the study was to evaluate the local epidemiology of orthopaedic injuries in polytrauma patients who underwent a CT pan scan. METHODS: A retrospective, observational analysis, based at an academic hospital, was done of polytrauma patients who underwent a CT pan scan during a two-year period. A database was compiled by accessing the picture archiving and communication system. RESULTS: A total of 296 polytrauma patients had a reported CT pan scan; 85% were male and 15% were female with a median age of 33 years. The most common mechanism of injury was motor vehicle accidents (33.1%). A total of 1 012 injuries were identified; 196 were spinal fractures (mostly cervical), 137 were pelvic/sacral fractures, and 101 were long bone fractures of the upper and lower limbs. The most frequent non-orthopaedic injury sustained was a chest injury. In a pedestrian-vehicle accident, the most common combination of injuries was a chest injury with an associated pelvic/sacral injury. Interpersonal and intentional injuries were significantly associated with a higher risk of thoracic spine fractures (relative risk [RR] 1.8, CI 1.1-2.9), whereas road traffic accidents were significantly associated with a higher risk of scapula/clavicula fractures (RR 2.0, CI 1.2-3.5) and a higher risk of tibia/fibula fractures (RR 3.5, CI 1.2-10.3). CONCLUSION: The majority of polytrauma patients were young males involved in road traffic accidents. A patient involved in a road traffic accident is 3.5 times more likely to sustain a tibia/fibula fracture as opposed to any other fracture. One in four patients who sustained a chest injury had an associated cervical spine injury, and one in three patients had a pelvic/sacral injury, and similarly with head injuries. The findings of this study highlight injury patterns that should be anticipated in polytrauma patients. 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":"67481596","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/v22n2a6
S. Philip, Marule P Kgagudi²
BACKGROUND: Adenoid cystic carcinoma is a rare epithelial tumour of the salivary glands It arises even more rarely in the aerodigestive tract, lacrimal glands and adnexal skin glands. Acral metastasis is a rare presentation of carcinoma of unknown origin. Head and neck malignancies with acral metastasis are extremely rare. CASE REPORT: We present our case of metastatic adenoid cystic carcinoma presenting in the form of a tumour arising from an adnexal skin gland of the foot DISCUSSION: The case is an example of atypical presentation and dilemma in diagnosis of adenoid cystic carcinoma (histopathological confusion). To our knowledge there is no case in the literature with similar clinicopathological highlights CONCLUSION: Corroborative information is crucial for accurate diagnosis and appropriate management of patients by multidisciplinary teams. The need for timeous presentation and treatment for masses, even if clinically asymptomatic, is also highlighted Level of evidence: Level 5
{"title":"Cutaneous adenoid cystic carcinoma: clinical conundrum of a lower limb mass","authors":"S. Philip, Marule P Kgagudi²","doi":"10.17159/2309-8309/2023/v22n2a6","DOIUrl":"https://doi.org/10.17159/2309-8309/2023/v22n2a6","url":null,"abstract":"BACKGROUND: Adenoid cystic carcinoma is a rare epithelial tumour of the salivary glands It arises even more rarely in the aerodigestive tract, lacrimal glands and adnexal skin glands. Acral metastasis is a rare presentation of carcinoma of unknown origin. Head and neck malignancies with acral metastasis are extremely rare. CASE REPORT: We present our case of metastatic adenoid cystic carcinoma presenting in the form of a tumour arising from an adnexal skin gland of the foot DISCUSSION: The case is an example of atypical presentation and dilemma in diagnosis of adenoid cystic carcinoma (histopathological confusion). To our knowledge there is no case in the literature with similar clinicopathological highlights CONCLUSION: Corroborative information is crucial for accurate diagnosis and appropriate management of patients by multidisciplinary teams. The need for timeous presentation and treatment for masses, even if clinically asymptomatic, is also highlighted 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":"67481677","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/v22n1a1
P. Fourie, Raoul D Erasmus, T. Botha, Hans W Jacobs³
BACKGROUND: Total hip arthroplasty (THA) is one of the most performed and most researched procedures worldwide, and there is an ever-growing demand for THA in an already resource-constrained system in South Africa. Early dislocation after THA remains a serious and costly problem; however, few THA outcome studies have been performed locally. This study therefore aimed to calculate the incidence of dislocation after THA and to identify risk factors for dislocation after THA in a South African academic hospital METHODS: In this retrospective cohort review, files and radiographs of 543 patients were reviewed for dislocation during the first year after primary THA. The reason for the THA, the surgical data, the implant data, and whether and when dislocation occurred were recorded for each patient. Fisher's exact tests and independent t-tests were done to analyse the association between variables and a patient's odds of experiencing a dislocation after THA RESULTS: Twenty (3.7%) out of 543 THAs dislocated during the first year, 17 of these within the first three months. The surgical approach used was not shown to be a significant risk factor (p = 0.650) for dislocation, although the Hardinge approach had been used for all 20 cases of dislocation. Similar dislocation rates (p = 0.967) were found for THAs done for displaced neck of femur (NOF) fractures (3.6%) and for elective THAs (3.7%). Trauma THAs made up more than half (55%) of our study population. Femoral head sizes < 32 mm (p = 0.390 for neck of femur THA and p = 0.451 for elective THA) and a single mobility design (p = 0.494) both produced a higher dislocation rate, although this was not statistically significant. Surgeon experience did not prove to be significant for our study population (p = 0.570 CONCLUSION: The dislocation rate after THA at our institution is lower than rates reported in the literature for NOF THA and similar to rates reported for elective THA. This was found despite the dislocation rate for the Hardinge approach being nearly eight times higher than expected. Minimal surgeon experience, implant coupling and smaller femoral head size did not prove to be significant risk factors for dislocation after THA Level of evidence: Level 4
背景:全髋关节置换术(THA)是世界范围内进行最多和研究最多的手术之一，在南非已经资源受限的系统中，对THA的需求不断增长。THA术后早期脱位仍然是一个严重且昂贵的问题;然而，很少有局部进行THA结果研究。因此，本研究旨在计算南非一家学术医院THA后脱位的发生率，并确定THA后脱位的危险因素。方法:在这项回顾性队列研究中，对543例原发性THA后第一年脱位患者的档案和x线片进行了回顾。记录每位患者髋关节置换术的原因、手术资料、植入物资料以及是否及何时发生脱位。进行Fisher精确检验和独立t检验来分析变量与THA后患者脱位几率之间的关系。结果:543例THA脱位中有20例(3.7%)在第一年脱位，其中17例发生在前三个月内。尽管所有20例脱位均采用了Hardinge入路，但所采用的手术入路并未显示为脱位的显著危险因素(p = 0.650)。移位型股骨颈(NOF)骨折行tha(3.6%)和择期tha(3.7%)的脱位率相似(p = 0.967)。创伤患者占我们研究人群的一半以上(55%)。股骨头尺寸< 32 mm(股骨颈THA p = 0.390，选择性THA p = 0.451)和单一活动设计(p = 0.494)均产生较高的脱位率，尽管这没有统计学意义。结论:在我们的机构，THA后脱位率低于文献中报道的非THA，与选择性THA相似。尽管Hardinge入路的脱位率几乎是预期的8倍，但我们还是发现了这一点。最少的手术经验、植入物耦合和较小的股骨头尺寸并未被证明是THA后脱位的重要危险因素
{"title":"Low dislocation rate one year after total hip arthroplasty at a tertiary hospital in South Africa","authors":"P. Fourie, Raoul D Erasmus, T. Botha, Hans W Jacobs³","doi":"10.17159/2309-8309/2023/v22n1a1","DOIUrl":"https://doi.org/10.17159/2309-8309/2023/v22n1a1","url":null,"abstract":"BACKGROUND: Total hip arthroplasty (THA) is one of the most performed and most researched procedures worldwide, and there is an ever-growing demand for THA in an already resource-constrained system in South Africa. Early dislocation after THA remains a serious and costly problem; however, few THA outcome studies have been performed locally. This study therefore aimed to calculate the incidence of dislocation after THA and to identify risk factors for dislocation after THA in a South African academic hospital METHODS: In this retrospective cohort review, files and radiographs of 543 patients were reviewed for dislocation during the first year after primary THA. The reason for the THA, the surgical data, the implant data, and whether and when dislocation occurred were recorded for each patient. Fisher's exact tests and independent t-tests were done to analyse the association between variables and a patient's odds of experiencing a dislocation after THA RESULTS: Twenty (3.7%) out of 543 THAs dislocated during the first year, 17 of these within the first three months. The surgical approach used was not shown to be a significant risk factor (p = 0.650) for dislocation, although the Hardinge approach had been used for all 20 cases of dislocation. Similar dislocation rates (p = 0.967) were found for THAs done for displaced neck of femur (NOF) fractures (3.6%) and for elective THAs (3.7%). Trauma THAs made up more than half (55%) of our study population. Femoral head sizes < 32 mm (p = 0.390 for neck of femur THA and p = 0.451 for elective THA) and a single mobility design (p = 0.494) both produced a higher dislocation rate, although this was not statistically significant. Surgeon experience did not prove to be significant for our study population (p = 0.570 CONCLUSION: The dislocation rate after THA at our institution is lower than rates reported in the literature for NOF THA and similar to rates reported for elective THA. This was found despite the dislocation rate for the Hardinge approach being nearly eight times higher than expected. Minimal surgeon experience, implant coupling and smaller femoral head size did not prove to be significant risk factors for dislocation after THA 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":"67481172","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 : 2022-01-01DOI: 10.17159/2309-8309/2022/v21n1a7
N. Ferreira, C. Anley, Etienne Joubert
ABSTRACT BACKGROUND: This review aims to collate all published work on the management of transarticular gunshot injuries to better inform decision-making when managing these injuries METHODS: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was undertaken. A literature search of major electronic databases was conducted to identify journal articles relating to the management of transarticular gunshot injuries published from database inception until 31 January 2021 RESULTS: Sixty-eight publications reporting on the management of 544 patients were included. Injuries to the lower limbs were reported in 438 cases (81%), while injuries to the upper limb accounted for 106 cases (19%). A total of 145 patients (27%) developed a deep infection. Following the routine use of antibiotics, 6% of patients (14/251) developed an infection. A significantly higher hip joint infection rate was seen in patients who sustained associated hollow viscus injury (11/30, 37% CONCLUSION: The management of transarticular gunshot injuries is currently based on limited high-quality evidence. Modern antibiotic and surgical management practices have resulted in low overall septic complications; however, different joints have different injury and complication profiles. Future research should be aimed at identifying joint-specific evidence-based care pathways Level of evidence: Level 4 Keywords: gunshot, ballistic, joint, transarticular, intra-articular
{"title":"Transarticular gunshot injuries: a systematic review of 150 years of management","authors":"N. Ferreira, C. Anley, Etienne Joubert","doi":"10.17159/2309-8309/2022/v21n1a7","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n1a7","url":null,"abstract":"ABSTRACT BACKGROUND: This review aims to collate all published work on the management of transarticular gunshot injuries to better inform decision-making when managing these injuries METHODS: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was undertaken. A literature search of major electronic databases was conducted to identify journal articles relating to the management of transarticular gunshot injuries published from database inception until 31 January 2021 RESULTS: Sixty-eight publications reporting on the management of 544 patients were included. Injuries to the lower limbs were reported in 438 cases (81%), while injuries to the upper limb accounted for 106 cases (19%). A total of 145 patients (27%) developed a deep infection. Following the routine use of antibiotics, 6% of patients (14/251) developed an infection. A significantly higher hip joint infection rate was seen in patients who sustained associated hollow viscus injury (11/30, 37% CONCLUSION: The management of transarticular gunshot injuries is currently based on limited high-quality evidence. Modern antibiotic and surgical management practices have resulted in low overall septic complications; however, different joints have different injury and complication profiles. Future research should be aimed at identifying joint-specific evidence-based care pathways Level of evidence: Level 4 Keywords: gunshot, ballistic, joint, transarticular, intra-articular","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67480643","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 : 2022-01-01DOI: 10.17159/2309-8309/2022/v21n1a8
Warren Meier, Mluleki Tsama, Abdirashid A Aden
ABSTRACT BACKGROUND: The occurrence of ganglion cysts around the elbow is rare, and the occurrence of these lesions without any symptoms of compression to the nearby structures is even rarer. Most published cases of elbow ganglions have reported patients with symptoms relating to compression of the radial nerve, or branches thereof secondary to anteriorly located cysts. We present two cases of ganglions occurring on the posterolateral aspect of the elbow with no pressure symptoms to the radial nerve CASE SERIES: The first case is a 33-year-old male, with a seven-month history of a spontaneous, slow-growing mass on the posterolateral aspect of his left elbow. The second case is a 38-year-old female, with a 12-month history of a spontaneous mass on the posterolateral aspect of her left elbow. In both cases, the reason for presentation was the unsightly elbow with an enlarging mass. The lesions were painless and both patients were neurologically intact with no restriction on range of motion of the joint. Both patients underwent excision of the mass for aesthetic reasons DISCUSSION: Patients with elbow ganglions usually have cysts located anterior to the radiocapitellar joint and almost invariably present with an associated motor, or less commonly, a sensory deficit of the radial nerve. Various treatment modalities have been reported; however, the vast majority undergo open surgical excision due to their association with progressive neurological symptoms. This usually leads to resolution of symptoms, and recurrence is rare CONCLUSION: The clinical presentation of the two patients reported in this case series seems to be far less frequent than patients presenting with a neuropathy of the radial nerve due to an anteriorly located elbow ganglion. It cannot, however, be excluded that there is an underreporting of asymptomatic elbow ganglions. According to our review of the English literature, this is only the third report of an asymptomatic elbow ganglion in the lateral compartment of the elbow Level of evidence: Level 5 Keywords: elbow, ganglion, cyst
{"title":"A rare occurrence of ganglion cysts on the posterolateral aspect of the elbow without neurological manifestations: a case series and review of the literature","authors":"Warren Meier, Mluleki Tsama, Abdirashid A Aden","doi":"10.17159/2309-8309/2022/v21n1a8","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n1a8","url":null,"abstract":"ABSTRACT BACKGROUND: The occurrence of ganglion cysts around the elbow is rare, and the occurrence of these lesions without any symptoms of compression to the nearby structures is even rarer. Most published cases of elbow ganglions have reported patients with symptoms relating to compression of the radial nerve, or branches thereof secondary to anteriorly located cysts. We present two cases of ganglions occurring on the posterolateral aspect of the elbow with no pressure symptoms to the radial nerve CASE SERIES: The first case is a 33-year-old male, with a seven-month history of a spontaneous, slow-growing mass on the posterolateral aspect of his left elbow. The second case is a 38-year-old female, with a 12-month history of a spontaneous mass on the posterolateral aspect of her left elbow. In both cases, the reason for presentation was the unsightly elbow with an enlarging mass. The lesions were painless and both patients were neurologically intact with no restriction on range of motion of the joint. Both patients underwent excision of the mass for aesthetic reasons DISCUSSION: Patients with elbow ganglions usually have cysts located anterior to the radiocapitellar joint and almost invariably present with an associated motor, or less commonly, a sensory deficit of the radial nerve. Various treatment modalities have been reported; however, the vast majority undergo open surgical excision due to their association with progressive neurological symptoms. This usually leads to resolution of symptoms, and recurrence is rare CONCLUSION: The clinical presentation of the two patients reported in this case series seems to be far less frequent than patients presenting with a neuropathy of the radial nerve due to an anteriorly located elbow ganglion. It cannot, however, be excluded that there is an underreporting of asymptomatic elbow ganglions. According to our review of the English literature, this is only the third report of an asymptomatic elbow ganglion in the lateral compartment of the elbow Level of evidence: Level 5 Keywords: elbow, ganglion, cyst","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67480698","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 : 2022-01-01DOI: 10.17159/2309-8309/2022/v21n1a2
Anne-Cecilia van Marie, Petra-Marie Acho, Christine O Chepape, R. Mahlaba, P. Dlamini, Samkelisiwe Magugu, Kamogelo K Mahlohla, Nicole Teis, Anna M Kachelhoffer, G. Joubert, M. Coetzee
ABSTRACT BACKGROUND: Preoperative anaemia has been shown to be associated with increased postoperative morbidity and mortality, prolonged hospital stay, and increased allogeneic blood transfusions. With elective surgery there is time to manage preoperative anaemia. The aim was to determine the prevalence of preoperative anaemia and evaluate how anaemia was investigated and managed in adult patients who were referred from the Orthopaedic Clinic to the Universitas Academic Hospital Anaesthesiology Clinic between January 2016 and December 2018 METHODS: The retrospective file audit included patient demographics, comorbidities and chronic medication, indication for elective surgery, haemoglobin level at first clinic visit, laboratory investigations done for anaemia, dates of clinic visits and surgery, whether the anaemia was corrected before surgery, and if there were any perioperative red cell transfusions RESULTS: A total of 178 patients were included. The cut-off value for anaemia was 13 g/dL in both sexes. Forty-four patients (25%, 95% CI 19-32%) had preoperative anaemia with a median haemoglobin of 12.25 g/dL (IQR 11.2; 12.7). Their mean age was 63.3 (SD ± 10.0) years. Fifteen patients (34%) were booked for knee arthroplasty and 24 patients (55%) for hip replacement surgery. No workup was done for the anaemia, and only 15/44 (34%) anaemic patients received any form of treatment. Eighteen anaemic patients (41%) received perioperative red cell transfusions. Eight of the transfused patients (44%) developed postoperative sepsis, while five were still anaemic postoperatively CONCLUSION: The prevalence of preoperative anaemia before elective orthopaedic surgery (25%) was the same as that reported before patient blood management was introduced internationally. None of the anaemic patients had a diagnostic workup and therefore did not receive therapy targeted at the cause of the anaemia. Perioperative red cell transfusions could have been significantly reduced. The clinic now focuses on managing preoperative anaemia Level of evidence: Level 3 Keywords: preoperative anaemia, elective orthopaedic procedures, patient blood management, preoperative care, blood transfusion
背景:术前贫血已被证明与术后发病率和死亡率增加、住院时间延长和异体输血增加有关。择期手术有时间处理术前贫血。目的是确定术前贫血的患病率，并评估2016年1月至2018年12月期间从骨科诊所转介到Universitas学术医院麻醉诊所的成年患者的贫血调查和处理方式。回顾性档案审核包括患者人口统计、合并症和慢性药物、择期手术的指征、首次就诊时的血红蛋白水平、贫血的实验室检查、就诊和手术日期、术前是否纠正贫血以及是否有围手术期红细胞输注。结果:共纳入178例患者。男女贫血的临界值均为13克/分升。44例患者(25%，95% CI 19-32%)术前贫血，中位血红蛋白为12.25 g/dL (IQR 11.2;12.7)。平均年龄63.3 (SD±10.0)岁。15例患者(34%)预定膝关节置换术，24例患者(55%)预定髋关节置换术。没有对贫血进行检查，只有15/44(34%)的贫血患者接受了任何形式的治疗。18例贫血患者(41%)接受围手术期红细胞输注。结论:择期骨科手术前术前贫血的发生率(25%)与国际上引入患者血液管理前的报告相同。所有的贫血患者都没有进行诊断检查，因此没有接受针对贫血原因的治疗。围手术期红细胞输注本可以显著减少。该诊所目前的重点是管理术前贫血证据等级:三级关键词:术前贫血，择期骨科手术，患者血液管理，术前护理，输血
{"title":"A retrospective file audit of preoperative anaemia in patients referred to an anaesthesiology clinic before elective orthopaedic surgery","authors":"Anne-Cecilia van Marie, Petra-Marie Acho, Christine O Chepape, R. Mahlaba, P. Dlamini, Samkelisiwe Magugu, Kamogelo K Mahlohla, Nicole Teis, Anna M Kachelhoffer, G. Joubert, M. Coetzee","doi":"10.17159/2309-8309/2022/v21n1a2","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n1a2","url":null,"abstract":"ABSTRACT BACKGROUND: Preoperative anaemia has been shown to be associated with increased postoperative morbidity and mortality, prolonged hospital stay, and increased allogeneic blood transfusions. With elective surgery there is time to manage preoperative anaemia. The aim was to determine the prevalence of preoperative anaemia and evaluate how anaemia was investigated and managed in adult patients who were referred from the Orthopaedic Clinic to the Universitas Academic Hospital Anaesthesiology Clinic between January 2016 and December 2018 METHODS: The retrospective file audit included patient demographics, comorbidities and chronic medication, indication for elective surgery, haemoglobin level at first clinic visit, laboratory investigations done for anaemia, dates of clinic visits and surgery, whether the anaemia was corrected before surgery, and if there were any perioperative red cell transfusions RESULTS: A total of 178 patients were included. The cut-off value for anaemia was 13 g/dL in both sexes. Forty-four patients (25%, 95% CI 19-32%) had preoperative anaemia with a median haemoglobin of 12.25 g/dL (IQR 11.2; 12.7). Their mean age was 63.3 (SD ± 10.0) years. Fifteen patients (34%) were booked for knee arthroplasty and 24 patients (55%) for hip replacement surgery. No workup was done for the anaemia, and only 15/44 (34%) anaemic patients received any form of treatment. Eighteen anaemic patients (41%) received perioperative red cell transfusions. Eight of the transfused patients (44%) developed postoperative sepsis, while five were still anaemic postoperatively CONCLUSION: The prevalence of preoperative anaemia before elective orthopaedic surgery (25%) was the same as that reported before patient blood management was introduced internationally. None of the anaemic patients had a diagnostic workup and therefore did not receive therapy targeted at the cause of the anaemia. Perioperative red cell transfusions could have been significantly reduced. The clinic now focuses on managing preoperative anaemia Level of evidence: Level 3 Keywords: preoperative anaemia, elective orthopaedic procedures, patient blood management, preoperative care, blood transfusion","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67480953","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 : 2022-01-01DOI: 10.17159/2309-8309/2022/v21n1a4
Johan A le Roux, Carel W Bezuidenhout, J. Klopper, H. Hobbs, R. von Bormann, M. Held
ABSTRACT BACKGROUND: Injury to the anterior cruciate ligament (ACL) is associated with sagittal and rotational laxity, which is exacerbated by damage to the anterolateral capsuloligamentous structures, also known as the anterolateral ligament (ALL). The amount of laxity reported in biomechanical studies might be clinically insignificant during a surgeon's examination, possibly influencing clinical judgement. We aimed to measure whether the motion generated by clinicians in a cadaver model after the ACL and ALL were transected is clinically significant METHODS: A group of orthopaedic surgeons and trainees examined a cadaver knee for sagittal and rotational laxity at 30° and 90° with intact ligaments, after the ACL was transected, and after the ACL and ALL were transected. The examiners were blinded to the dissection process. Rotational and sagittal movements during these examinations were recorded by a computer-assisted surgery (CAS) system RESULTS: Twenty-four orthopaedic surgeons took part in the study. The median sagittal plane motion captured by CAS at 30° flexion was 7 mm (IQR 2 mm, p-value 0.32) in the intact knee, 9 mm (IQR 1 mm, p-value 0.34) after the ACL was cut and 9 mm (IQR 3 mm, p-value 0.63) after ACL and ALL were cut. The median arc of rotational motion at 30° was 19° (IQR 7°, p-value 0.12) in the intact knee, 24° (IQR 5°, p-value 0.56) after the ACL was cut, and 22° (IQR 6°, p-value 0.8) after the ACL and ALL were cut. None of the differences in these movements was significant CONCLUSION: The surgeons could not generate significant differences in sagittal or rotational motion in a cadaver model, which could be objectively detected by CAS, when examining the intact knee, ACL deficient (only), or combined ACL and ALL deficient knee. This challenges the utility of known clinical tests and calls for improved objective laxity assessment tools to provide input in clinical decision-making and measure outcomes of these injuries Level of evidence: Level 5 Keywords: knee, anterolateral ligament, anterior drawer's test, pivot shift, rotatory instability, anterior cruciate ligament, iliotibial band, Kaplan fibres
摘要背景:前交叉韧带(ACL)损伤与矢状和旋转松弛有关，前外侧荚膜寡聚结构(也称为前外侧韧带(ALL))损伤会加剧这种情况。在外科医生的检查中，生物力学研究报告的松弛程度可能在临床上不显著，可能影响临床判断。我们的目的是测量临床医生在横断ACL和ALL后在尸体模型中产生的运动是否具有临床意义。方法:一组骨科医生和实习生检查了30°和90°韧带完整的尸体膝盖，横断ACL后，横断ACL和ALL后的矢状和旋转松弛。审查员对解剖过程一无所知。计算机辅助手术(CAS)系统记录了这些检查过程中的旋转和矢状位运动。结果:24名骨科医生参加了这项研究。在完整膝关节30°屈曲时，CAS捕获的正中矢状面运动为7 mm (IQR 2 mm, p值0.32)，ACL切割后为9 mm (IQR 1 mm, p值0.34)，ACL和ALL切割后为9 mm (IQR 3 mm, p值0.63)。完整膝关节30°旋转运动的中位弧为19°(IQR 7°，p值0.12)，前交叉韧带切开后为24°(IQR 5°，p值0.56)，前交叉韧带和ALL切开后为22°(IQR 6°，p值0.8)。结论:当检查完整膝关节、(仅)ACL缺陷或ACL合并ALL缺陷膝关节时，外科医生无法在尸体模型中产生明显的矢状或旋转运动差异，这可以通过CAS客观地检测到。这挑战了已知临床试验的实用性，并要求改进客观松弛评估工具，为临床决策提供输入，并测量这些损伤的结果。证据水平:5级关键词:膝关节、前外侧韧带、前抽屉试验、枢轴移位、旋转不稳定、前十字韧带、髂胫束、Kaplan纤维
{"title":"Not strong enough? Movements generated during clinical examination of sagittal and rotational laxity in a cadaver knee","authors":"Johan A le Roux, Carel W Bezuidenhout, J. Klopper, H. Hobbs, R. von Bormann, M. Held","doi":"10.17159/2309-8309/2022/v21n1a4","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n1a4","url":null,"abstract":"ABSTRACT BACKGROUND: Injury to the anterior cruciate ligament (ACL) is associated with sagittal and rotational laxity, which is exacerbated by damage to the anterolateral capsuloligamentous structures, also known as the anterolateral ligament (ALL). The amount of laxity reported in biomechanical studies might be clinically insignificant during a surgeon's examination, possibly influencing clinical judgement. We aimed to measure whether the motion generated by clinicians in a cadaver model after the ACL and ALL were transected is clinically significant METHODS: A group of orthopaedic surgeons and trainees examined a cadaver knee for sagittal and rotational laxity at 30° and 90° with intact ligaments, after the ACL was transected, and after the ACL and ALL were transected. The examiners were blinded to the dissection process. Rotational and sagittal movements during these examinations were recorded by a computer-assisted surgery (CAS) system RESULTS: Twenty-four orthopaedic surgeons took part in the study. The median sagittal plane motion captured by CAS at 30° flexion was 7 mm (IQR 2 mm, p-value 0.32) in the intact knee, 9 mm (IQR 1 mm, p-value 0.34) after the ACL was cut and 9 mm (IQR 3 mm, p-value 0.63) after ACL and ALL were cut. The median arc of rotational motion at 30° was 19° (IQR 7°, p-value 0.12) in the intact knee, 24° (IQR 5°, p-value 0.56) after the ACL was cut, and 22° (IQR 6°, p-value 0.8) after the ACL and ALL were cut. None of the differences in these movements was significant CONCLUSION: The surgeons could not generate significant differences in sagittal or rotational motion in a cadaver model, which could be objectively detected by CAS, when examining the intact knee, ACL deficient (only), or combined ACL and ALL deficient knee. This challenges the utility of known clinical tests and calls for improved objective laxity assessment tools to provide input in clinical decision-making and measure outcomes of these injuries Level of evidence: Level 5 Keywords: knee, anterolateral ligament, anterior drawer's test, pivot shift, rotatory instability, anterior cruciate ligament, iliotibial band, Kaplan fibres","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481014","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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