Pub Date : 2022-01-01DOI: 10.17159/2309-8309/2022/v21n3a7
R. Venter, L. Kotze, N. Ferreira
BACKGROUND: Orthopaedic surgery often benefits from innovation in biomedical engineering, with 3D printing being one of the latest examples. Proving cost-effectiveness and improved clinical outcomes remains challenging. Because of the reduced cost and increased accessibility, it has been possible to start an orthopaedic 3D-printing laboratory in a South African tertiary hospital, exploring the place for this emergent technology in orthopaedic practice. This case series aims to illustrate the clinical use of 3D-printed anatomical models and investigate the time and cost involved in their manufacture METHODS: The design and manufacturing process is discussed, and a retrospective descriptive case series is presented of all models manufactured from January 2020 to April 2021. Using three illustrative cases, we elaborate on two main usage situations: intraoperative reference models (haptic maps) or rehearsal and templating (simulation models RESULTS: In the study, 3D-printed anatomical models were manufactured for 16 patients. For 12 patients, these were simulation models, and for the other four patients, haptic maps were made. The mean time for manufacture was 33 hours (range 8-62), and the median cost per patient was ZAR 3 257.62 (range ZAR 927.17 to ZAR 7 177.09 CONCLUSION: Considering the decreasing cost and ease of using 3D-printing technology, starting a clinician-run orthopaedic 3D-printing laboratory at a South African training hospital has become possible. In this series we illustrate how 3D printing has been used at our unit for planning and rehearsal of a wide range of orthopaedic cases, and we establish a baseline of time and cost expenditure. The cost-effectiveness of implementing 3D-printing technology in everyday orthopaedic practice warrants further investigation Level of evidence: Level 5
{"title":"A clinician-run 3D-printing laboratory for orthopaedic preoperative planning: an illustrative case series","authors":"R. Venter, L. Kotze, N. Ferreira","doi":"10.17159/2309-8309/2022/v21n3a7","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n3a7","url":null,"abstract":"BACKGROUND: Orthopaedic surgery often benefits from innovation in biomedical engineering, with 3D printing being one of the latest examples. Proving cost-effectiveness and improved clinical outcomes remains challenging. Because of the reduced cost and increased accessibility, it has been possible to start an orthopaedic 3D-printing laboratory in a South African tertiary hospital, exploring the place for this emergent technology in orthopaedic practice. This case series aims to illustrate the clinical use of 3D-printed anatomical models and investigate the time and cost involved in their manufacture METHODS: The design and manufacturing process is discussed, and a retrospective descriptive case series is presented of all models manufactured from January 2020 to April 2021. Using three illustrative cases, we elaborate on two main usage situations: intraoperative reference models (haptic maps) or rehearsal and templating (simulation models RESULTS: In the study, 3D-printed anatomical models were manufactured for 16 patients. For 12 patients, these were simulation models, and for the other four patients, haptic maps were made. The mean time for manufacture was 33 hours (range 8-62), and the median cost per patient was ZAR 3 257.62 (range ZAR 927.17 to ZAR 7 177.09 CONCLUSION: Considering the decreasing cost and ease of using 3D-printing technology, starting a clinician-run orthopaedic 3D-printing laboratory at a South African training hospital has become possible. In this series we illustrate how 3D printing has been used at our unit for planning and rehearsal of a wide range of orthopaedic cases, and we establish a baseline of time and cost expenditure. The cost-effectiveness of implementing 3D-printing technology in everyday orthopaedic practice warrants further investigation Level of evidence: Level 5","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":"67481268","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/v21n4a2
R. Erasmus, P. Fourie, C. Janse van Rensburg, H. Jacobs
BACKGROUND: The direct lateral approach for total hip replacement has been traditionally reserved and described for neck of femur fractures. Advantages of this approach include technically easy access to the acetabulum and femur and low incidence of hip dislocation. Imperfect positioning of the acetabular component leads to increased risk for dislocations, accelerated wear, reduced range of motion and increased revision rate. Freehand technique has been the gold standard for many decades, but newer technologies like computer navigation and robotic-assisted surgery have shown to improve the accuracy of cup placement. This study reports on the accuracy of freehand cup positioning via the direct lateral approach with mention of the dislocation rate METHODS: We retrospectively reviewed 253 patients who had total hip replacements done via the direct lateral approach. The patients' files were evaluated for patient parameters, demographic details, aetiology of hip pathology, confirmation of approach used, comorbidities and history of previous relevant surgery. The postoperative radiographs were analysed for acetabular component position inclination and anteversion. Dislocation rates were calculated as a secondary objective RESULTS: The radiographic analysis was performed using the Liaw method based on trigonometry of the eclipse generated. This showed a mean cup inclination of 42.3° (95% CI: 41.3-43.3°) and anteversion of 12.7° (95% CI: 12.0-13.7°). A total of 57% of the acetabular cups were within the safe zones described by Lewinnek. Of them, 78% were in the 30-50° range for inclination and 73% in the 5-25° range for anteversion. There were ten dislocations within one year from the index procedure: a dislocation rate of 4.0% (95% CI: 2.8-8.5% CONCLUSION: The freehand technique using the direct lateral approach for acetabular cup placement produces a poor overall accuracy of only 57%. Although our study only commented on ten dislocations, the rate (4%) is significantly worse compared to the 0.43% reported in literature for the direct lateral approach. The radiographic results for inclination and anteversion are comparable to other freehand techniques, regardless of the approach used, but significantly worse than results achieved with navigation and robotics Level of evidence: Level 4
{"title":"An audit on the accuracy of freehand acetabular cup positioning in total hip arthroplasty with the direct lateral approach at a tertiary institution over seven years","authors":"R. Erasmus, P. Fourie, C. Janse van Rensburg, H. Jacobs","doi":"10.17159/2309-8309/2022/v21n4a2","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n4a2","url":null,"abstract":"BACKGROUND: The direct lateral approach for total hip replacement has been traditionally reserved and described for neck of femur fractures. Advantages of this approach include technically easy access to the acetabulum and femur and low incidence of hip dislocation. Imperfect positioning of the acetabular component leads to increased risk for dislocations, accelerated wear, reduced range of motion and increased revision rate. Freehand technique has been the gold standard for many decades, but newer technologies like computer navigation and robotic-assisted surgery have shown to improve the accuracy of cup placement. This study reports on the accuracy of freehand cup positioning via the direct lateral approach with mention of the dislocation rate METHODS: We retrospectively reviewed 253 patients who had total hip replacements done via the direct lateral approach. The patients' files were evaluated for patient parameters, demographic details, aetiology of hip pathology, confirmation of approach used, comorbidities and history of previous relevant surgery. The postoperative radiographs were analysed for acetabular component position inclination and anteversion. Dislocation rates were calculated as a secondary objective RESULTS: The radiographic analysis was performed using the Liaw method based on trigonometry of the eclipse generated. This showed a mean cup inclination of 42.3° (95% CI: 41.3-43.3°) and anteversion of 12.7° (95% CI: 12.0-13.7°). A total of 57% of the acetabular cups were within the safe zones described by Lewinnek. Of them, 78% were in the 30-50° range for inclination and 73% in the 5-25° range for anteversion. There were ten dislocations within one year from the index procedure: a dislocation rate of 4.0% (95% CI: 2.8-8.5% CONCLUSION: The freehand technique using the direct lateral approach for acetabular cup placement produces a poor overall accuracy of only 57%. Although our study only commented on ten dislocations, the rate (4%) is significantly worse compared to the 0.43% reported in literature for the direct lateral approach. The radiographic results for inclination and anteversion are comparable to other freehand techniques, regardless of the approach used, but significantly worse than results achieved with navigation and robotics Level of evidence: Level 4","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":"67481375","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/v21n4a3
A. Nansook, P. Ryans
BACKGROUND: Total knee arthroplasty (TKA) rates have significantly increased over the past few decades; consequently, so too have the absolute number of complications. International literature expounds on complications in the rheumatoid arthritis (RA) and osteoarthritis (OA) subgroups from the developed context, but these findings cannot be generalised to the developing world, where access to medication, medical facilities and patient characteristics may differ. The purpose of this study was to determine the comparative rates and nature of complications that occur post total knee arthroplasty in RA and OA patients at a single South African quaternary hospital. METHODS: This was a retrospective comparative study of complication rates in two groups following TKA at Inkosi Albert Luthuli Central Hospital (IALCH) arthroplasty unit, between 1 January 2014 and 29 February 2020. The data was collected retrospectively, utilising the digitised patient management system at the hospital. Data extraction included patient demographics, time to surgery, indication for surgery and early complication rates. Descriptive analysis was performed to quantify complications, comparing the two groups. RESULTS: The chart review yielded 332 cases, comprising 41 RA and 291 OA patients. The mean age of the combined participant group was 65 years (standard deviation [SD] 8). Most cases were female (87%, 289 of 332), with males comprising 13% (43 of 332). Concomitant human immunodeficiency virus (HIV) was present in 6% of patients (20 of 332), and 24% (80 of 332) had diabetes mellitus (DM). The absolute number of complications was greater in the OA group, where revision surgery was performed in 3% (8 of 291) of cases, infection occurred in 1% (3 of 291), mechanical complications in 3% (10 of 291), and deep vein thrombosis (DVT) in 1% (2 of 291) of cases. There was one complication, a DVT, in the RA group (2%, 1 of 41). CONCLUSION: In the current study, complications after TKA occurred predominantly in the OA group, 8% (23 of 291) as compared to the RA group, 2% (1 of 41). Complications included DVT, revision surgery, infection and mechanical complications. The study was underpowered to detect significant differences between the groups. Further large-scale investigation will be required to determine if differences in complication rate are significant when low complication incidence is anticipated. Level of evidence: Level 4.
{"title":"A retrospective comparative study of complications after total knee replacement in rheumatoid arthritis and osteoarthritis patients","authors":"A. Nansook, P. Ryans","doi":"10.17159/2309-8309/2022/v21n4a3","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n4a3","url":null,"abstract":"BACKGROUND: Total knee arthroplasty (TKA) rates have significantly increased over the past few decades; consequently, so too have the absolute number of complications. International literature expounds on complications in the rheumatoid arthritis (RA) and osteoarthritis (OA) subgroups from the developed context, but these findings cannot be generalised to the developing world, where access to medication, medical facilities and patient characteristics may differ. The purpose of this study was to determine the comparative rates and nature of complications that occur post total knee arthroplasty in RA and OA patients at a single South African quaternary hospital. METHODS: This was a retrospective comparative study of complication rates in two groups following TKA at Inkosi Albert Luthuli Central Hospital (IALCH) arthroplasty unit, between 1 January 2014 and 29 February 2020. The data was collected retrospectively, utilising the digitised patient management system at the hospital. Data extraction included patient demographics, time to surgery, indication for surgery and early complication rates. Descriptive analysis was performed to quantify complications, comparing the two groups. RESULTS: The chart review yielded 332 cases, comprising 41 RA and 291 OA patients. The mean age of the combined participant group was 65 years (standard deviation [SD] 8). Most cases were female (87%, 289 of 332), with males comprising 13% (43 of 332). Concomitant human immunodeficiency virus (HIV) was present in 6% of patients (20 of 332), and 24% (80 of 332) had diabetes mellitus (DM). The absolute number of complications was greater in the OA group, where revision surgery was performed in 3% (8 of 291) of cases, infection occurred in 1% (3 of 291), mechanical complications in 3% (10 of 291), and deep vein thrombosis (DVT) in 1% (2 of 291) of cases. There was one complication, a DVT, in the RA group (2%, 1 of 41). CONCLUSION: In the current study, complications after TKA occurred predominantly in the OA group, 8% (23 of 291) as compared to the RA group, 2% (1 of 41). Complications included DVT, revision surgery, infection and mechanical complications. The study was underpowered to detect significant differences between the groups. Further large-scale investigation will be required to determine if differences in complication rate are significant when low complication incidence is anticipated. Level of evidence: Level 4.","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":"67481381","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/v21n2a6
N. Kauta, J. Du Plessis, J. D. de Wet, B. Vrettos, S. Roche
Anterior shoulder dislocation is a common condition that most orthopaedic surgeons will have to deal with in their practice. Nonoperative management of the initial traumatic anterior shoulder dislocation is likely to lead to a recurrent shoulder dislocation in more than 90% of cases in the younger active population. Recurrent anterior shoulder dislocation can persist even after instability surgery in certain cases. A detailed, accurate assessment of the patient is of paramount importance for successful treatment. This review aims to provide insight into key concepts to consider in the assessment of an anterior shoulder dislocation. Predisposing factors, clinical examination and the role of imaging in the assessment of an anterior shoulder dislocation will be reviewed. Level of evidence: Level 5
{"title":"Current concepts on the assessment of a patient with a traumatic anterior shoulder dislocation","authors":"N. Kauta, J. Du Plessis, J. D. de Wet, B. Vrettos, S. Roche","doi":"10.17159/2309-8309/2022/v21n2a6","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n2a6","url":null,"abstract":"Anterior shoulder dislocation is a common condition that most orthopaedic surgeons will have to deal with in their practice. Nonoperative management of the initial traumatic anterior shoulder dislocation is likely to lead to a recurrent shoulder dislocation in more than 90% of cases in the younger active population. Recurrent anterior shoulder dislocation can persist even after instability surgery in certain cases. A detailed, accurate assessment of the patient is of paramount importance for successful treatment. This review aims to provide insight into key concepts to consider in the assessment of an anterior shoulder dislocation. Predisposing factors, clinical examination and the role of imaging in the assessment of an anterior shoulder dislocation will be reviewed. Level of evidence: Level 5","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":"67481404","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/v21n2a4
S. Sibindi, A. Mageza, A. Socci
BACKGROUND: To provide a bibliometric analysis of published orthopaedic research in the form of peer-reviewed articles as well as non-indexed articles from Zimbabwe in the past six decades. METHODS: We carried out a literature search of the 'Clarivariate Analytics' Web of Science database, specific journals not included in the database and the University of Zimbabwe repository. We then selected articles focused on research in orthopaedic pathology in Zimbabwe. These articles were then classified by year of publication; focus of research; first and last author country of origin; collaboration type between high-, middle- and low-income countries; journal title; journal country; methodology; and level of evidence. RESULTS: A total of 27 articles published from 1965 to 2020 were found in the search with 26 having a single focus of research and one multiple foci. The highest focus of research was osteoporosis with six articles (22%), while trauma was second with five articles (19%). A majority, 19/27 (70%), of studies had a first author from Zimbabwe, while a plurality, 10/27 (37%), had a Zimbabwean last author. Most collaborations, 12/27 (44%), were high-income-low-income countries, with most studies being concomitantly published in the United States, 13/27 (48%). Cross-sectional descriptive studies represented the most common methodology with 13/27 articles carried out in this method (48%). The majority of these articles, 14/27 (52%), represented a low level of evidence at level 4, while 11/27 articles (41%) of articles were of a high level of evidence (levels 1 or 2). CONCLUSION: There is a limited amount of published orthopaedic surgery research work from Zimbabwe, highlighting the need for more and higher quality research from Zimbabwe. Among different models, partnerships between Zimbabwean researchers and researchers from other international institutions appear to be the most productive in terms of research output and hence should be replicated more broadly. Level of evidence: Level 4
背景:提供文献计量学分析，以同行评议文章的形式发表的骨科研究以及津巴布韦过去六十年的非索引文章。方法:我们对“Clarivariate Analytics”Web of Science数据库、数据库中未包含的特定期刊和津巴布韦大学知识库进行了文献检索。然后，我们选择了有关津巴布韦骨科病理学研究的文章。然后这些文章按出版年份分类;研究重点;第一和最后作者原籍国;高、中、低收入国家之间的合作类型;杂志标题;杂志;方法;和证据水平。结果:检索到1965 - 2020年间发表的文献27篇，其中单焦点研究26篇，多焦点研究1篇。研究重点最高的是骨质疏松症，有6篇(22%)，其次是创伤，有5篇(19%)。大多数研究(19/27(70%))的第一作者来自津巴布韦，而多数研究(10/27(37%))的最后作者来自津巴布韦。大多数合作(12/27)(44%)是高收入低收入国家，大多数研究同时在美国发表(13/27)(48%)。横断面描述性研究是最常见的方法，有13/27的文章采用了这种方法(48%)。这些文章中的大多数，14/27(52%)，代表低证据水平为4级，而11/27(41%)的文章为高证据水平(1或2级)。结论:津巴布韦已发表的骨科外科研究工作数量有限，突出表明津巴布韦需要更多和更高质量的研究。在不同的模式中，津巴布韦研究人员和来自其他国际机构的研究人员之间的伙伴关系在研究产出方面似乎是最富有成效的，因此应该更广泛地复制。证据等级:四级
{"title":"Orthopaedic research in Zimbabwe: a seminal bibliometric analysis","authors":"S. Sibindi, A. Mageza, A. Socci","doi":"10.17159/2309-8309/2022/v21n2a4","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n2a4","url":null,"abstract":"BACKGROUND: To provide a bibliometric analysis of published orthopaedic research in the form of peer-reviewed articles as well as non-indexed articles from Zimbabwe in the past six decades. METHODS: We carried out a literature search of the 'Clarivariate Analytics' Web of Science database, specific journals not included in the database and the University of Zimbabwe repository. We then selected articles focused on research in orthopaedic pathology in Zimbabwe. These articles were then classified by year of publication; focus of research; first and last author country of origin; collaboration type between high-, middle- and low-income countries; journal title; journal country; methodology; and level of evidence. RESULTS: A total of 27 articles published from 1965 to 2020 were found in the search with 26 having a single focus of research and one multiple foci. The highest focus of research was osteoporosis with six articles (22%), while trauma was second with five articles (19%). A majority, 19/27 (70%), of studies had a first author from Zimbabwe, while a plurality, 10/27 (37%), had a Zimbabwean last author. Most collaborations, 12/27 (44%), were high-income-low-income countries, with most studies being concomitantly published in the United States, 13/27 (48%). Cross-sectional descriptive studies represented the most common methodology with 13/27 articles carried out in this method (48%). The majority of these articles, 14/27 (52%), represented a low level of evidence at level 4, while 11/27 articles (41%) of articles were of a high level of evidence (levels 1 or 2). CONCLUSION: There is a limited amount of published orthopaedic surgery research work from Zimbabwe, highlighting the need for more and higher quality research from Zimbabwe. Among different models, partnerships between Zimbabwean researchers and researchers from other international institutions appear to be the most productive in terms of research output and hence should be replicated more broadly. Level of evidence: Level 4","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":"67481306","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/v21n1a3
Cara Dunn, M. Held, M. Laubscher, M. Nortje, S. Roche, R. Dunn
ABSTRACT BACKGROUND: With increasing pressure on our training hospitals, we undertook to ascertain whether our clinical orthopaedic surgery training platform is providing adequate surgical exposure, both in diversity and the level of trainee participation METHODS: The orthopaedic surgery database was interrogated for theatre procedures logged for the 12-month period 1 January to 31 December 2018. Each theatre case was assessed as to the level of trainee participation, whether it was performed during or after hours, and categorised as being elective or trauma in nature, as well as the orthopaedic subdiscipline RESULTS: A total of 3 147 orthopaedic surgical procedures were logged with an even split of elective (51.1%) and trauma (49.9%) cases. Adults predominated in the trauma group while the paediatric service contributed most to the elective cases, followed by arthroplasty and spine. Overall, 25.5% of procedures were performed by consultants and 74.5% by registrars. Registrars were more frequently the primary surgeon in trauma cases (90%) compared to elective procedures (59%) (p < 0.001). Of the elective cases, 37% were performed by registrars as supervised unscrubbed and 22% as supervised scrubbed operations. In total, 17.5% of cases were performed after hours, with 31.7% of trauma surgeries and only 2.9% of elective surgeries occurring after hours. Registrars were the primary surgeon in 98.7% of after-hours trauma cases and 58% of after-hours elective cases under unscrubbed supervision CONCLUSION: Our study presents the surgical experience and level of participation available to orthopaedic surgical trainees in a South African training hospital where their exposure was an equal number of elective and trauma cases. The vast majority of the cases were performed by the registrars in their supervised unscrubbed capacity although the more complex, elective cases were performed by consultants. Almost all after-hours trauma cases were performed by registrars. This suggests the platform allows for a high level of registrar surgical participation and training despite the challenges. Further review is required to assess achievement of trainee competency and whether in fact the current experience is adequate Level of evidence: Level 4 Keywords: orthopaedic registrar surgical experience, South African orthopaedic training exposure, orthopaedic case exposure
{"title":"Orthopaedic surgical training exposure at a South African academic hospital - is the experience diverse and in depth?","authors":"Cara Dunn, M. Held, M. Laubscher, M. Nortje, S. Roche, R. Dunn","doi":"10.17159/2309-8309/2022/v21n1a3","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n1a3","url":null,"abstract":"ABSTRACT BACKGROUND: With increasing pressure on our training hospitals, we undertook to ascertain whether our clinical orthopaedic surgery training platform is providing adequate surgical exposure, both in diversity and the level of trainee participation METHODS: The orthopaedic surgery database was interrogated for theatre procedures logged for the 12-month period 1 January to 31 December 2018. Each theatre case was assessed as to the level of trainee participation, whether it was performed during or after hours, and categorised as being elective or trauma in nature, as well as the orthopaedic subdiscipline RESULTS: A total of 3 147 orthopaedic surgical procedures were logged with an even split of elective (51.1%) and trauma (49.9%) cases. Adults predominated in the trauma group while the paediatric service contributed most to the elective cases, followed by arthroplasty and spine. Overall, 25.5% of procedures were performed by consultants and 74.5% by registrars. Registrars were more frequently the primary surgeon in trauma cases (90%) compared to elective procedures (59%) (p < 0.001). Of the elective cases, 37% were performed by registrars as supervised unscrubbed and 22% as supervised scrubbed operations. In total, 17.5% of cases were performed after hours, with 31.7% of trauma surgeries and only 2.9% of elective surgeries occurring after hours. Registrars were the primary surgeon in 98.7% of after-hours trauma cases and 58% of after-hours elective cases under unscrubbed supervision CONCLUSION: Our study presents the surgical experience and level of participation available to orthopaedic surgical trainees in a South African training hospital where their exposure was an equal number of elective and trauma cases. The vast majority of the cases were performed by the registrars in their supervised unscrubbed capacity although the more complex, elective cases were performed by consultants. Almost all after-hours trauma cases were performed by registrars. This suggests the platform allows for a high level of registrar surgical participation and training despite the challenges. Further review is required to assess achievement of trainee competency and whether in fact the current experience is adequate Level of evidence: Level 4 Keywords: orthopaedic registrar surgical experience, South African orthopaedic training exposure, orthopaedic case exposure","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":"67481006","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/v21n2a7
J. Roux, R. Bormann, S. Braun, A. Imhoff, M. Held
BACKGROUND: A 26-year-old patient presented to a specialised knee clinic in a public hospital with ongoing pain after having sustained a soccer injury six years prior. A large osteochondral defect of the distal medial femoral condyle was diagnosed. Due to resource limitations, fresh allograft or a large osteochondral autograft transplantation system (Mega-OATS) workbench was unavailable. CASE REPORT: A Mega-OATS cartilage transplantation was done, using the patient's posteromedial femoral condyle as donor tissue, and transplanted to the defect in the distal femoral condyle, a technique that has been well documented and followed up. At six weeks postoperatively, an MRI showed early incorporation of the graft tissue. Clinical outcomes were excellent at one year follow-up with the EQ-5D 5L score 11111, the Knee Injury and Osteoarthritis Outcome Score (KOOS-PS) 100%, and the Lysholm score also 100%. Radiographs at one year confirmed an unchanged graft position and showed no signs of osteoarthritis. DISCUSSION: Large osteochondral lesions in the knee (> 4 cm2) are challenging to treat, and the most commonly used modalities are fresh osteochondral allograft (OCA) or autologous chondrocyte implantation (ACI). Mega-OATS of the knee has previously been described but is not commonly used due to the requirement of a specialised and expensive workbench, and fear of morbidity at the donor site. CONCLUSION: Mega-OATS of the knee is possible without a specialised workbench or tools and had good clinical outcomes at two-year follow-up of the patient. Level of evidence: Level 5
{"title":"Mega-OATS of the knee without specialised instrumentation: a low-cost option for large cartilage defects in a resource-restrained environment","authors":"J. Roux, R. Bormann, S. Braun, A. Imhoff, M. Held","doi":"10.17159/2309-8309/2022/v21n2a7","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n2a7","url":null,"abstract":"BACKGROUND: A 26-year-old patient presented to a specialised knee clinic in a public hospital with ongoing pain after having sustained a soccer injury six years prior. A large osteochondral defect of the distal medial femoral condyle was diagnosed. Due to resource limitations, fresh allograft or a large osteochondral autograft transplantation system (Mega-OATS) workbench was unavailable. CASE REPORT: A Mega-OATS cartilage transplantation was done, using the patient's posteromedial femoral condyle as donor tissue, and transplanted to the defect in the distal femoral condyle, a technique that has been well documented and followed up. At six weeks postoperatively, an MRI showed early incorporation of the graft tissue. Clinical outcomes were excellent at one year follow-up with the EQ-5D 5L score 11111, the Knee Injury and Osteoarthritis Outcome Score (KOOS-PS) 100%, and the Lysholm score also 100%. Radiographs at one year confirmed an unchanged graft position and showed no signs of osteoarthritis. DISCUSSION: Large osteochondral lesions in the knee (> 4 cm2) are challenging to treat, and the most commonly used modalities are fresh osteochondral allograft (OCA) or autologous chondrocyte implantation (ACI). Mega-OATS of the knee has previously been described but is not commonly used due to the requirement of a specialised and expensive workbench, and fear of morbidity at the donor site. CONCLUSION: Mega-OATS of the knee is possible without a specialised workbench or tools and had good clinical outcomes at two-year follow-up of the patient. Level of evidence: Level 5","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":"67481426","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/v21n4a5
N. Thikhathali, M. Ngcelwane
BACKGROUND: Road traffic accidents (RTAs), the second commonest cause of trauma in South Africa (SA), are on the rise. It is therefore important to study and understand the burden of RTA-related injuries on our orthopaedic healthcare and healthcare in general, in order to devise new prevention strategies to minimise the number of RTAs METHODS: A retrospective analysis of data from orthopaedic trauma intake records was done for patients admitted with RTA-related injuries to the orthopaedic department at a South African tertiary hospital between February 2019 and January 2020. Hospital records and the PAC (picture archiving and communication) system were analysed for radiological studies done. The Uniform Patient Fee Schedule (UPFS) was analysed for individual costing of all variables being studied RESULTS: There were 642 patients seen and managed with RTA-related injuries included in this study. Seventy-one per cent of them were males, with an average age of 35 years. The majority (76.2%) were motor vehicle occupants, whereas 17% were pedestrians. Seventeen per cent of them had polytrauma. Four hundred and sixty-two (76%) patients required some form of surgical intervention and spent an average of 171 minutes in theatre per procedure. Ten per cent of these patients required ICU/HCU admission for an average of 13 days. The total length of hospital stay was an average of 21.8 days. The majority of patients (67%) had some form of orthopaedic implant inserted, with an average of 1.3 implants per patient. The average cost per patient was R92 737.39. The major cost drivers were hospital stay, ICU/HCU stay, implant cost, radiological studies and theatre utilisation, respectively CONCLUSION: Management of RTA-related trauma puts a significant burden on orthopaedic healthcare management and resource utilisation. While we may not be able to directly influence other contributing factors to high costs, reducing the use of temporary external fixators may help reduce the cost of managing RTA victims These findings provide scientific data which will help support the implementation of preventative measures aimed at minimising the numbers of RTAs we see on our roads, thereby minimising the burden this puts on our healthcare system. Level of evidence: Level 3
{"title":"The burden of road traffic accident-related trauma to orthopaedic healthcare and resource utilisation at a South African tertiary hospital: a cost analysis study","authors":"N. Thikhathali, M. Ngcelwane","doi":"10.17159/2309-8309/2022/v21n4a5","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n4a5","url":null,"abstract":"BACKGROUND: Road traffic accidents (RTAs), the second commonest cause of trauma in South Africa (SA), are on the rise. It is therefore important to study and understand the burden of RTA-related injuries on our orthopaedic healthcare and healthcare in general, in order to devise new prevention strategies to minimise the number of RTAs METHODS: A retrospective analysis of data from orthopaedic trauma intake records was done for patients admitted with RTA-related injuries to the orthopaedic department at a South African tertiary hospital between February 2019 and January 2020. Hospital records and the PAC (picture archiving and communication) system were analysed for radiological studies done. The Uniform Patient Fee Schedule (UPFS) was analysed for individual costing of all variables being studied RESULTS: There were 642 patients seen and managed with RTA-related injuries included in this study. Seventy-one per cent of them were males, with an average age of 35 years. The majority (76.2%) were motor vehicle occupants, whereas 17% were pedestrians. Seventeen per cent of them had polytrauma. Four hundred and sixty-two (76%) patients required some form of surgical intervention and spent an average of 171 minutes in theatre per procedure. Ten per cent of these patients required ICU/HCU admission for an average of 13 days. The total length of hospital stay was an average of 21.8 days. The majority of patients (67%) had some form of orthopaedic implant inserted, with an average of 1.3 implants per patient. The average cost per patient was R92 737.39. The major cost drivers were hospital stay, ICU/HCU stay, implant cost, radiological studies and theatre utilisation, respectively CONCLUSION: Management of RTA-related trauma puts a significant burden on orthopaedic healthcare management and resource utilisation. While we may not be able to directly influence other contributing factors to high costs, reducing the use of temporary external fixators may help reduce the cost of managing RTA victims These findings provide scientific data which will help support the implementation of preventative measures aimed at minimising the numbers of RTAs we see on our roads, thereby minimising the burden this puts on our healthcare system. Level of evidence: Level 3","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":"67481534","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/v21n1a1
H. Pretorius, M. Burger, N. Ferreira
Background Current orthopaedic practice requires a forearm nail that is length and rotationally stable and which can restore functional anatomy. A forearm nailing system was designed based on clinical need. This nailing system features unique designs and locking holes that offer a larger approach and escape angle for ease of interlocking. The aim of the present study was to test the prototype and evaluate the design changes in cadaver bones. Methods A cross-sectional cadaveric study, including ten cadavers with normal forearm anatomy (n = 20 forearms) was conducted. Both forearms of the cadavers were used to evaluate the locking times and exposure time during i) insertion; ii) locking; and iii) removal of the nails, resulting in the evaluation of a total of 40 procedures. All nails were assessed for insertions of interlocking screws. Results The nail was successfully inserted into 38 bones. Inserted nails were available for locking (n = 38), and all locking attempts at both driving ends (n = 38, 100%), as well as the non-driving ends (n = 76, 100%), were successful. Freehand locking at the non-driving end of the nail (38 cases, 76 locking holes) took a median of 44.5 seconds (interquartile range [IQR] 33.0–59.0), while the number of exposures ranged from 2 to 12 with a median of 5.5 exposures (IQR 4.0–8.0). The freehand locking procedure’s exposure time was 0.09 minutes (IQR 0.07–0.23). Conclusion The proposed forearm intramedullary nail design modifications allowed for successful implan- tation, interlocking and removal of nails in both radius and ulna cadaver bones, with acceptable radiation exposure. Level of evidence Level 5
{"title":"Evaluating the design modifications of an intramedullary forearm nail system: a cadaver study","authors":"H. Pretorius, M. Burger, N. Ferreira","doi":"10.17159/2309-8309/2022/v21n1a1","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n1a1","url":null,"abstract":"Background Current orthopaedic practice requires a forearm nail that is length and rotationally stable and which can restore functional anatomy. A forearm nailing system was designed based on clinical need. This nailing system features unique designs and locking holes that offer a larger approach and escape angle for ease of interlocking. The aim of the present study was to test the prototype and evaluate the design changes in cadaver bones. Methods A cross-sectional cadaveric study, including ten cadavers with normal forearm anatomy (n = 20 forearms) was conducted. Both forearms of the cadavers were used to evaluate the locking times and exposure time during i) insertion; ii) locking; and iii) removal of the nails, resulting in the evaluation of a total of 40 procedures. All nails were assessed for insertions of interlocking screws. Results The nail was successfully inserted into 38 bones. Inserted nails were available for locking (n = 38), and all locking attempts at both driving ends (n = 38, 100%), as well as the non-driving ends (n = 76, 100%), were successful. Freehand locking at the non-driving end of the nail (38 cases, 76 locking holes) took a median of 44.5 seconds (interquartile range [IQR] 33.0–59.0), while the number of exposures ranged from 2 to 12 with a median of 5.5 exposures (IQR 4.0–8.0). The freehand locking procedure’s exposure time was 0.09 minutes (IQR 0.07–0.23). Conclusion The proposed forearm intramedullary nail design modifications allowed for successful implan- tation, interlocking and removal of nails in both radius and ulna cadaver bones, with acceptable radiation exposure. Level of evidence Level 5","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":"67480940","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/v21n3a3
M. Çetinkaya, V. Gezengana, T. Mann, J. du Toit, J. Davis
BACKGROUND: Severe kyphotic deformity in young children may have devastating outcomes when neglected. Halo-pelvic traction has been shown to be very effective as part of the treatment for severe kyphosis, but little is known about application of this technique in very young individuals. The aim of this case series was to provide novel insights into the surgical technique associated with halo-external fixator frame (HEFF) treatment for severe spinal deformity in patients younger than 4 years old, along with the associated radiologic outcomes and complications METHODS: Clinical and demographic characteristics including the duration in the HEFF, HEFF-associated change in kyphosis angle (KA) and final KA following definitive surgery were extracted from medical records RESULTS: Five female patients with a mean age of 36 months (range 30-44) were included. Three patients had thoracic spinal tuberculosis (mean KA 82°), one had lumbar spinal tuberculosis (KA 42°) and one had iatrogenic post-laminectomy cervical kyphosis (type 1 neurofibromatosis)(KA 112°). The HEFF was applied for a mean of six weeks and resulted in a mean thoracic deformity correction of 29° (38%), a lumbar correction of 23° (55%) and cervical correction of 47° (42%). Definitive surgery resulted in a further mean overall deformity correction of 28, and patients had a satisfactory KA angle (23° lordosis to 31° kyphosis) at the last follow-up. HEFF-associated complications included pin-site infection, pneumonia and frame dislodgement CONCLUSION: HEFF appears to be an effective method for correcting severe kyphotic spinal deformity in very young patients where other options are limited. It allows for independent mobilisation and can provide for spinal stabilisation while awaiting bony healing after definitive surgery. However, healthcare providers should be aware of the potential dangers of HEFF hardware, such as difficulty in establishing an airway due to the fixed position of the neck Level of evidence: Level 4
{"title":"Halo-external fixator frame-assisted correction to treat severe kyphotic deformity in children younger than 4 years old","authors":"M. Çetinkaya, V. Gezengana, T. Mann, J. du Toit, J. Davis","doi":"10.17159/2309-8309/2022/v21n3a3","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n3a3","url":null,"abstract":"BACKGROUND: Severe kyphotic deformity in young children may have devastating outcomes when neglected. Halo-pelvic traction has been shown to be very effective as part of the treatment for severe kyphosis, but little is known about application of this technique in very young individuals. The aim of this case series was to provide novel insights into the surgical technique associated with halo-external fixator frame (HEFF) treatment for severe spinal deformity in patients younger than 4 years old, along with the associated radiologic outcomes and complications METHODS: Clinical and demographic characteristics including the duration in the HEFF, HEFF-associated change in kyphosis angle (KA) and final KA following definitive surgery were extracted from medical records RESULTS: Five female patients with a mean age of 36 months (range 30-44) were included. Three patients had thoracic spinal tuberculosis (mean KA 82°), one had lumbar spinal tuberculosis (KA 42°) and one had iatrogenic post-laminectomy cervical kyphosis (type 1 neurofibromatosis)(KA 112°). The HEFF was applied for a mean of six weeks and resulted in a mean thoracic deformity correction of 29° (38%), a lumbar correction of 23° (55%) and cervical correction of 47° (42%). Definitive surgery resulted in a further mean overall deformity correction of 28, and patients had a satisfactory KA angle (23° lordosis to 31° kyphosis) at the last follow-up. HEFF-associated complications included pin-site infection, pneumonia and frame dislodgement CONCLUSION: HEFF appears to be an effective method for correcting severe kyphotic spinal deformity in very young patients where other options are limited. It allows for independent mobilisation and can provide for spinal stabilisation while awaiting bony healing after definitive surgery. However, healthcare providers should be aware of the potential dangers of HEFF hardware, such as difficulty in establishing an airway due to the fixed position of the neck Level of evidence: Level 4","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":"67481109","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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