Pub Date : 2022-01-01DOI: 10.17159/2309-8309/2022/v21n3a5
T. Koyejo, O. Olusunmade, O. Olufemi
BACKGROUND: Primary bone tumours, although rare, are an important rising cause of morbidity and mortality in Africa. Late presentation, delayed diagnosis and failure to obtain consent for surgical procedures are important causes of loss of limb and life especially in the West African subregion. Existing data on primary bone tumours in Nigeria have been based on studies performed at various regional levels. The aim of this study is to determine the epidemiological pattern of primary bone tumours in Nigeria in general, including demographics, predominant tumour types and predominant skeletal location by reviewing existing data METHODS: A search of the following databases: University of Edinburgh Library, PubMed, CINAHL and SCOPUS from 2000 till January 2021 following PRISMA guidelines was conducted to identify studies conducted in Nigeria with relevant epidemiological data on primary bone tumours in Nigeria RESULTS: The search yielded a total of 952 hits from which seven hospital-based retrospective studies met the inclusion criteria for review. The estimated incidence rate of primary bone tumours ranged from 0.08 to 0.31 per 100 000 population. All studies showed a male preponderance. The peak age group of individuals presenting with both benign and malignant primary bone tumours was 11-20 years. Overall, benign tumours were more common. Osteochondromas were the most common benign tumours, while the commonest malignant tumours identified were osteosarcomas. The most common location for both benign and malignant tumours were the tibia and fibula CONCLUSION: Nigeria shares some similar epidemiological characteristics of primary bone tumour with other countries; however, some peculiar differences have been identified in this study. Population-based studies are required to obtain more accurate epidemiological data about this disease Level of evidence: Level 2
{"title":"Epidemiology of primary bone tumours in Nigeria: a systematic review","authors":"T. Koyejo, O. Olusunmade, O. Olufemi","doi":"10.17159/2309-8309/2022/v21n3a5","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n3a5","url":null,"abstract":"BACKGROUND: Primary bone tumours, although rare, are an important rising cause of morbidity and mortality in Africa. Late presentation, delayed diagnosis and failure to obtain consent for surgical procedures are important causes of loss of limb and life especially in the West African subregion. Existing data on primary bone tumours in Nigeria have been based on studies performed at various regional levels. The aim of this study is to determine the epidemiological pattern of primary bone tumours in Nigeria in general, including demographics, predominant tumour types and predominant skeletal location by reviewing existing data METHODS: A search of the following databases: University of Edinburgh Library, PubMed, CINAHL and SCOPUS from 2000 till January 2021 following PRISMA guidelines was conducted to identify studies conducted in Nigeria with relevant epidemiological data on primary bone tumours in Nigeria RESULTS: The search yielded a total of 952 hits from which seven hospital-based retrospective studies met the inclusion criteria for review. The estimated incidence rate of primary bone tumours ranged from 0.08 to 0.31 per 100 000 population. All studies showed a male preponderance. The peak age group of individuals presenting with both benign and malignant primary bone tumours was 11-20 years. Overall, benign tumours were more common. Osteochondromas were the most common benign tumours, while the commonest malignant tumours identified were osteosarcomas. The most common location for both benign and malignant tumours were the tibia and fibula CONCLUSION: Nigeria shares some similar epidemiological characteristics of primary bone tumour with other countries; however, some peculiar differences have been identified in this study. Population-based studies are required to obtain more accurate epidemiological data about this disease Level of evidence: Level 2","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":"67481202","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/v21n2a3
M. Keller, R. Barnes, C. Brandt, L. Hepworth
BACKGROUND: The second to fifth metacarpal fractures are immobilised with splints, plaster of Paris (POP) or buddy strapping for a period of time. However, no recent evidence-based splinting and immobilisation programme exists for the management thereof, leaving a gap in the literature to inform clinical practice. This review aimed to review, appraise and collate the literature on splints and immobilisation approaches used for second to fifth metacarpal fractures after surgical and conservative management in adults aged 20 to 59 years. METHODS: The review included experimental study designs, quasi-experimental studies, cohort studies and case-control studies from January 2008 to September 2018. Two reviewers independently screened, selected, appraised and extracted data from the included studies. Preferred reporting items for systematic reviews and meta-analysis (PRISMA) guided the reporting. Joanna Briggs Institute (jBl) critical appraisal tools were used to assess the risk of bias for each included study. RESULTS: Database searches generated 1 005 articles with ten additional articles found on Google Scholar. Ten articles were included: two randomised controlled trials (RCTs), one quasi-RCT, four prospective studies, one retrospective record review, one retrospective study and one comparative study with descriptive reporting of the results. CONCLUSION: High level 1b evidence suggests that no reduction, a soft wrap and buddy strapping for three weeks with early active finger and wrist mobilisation are effective for individuals who sustained boxer's fractures with < 70° angulation. To guide clinical practice, high-level research is needed to determine the immobilisation of second to fifth metacarpal fracture types. Level of evidence: Level 2
{"title":"Splints and immobilisation approaches used for second to fifth metacarpal fractures: a systematic review","authors":"M. Keller, R. Barnes, C. Brandt, L. Hepworth","doi":"10.17159/2309-8309/2022/v21n2a3","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n2a3","url":null,"abstract":"BACKGROUND: The second to fifth metacarpal fractures are immobilised with splints, plaster of Paris (POP) or buddy strapping for a period of time. However, no recent evidence-based splinting and immobilisation programme exists for the management thereof, leaving a gap in the literature to inform clinical practice. This review aimed to review, appraise and collate the literature on splints and immobilisation approaches used for second to fifth metacarpal fractures after surgical and conservative management in adults aged 20 to 59 years. METHODS: The review included experimental study designs, quasi-experimental studies, cohort studies and case-control studies from January 2008 to September 2018. Two reviewers independently screened, selected, appraised and extracted data from the included studies. Preferred reporting items for systematic reviews and meta-analysis (PRISMA) guided the reporting. Joanna Briggs Institute (jBl) critical appraisal tools were used to assess the risk of bias for each included study. RESULTS: Database searches generated 1 005 articles with ten additional articles found on Google Scholar. Ten articles were included: two randomised controlled trials (RCTs), one quasi-RCT, four prospective studies, one retrospective record review, one retrospective study and one comparative study with descriptive reporting of the results. CONCLUSION: High level 1b evidence suggests that no reduction, a soft wrap and buddy strapping for three weeks with early active finger and wrist mobilisation are effective for individuals who sustained boxer's fractures with < 70° angulation. To guide clinical practice, high-level research is needed to determine the immobilisation of second to fifth metacarpal fracture types. Level of evidence: Level 2","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":"67481293","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/v21n4a4
A. Rachuene, R. Dey, S. de Villiers, K. Berry, M. Mulder, J. Du Plessis, S. Roche
BACKGROUND: The aim of this study was to review vitamin D levels in patients who underwent Latarjet procedures at a tertiary teaching hospital and a private clinic. METHODS: A retrospective review of clinical and radiological records was performed for 22 patients who underwent Latarjet procedure between November 2017 and June 2019. Postoperative vitamin D levels were retrieved and classified into sufficient (> 75 nmol/L), insufficient (25-75 nmol/L), and deficient (< 25 nmol/L) groups. Two observers assessed radiographic images of the patients at six weeks and three months after surgery. Any bone resorption, fracture and nonunion were reported, and interobserver reliability was analysed using the intraclass correlation coefficient (ICC). RESULTS: The median age was 20.5 years and was predominantly male. A little more than two-thirds (68.1%) of the patients were found to have insufficient or deficient levels of vitamin D. One patient from the insufficient group had postoperative bone resorption. Good interobserver reliability was observed with the ICC value being 0.86. CONCLUSION: This study found a prevalence of insufficient/deficient vitamin D levels in young patients undergoing a Latarjet procedure. This study serves as a reminder to orthopaedic surgeons that vitamin D deficiency is prevalent among patients undergoing Latarjet Level of evidence: Level 4.
{"title":"Retrospective audit of serum vitamin D levels in patients who underwent Latarjet procedure for anterior shoulder instability","authors":"A. Rachuene, R. Dey, S. de Villiers, K. Berry, M. Mulder, J. Du Plessis, S. Roche","doi":"10.17159/2309-8309/2022/v21n4a4","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n4a4","url":null,"abstract":"BACKGROUND: The aim of this study was to review vitamin D levels in patients who underwent Latarjet procedures at a tertiary teaching hospital and a private clinic. METHODS: A retrospective review of clinical and radiological records was performed for 22 patients who underwent Latarjet procedure between November 2017 and June 2019. Postoperative vitamin D levels were retrieved and classified into sufficient (> 75 nmol/L), insufficient (25-75 nmol/L), and deficient (< 25 nmol/L) groups. Two observers assessed radiographic images of the patients at six weeks and three months after surgery. Any bone resorption, fracture and nonunion were reported, and interobserver reliability was analysed using the intraclass correlation coefficient (ICC). RESULTS: The median age was 20.5 years and was predominantly male. A little more than two-thirds (68.1%) of the patients were found to have insufficient or deficient levels of vitamin D. One patient from the insufficient group had postoperative bone resorption. Good interobserver reliability was observed with the ICC value being 0.86. CONCLUSION: This study found a prevalence of insufficient/deficient vitamin D levels in young patients undergoing a Latarjet procedure. This study serves as a reminder to orthopaedic surgeons that vitamin D deficiency is prevalent among patients undergoing Latarjet 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":"67481449","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/v21n2a0
L. Marais
With my term as Editor-in-Chief of the SAOJ coming to an end soon, I cannot help but reflect on some of my past experiences in this role. Perhaps the most challenging (and satisfying) was the need to get to grips with some of the more intricate aspects of research methodology and statistics. At first glance, these concepts seem fairly straightforward, but almost ubiquitously become exceedingly complex the harder you look. The odds ratio (OR) is an excellent case in point. There are a number of ways in which the measure of association between an exposure and an outcome can be expressed. ORs are probably the most commonly used. The current emphasis on reporting 95% confidence intervals (CI), rather than only p-values, has resulted in us seeing and doing a lot more logistic regression. Along with the 95% CI, the statistical program also provides the OR, which is then reported in our results. Now, ORs are tricky things. To justify this statement, I am going to have to go way back to the start, where all good research should start, with the definitions. A ratio is simply a number obtained by dividing one number by another number, and there is not necessarily a relationship between the numerator and denominator. A proportion is a ratio that relates a part to a whole, thus there is a relationship between the numerator and denominator. Rate is a proportion where the denominator also takes into account another dimension, typically time. Defining probability (P) is a minefield, but for our purposes, we will limit it to the measure of the likelihood that an event will occur. With the basics out of the way, let us delve a little deeper. Relative risk (RR), also known as the risk ratio, is a descriptive statistic commonly used in analytical studies. Risk can be defined as the probability of the outcome of interest occurring. RR is therefore essentially a ratio of proportions. In statistical terms, RR is equal to the event rate in the exposed group divided by the event rate in the non-exposed (control) group (Figure 1). For example, imagine we are performing a study comparing the risk of developing infection following grade III open fractures when antibiotics are given within an hour of the injury (treatment group) or not (control group). If 5 out of 100 patients in the treatment group and 20 out of 100 patients in the control group get an infection, we have a relative risk of 0.25. RR = 0.25 means exposed patients (i.e., in the treatment group) are 0.25 times as likely to develop the outcome of interest. We could also state that patients receiving antibiotics within an hour were 75% (0.75 = 1 − 0.25) less likely to develop infection. As clinicians we generally prefer to think in terms of probabilities and relative risk. The other commonly used descriptive statistic to report measure of association is the odds ratio (OR). Odds can be defined as the relative probability of the outcome of interest occurring. So, what is this probability relative to? – the probab
{"title":"Data and decision making – from odd to artificial","authors":"L. Marais","doi":"10.17159/2309-8309/2022/v21n2a0","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n2a0","url":null,"abstract":"With my term as Editor-in-Chief of the SAOJ coming to an end soon, I cannot help but reflect on some of my past experiences in this role. Perhaps the most challenging (and satisfying) was the need to get to grips with some of the more intricate aspects of research methodology and statistics. At first glance, these concepts seem fairly straightforward, but almost ubiquitously become exceedingly complex the harder you look. The odds ratio (OR) is an excellent case in point. There are a number of ways in which the measure of association between an exposure and an outcome can be expressed. ORs are probably the most commonly used. The current emphasis on reporting 95% confidence intervals (CI), rather than only p-values, has resulted in us seeing and doing a lot more logistic regression. Along with the 95% CI, the statistical program also provides the OR, which is then reported in our results. Now, ORs are tricky things. To justify this statement, I am going to have to go way back to the start, where all good research should start, with the definitions. A ratio is simply a number obtained by dividing one number by another number, and there is not necessarily a relationship between the numerator and denominator. A proportion is a ratio that relates a part to a whole, thus there is a relationship between the numerator and denominator. Rate is a proportion where the denominator also takes into account another dimension, typically time. Defining probability (P) is a minefield, but for our purposes, we will limit it to the measure of the likelihood that an event will occur. With the basics out of the way, let us delve a little deeper. Relative risk (RR), also known as the risk ratio, is a descriptive statistic commonly used in analytical studies. Risk can be defined as the probability of the outcome of interest occurring. RR is therefore essentially a ratio of proportions. In statistical terms, RR is equal to the event rate in the exposed group divided by the event rate in the non-exposed (control) group (Figure 1). For example, imagine we are performing a study comparing the risk of developing infection following grade III open fractures when antibiotics are given within an hour of the injury (treatment group) or not (control group). If 5 out of 100 patients in the treatment group and 20 out of 100 patients in the control group get an infection, we have a relative risk of 0.25. RR = 0.25 means exposed patients (i.e., in the treatment group) are 0.25 times as likely to develop the outcome of interest. We could also state that patients receiving antibiotics within an hour were 75% (0.75 = 1 − 0.25) less likely to develop infection. As clinicians we generally prefer to think in terms of probabilities and relative risk. The other commonly used descriptive statistic to report measure of association is the odds ratio (OR). Odds can be defined as the relative probability of the outcome of interest occurring. So, what is this probability relative to? – the probab","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":"67480708","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/v21n4a1
M. P. Phala, P. Rachuene, Bongani Socutshana, ¹. Khetani, S. Bila³
BACKGROUND: Lower limb fractures occurring in and around the home environment and caused by collapsing access gates present frequently to our emergency unit. There is currently limited literature evaluating injuries resulting from access gate accidents. The aim of this study was to evaluate the patterns of lower limb fractures, management options offered and concomitant injuries in children as well as adolescents presenting with access gate-related lower limb traumas. METHODS: A retrospective cross-sectional review of 43 children with 46 lower limb fractures was conducted between 1 January 2017 and 31 December 2020. Hospital records and radiology archives of all children and adolescents under 12 years of age (24 males and 8 females) with lower limb fractures sustained following an access gate injury were reviewed and included for analysis. Data was analysed descriptively using SAS (SAS Institute Inc, Carey, NC, USA), Release 9.4. RESULTS: The prevalence of access gate-related injuries for all lower limb fractures in children and adolescents treated during the four-year period was 11%. The findings revealed that femur fractures are more common, accounting for 50.0% of the cases. The majority of cases were of patients younger than 6 years (71.9%), and predominantly affecting males (3:1). The fractures occurred in a home environment and were commonly related to non-motorised gates, in 93.8% of cases. The oblique fracture patterns comprised 40.6% of the fractures, and 68.8% of the fractures were located in the diaphysis. Open fractures constituted 50.0% of the tibia fractures. Mild head injuries associated with lower limb fractures were observed in 12.5% of the cases. CONCLUSION: The results demonstrated the prevalence of lower limb fractures above all injuries related to access gates. The majority of the injuries observed in this study occurred in manually operated gates, and commonly affected younger patients. In light of these findings, further studies are required into the reasons for these injuries and preventative measures Level of evidence: Level 4.
背景:下肢骨折发生在家庭环境和周围，并引起塌陷的入口门经常出现在我们的急诊室。目前评价出入口事故造成的伤害的文献有限。本研究的目的是评估儿童和青少年出现与通道门相关的下肢创伤的下肢骨折模式、治疗方案和伴随损伤。方法:对2017年1月1日至2020年12月31日期间43例下肢骨折的儿童进行回顾性横断面分析。我们回顾了所有12岁以下儿童和青少年(24名男性和8名女性)在通道门损伤后下肢骨折的医院记录和放射学档案，并将其纳入分析。使用SAS (SAS Institute Inc, Carey, NC, USA)， Release 9.4对数据进行描述性分析。结果:在四年治疗期间，所有儿童和青少年下肢骨折的通道门相关损伤发生率为11%。结果显示，股骨骨折更为常见，占病例的50.0%。以6岁以下患者居多(71.9%)，以男性为主(3:1)。骨折发生在家庭环境中，通常与非机动门有关，占93.8%。斜向骨折占40.6%，骨干骨折占68.8%。开放性骨折占胫骨骨折的50.0%。12.5%的病例出现轻度头部损伤合并下肢骨折。结论:下肢骨折的发生率高于所有与通道门相关的损伤。本研究中观察到的大多数损伤发生在手动操作的门，通常影响年轻患者。根据这些发现，需要进一步研究这些伤害的原因和预防措施。证据等级:四级。
{"title":"Access gate-related lower limb fractures in children and adolescents: a review of injury patterns and evaluation of associated injuries","authors":"M. P. Phala, P. Rachuene, Bongani Socutshana, ¹. Khetani, S. Bila³","doi":"10.17159/2309-8309/2022/v21n4a1","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n4a1","url":null,"abstract":"BACKGROUND: Lower limb fractures occurring in and around the home environment and caused by collapsing access gates present frequently to our emergency unit. There is currently limited literature evaluating injuries resulting from access gate accidents. The aim of this study was to evaluate the patterns of lower limb fractures, management options offered and concomitant injuries in children as well as adolescents presenting with access gate-related lower limb traumas. METHODS: A retrospective cross-sectional review of 43 children with 46 lower limb fractures was conducted between 1 January 2017 and 31 December 2020. Hospital records and radiology archives of all children and adolescents under 12 years of age (24 males and 8 females) with lower limb fractures sustained following an access gate injury were reviewed and included for analysis. Data was analysed descriptively using SAS (SAS Institute Inc, Carey, NC, USA), Release 9.4. RESULTS: The prevalence of access gate-related injuries for all lower limb fractures in children and adolescents treated during the four-year period was 11%. The findings revealed that femur fractures are more common, accounting for 50.0% of the cases. The majority of cases were of patients younger than 6 years (71.9%), and predominantly affecting males (3:1). The fractures occurred in a home environment and were commonly related to non-motorised gates, in 93.8% of cases. The oblique fracture patterns comprised 40.6% of the fractures, and 68.8% of the fractures were located in the diaphysis. Open fractures constituted 50.0% of the tibia fractures. Mild head injuries associated with lower limb fractures were observed in 12.5% of the cases. CONCLUSION: The results demonstrated the prevalence of lower limb fractures above all injuries related to access gates. The majority of the injuries observed in this study occurred in manually operated gates, and commonly affected younger patients. In light of these findings, further studies are required into the reasons for these injuries and preventative measures 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":"67481319","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 : 2021-08-31DOI: 10.17159/2309-8309/2021/v20n3a5
H. Pretorius, N. Ferreira, M. Burger
ABSTRACT BACKGROUND: The aim of this study was to accurately establish the variability in the anatomy of the radius and ulna in the context of the design of an intramedullary nail for both bones METHODS: Forearm computed tomography scans were used to measure the specific internal and external anatomy of the radius and ulna in adult patients. Patients with fractures or dislocations involving either the radius and/or ulna were excluded RESULTS: A total of 97 scans, comprising 84% male and 16% female patients, were included. The mean radius length was 238.43±18.38 mm (95% CI 234.60-241.74 mm). The mean curvature was an arc with a radius of 561.43±93.49 mm (95% CI 543.09-580.78 mm). The smallest measurement of the canal width was 5.17 mm (95% CI 4.87-5.47 mm). The ulna showed a mean length of 259.90±19.88 mm (95% CI 255.89-263.91 mm). The smallest measurement of the canal width was 4.80±1.30 mm (95% CI 4.53-5.87 mm). The mean proximal shaft angle was 11.39±3.30° (95% CI 10.76-12.82° CONCLUSION: This computed tomography scan-based anthropomorphic study has identified novel anatomical features and associations of human forearm bones. This information will be used in the design and manufacture of anatomic intramedullary devices to better manage radius and ulna fractures or pathology Level of evidence: Level 4 Keywords: radius, ulna, anatomy, osteology, radius of curvature, intramedullary design
{"title":"A computer tomography-based anthropomorphic study of forearm osteology: implications for prosthetic design","authors":"H. Pretorius, N. Ferreira, M. Burger","doi":"10.17159/2309-8309/2021/v20n3a5","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n3a5","url":null,"abstract":"ABSTRACT BACKGROUND: The aim of this study was to accurately establish the variability in the anatomy of the radius and ulna in the context of the design of an intramedullary nail for both bones METHODS: Forearm computed tomography scans were used to measure the specific internal and external anatomy of the radius and ulna in adult patients. Patients with fractures or dislocations involving either the radius and/or ulna were excluded RESULTS: A total of 97 scans, comprising 84% male and 16% female patients, were included. The mean radius length was 238.43±18.38 mm (95% CI 234.60-241.74 mm). The mean curvature was an arc with a radius of 561.43±93.49 mm (95% CI 543.09-580.78 mm). The smallest measurement of the canal width was 5.17 mm (95% CI 4.87-5.47 mm). The ulna showed a mean length of 259.90±19.88 mm (95% CI 255.89-263.91 mm). The smallest measurement of the canal width was 4.80±1.30 mm (95% CI 4.53-5.87 mm). The mean proximal shaft angle was 11.39±3.30° (95% CI 10.76-12.82° CONCLUSION: This computed tomography scan-based anthropomorphic study has identified novel anatomical features and associations of human forearm bones. This information will be used in the design and manufacture of anatomic intramedullary devices to better manage radius and ulna fractures or pathology Level of evidence: Level 4 Keywords: radius, ulna, anatomy, osteology, radius of curvature, intramedullary design","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46256652","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 : 2021-08-31DOI: 10.17159/2309-8309/2021/v20n3a8
Janet L de Stadler, N. Kruger, Shivani Singh, E. Banderker, S. Dix-Peek, K. Pillay
ABSTRACT BACKGROUND: Multiple hereditary exostosis (MHE) is a rare autosomal dominant disorder predisposing to the development of multiple osteochondromas. Malignant transformation is an uncommon complication of osteochondromas and is especially rare in the paediatric population. Making a diagnosis of malignant transformation is recognised as a challenge globally METHODS: We obtained informed consent and ethics approval prior to reviewing the hospital file, radiology and pathology of our index patient, as well as conducting a directed literature search RESULTS: An 11-year-old male with MHE presented with new onset pain in the right leg with an associated inability to weight bear. Plain radiographs and magnetic resonance imaging (MRI) showed features consistent with malignant transformation. The child underwent a Malawer 1 resection of the proximal fibula with no complications. The pathology confirmed a grade 1 secondary peripheral chondrosarcoma (CS) arising in an osteochondroma The rate of malignant transformation in MHE is as high as 36.3% in select specialist tertiary centres. Ninety per cent of the resultant malignancies are chondrosarcomas. Malignant transformation before the age of 20 years is exceptional. Plain radiology is routinely used for monitoring of patients with MHE. Other modalities exist to assess for cartilage cap thickness, a much-debated criterion of malignant change. Pathology is essential for confirmation of malignant transformation as well as to exclude high grade lesions. Treatment is wide local excision (WLE) with limb-sparing surgery and long-term follow-up to detect for local recurrences. CONCLUSION: The malignant transformation of osteochondromas occurs more frequently in individuals with MHE and may even arise in the paediatric population. In the presence of suspicious clinical or radiological features, en-bloc surgical resection and histopathological correlation is mandatory to make the diagnosis. We encourage a multidisciplinary team approach with collaboration between the orthopaedic surgeon, radiologist and pathologist Level of evidence: Level 5 Keywords: multiple hereditary exostosis (MHE), chondrosarcoma, osteochondroma, malignant transformation
{"title":"Malignant transformation in an 11-year-old child with multiple hereditary exostosis","authors":"Janet L de Stadler, N. Kruger, Shivani Singh, E. Banderker, S. Dix-Peek, K. Pillay","doi":"10.17159/2309-8309/2021/v20n3a8","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n3a8","url":null,"abstract":"ABSTRACT BACKGROUND: Multiple hereditary exostosis (MHE) is a rare autosomal dominant disorder predisposing to the development of multiple osteochondromas. Malignant transformation is an uncommon complication of osteochondromas and is especially rare in the paediatric population. Making a diagnosis of malignant transformation is recognised as a challenge globally METHODS: We obtained informed consent and ethics approval prior to reviewing the hospital file, radiology and pathology of our index patient, as well as conducting a directed literature search RESULTS: An 11-year-old male with MHE presented with new onset pain in the right leg with an associated inability to weight bear. Plain radiographs and magnetic resonance imaging (MRI) showed features consistent with malignant transformation. The child underwent a Malawer 1 resection of the proximal fibula with no complications. The pathology confirmed a grade 1 secondary peripheral chondrosarcoma (CS) arising in an osteochondroma The rate of malignant transformation in MHE is as high as 36.3% in select specialist tertiary centres. Ninety per cent of the resultant malignancies are chondrosarcomas. Malignant transformation before the age of 20 years is exceptional. Plain radiology is routinely used for monitoring of patients with MHE. Other modalities exist to assess for cartilage cap thickness, a much-debated criterion of malignant change. Pathology is essential for confirmation of malignant transformation as well as to exclude high grade lesions. Treatment is wide local excision (WLE) with limb-sparing surgery and long-term follow-up to detect for local recurrences. CONCLUSION: The malignant transformation of osteochondromas occurs more frequently in individuals with MHE and may even arise in the paediatric population. In the presence of suspicious clinical or radiological features, en-bloc surgical resection and histopathological correlation is mandatory to make the diagnosis. We encourage a multidisciplinary team approach with collaboration between the orthopaedic surgeon, radiologist and pathologist Level of evidence: Level 5 Keywords: multiple hereditary exostosis (MHE), chondrosarcoma, osteochondroma, malignant transformation","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44241341","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 : 2021-08-31DOI: 10.17159/2309-8309/2021/v20n3a4
J. Roux, R. Dey, A. Deichl, Oscar Torney, M. Laubscher, S. Graham, M. Held
ABSTRACT BACKGROUND: The use of patient-reported outcome measures (PROMs) for knee pathology may be affected by socioeconomic factors, language barriers and time constraints in busy outpatient clinics. The squat-and-smile test (SST) is an example of such a test that has previously been validated for femur fractures. The aim of this study was to validate the SST against other PROMs in patients with knee pathology METHODS: Patients presenting to a subspecialist knee clinic in a large hospital in sub-Saharan Africa were approached to participate. They were asked to squat and the depth of the squat as well as the need to support themselves were classified into four categories. To describe their pain, participants also selected one of three smiley faces (unhappy, neutral, smiling). These test scores were correlated to the patient's Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Lysholm score and EQ-5D scores RESULTS: Seventy patients (median age 53.4 years) were included. The squat depth correlated moderately with the KOOS score (r=0.56) and poorly with the EQ-5D and Lysholm scores (r=0.46; r=0.43). The need for squat support had poor correlations with the KOOS, EQ-5D and Lysholm scores (r=0.29; r=0.31; r=0.31), as did the smiley face component (r=0.40; r=0.32; r=0.30 CONCLUSION: For patients with knee pathology, the squat depth correlates moderately with other PROMs. It could therefore be used in settings for which conventional PROMs have limited application. Support needed to squat, and a visual analogue scale of smiley faces, had poor correlation when compared to other knee PROMs and should not be used for the assessment of knee pathology Level of evidence: Level 4 Keywords: squat and smile, KOOS, PROM, smiley faces, outcome score
{"title":"Correlation of the squat-and-smile test against other patient-reported outcome scores in knee pathology","authors":"J. Roux, R. Dey, A. Deichl, Oscar Torney, M. Laubscher, S. Graham, M. Held","doi":"10.17159/2309-8309/2021/v20n3a4","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n3a4","url":null,"abstract":"ABSTRACT BACKGROUND: The use of patient-reported outcome measures (PROMs) for knee pathology may be affected by socioeconomic factors, language barriers and time constraints in busy outpatient clinics. The squat-and-smile test (SST) is an example of such a test that has previously been validated for femur fractures. The aim of this study was to validate the SST against other PROMs in patients with knee pathology METHODS: Patients presenting to a subspecialist knee clinic in a large hospital in sub-Saharan Africa were approached to participate. They were asked to squat and the depth of the squat as well as the need to support themselves were classified into four categories. To describe their pain, participants also selected one of three smiley faces (unhappy, neutral, smiling). These test scores were correlated to the patient's Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Lysholm score and EQ-5D scores RESULTS: Seventy patients (median age 53.4 years) were included. The squat depth correlated moderately with the KOOS score (r=0.56) and poorly with the EQ-5D and Lysholm scores (r=0.46; r=0.43). The need for squat support had poor correlations with the KOOS, EQ-5D and Lysholm scores (r=0.29; r=0.31; r=0.31), as did the smiley face component (r=0.40; r=0.32; r=0.30 CONCLUSION: For patients with knee pathology, the squat depth correlates moderately with other PROMs. It could therefore be used in settings for which conventional PROMs have limited application. Support needed to squat, and a visual analogue scale of smiley faces, had poor correlation when compared to other knee PROMs and should not be used for the assessment of knee pathology Level of evidence: Level 4 Keywords: squat and smile, KOOS, PROM, smiley faces, outcome score","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45210345","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 : 2021-08-31DOI: 10.17159/2309-8309/2021/v20n3a1
Jaco J. Naude, O. Koch, L. Schmidt, T. Roux
ABSTRACT BACKGROUND: The purpose of this study was to establish a subjective patient experience with wide awake local anaesthesia no tourniquet (WALANT) procedures performed in the institution from May 2019 to March 2020. WALANT surgery was initiated to improve standard operating procedure and to decrease theatre burden METHODS: This prospective, descriptive study included 100 patients with a mean age of 59 years who required either a carpal tunnel or trigger finger release. The patients' pain experience was documented on the visual analogue scale (VAS) for the local anaesthetic injection and the surgical procedure. Overall experience was assessed on the patient's preference to have the procedure performed by the WALANT method or the conventional method RESULTS: One hundred patients were included, of which 67 had medical comorbidities. The mean VAS score was 1.5 (SD±1.6) with pain on injection. The mean VAS pain score during the surgical procedure was 0.2 (SD±0.7). One hundred per cent of patients (100/100) felt they would do the WALANT outpatient procedure again instead of admission to hospital and surgery in the theatre. Two complications occurred related to wound care problems, and were successfully managed. None of the patients required reoperations for incomplete release of the carpal tunnel or trigger finger surgery CONCLUSION: The results of this study suggest that minor hand surgery using the WALANT protocol can be performed effectively and with high patient satisfaction rates in the orthopaedic outpatient clinic, and is a useful tool in the skillset of a hand surgeon Level of evidence: Level 4 Keywords: WALANT, hand surgery, trigger finger, carpal tunnel release
{"title":"Positive patient experience of wide awake local anaesthesia no tourniquet (WALANT) hand surgery in the government setting: a prospective descriptive study","authors":"Jaco J. Naude, O. Koch, L. Schmidt, T. Roux","doi":"10.17159/2309-8309/2021/v20n3a1","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n3a1","url":null,"abstract":"ABSTRACT BACKGROUND: The purpose of this study was to establish a subjective patient experience with wide awake local anaesthesia no tourniquet (WALANT) procedures performed in the institution from May 2019 to March 2020. WALANT surgery was initiated to improve standard operating procedure and to decrease theatre burden METHODS: This prospective, descriptive study included 100 patients with a mean age of 59 years who required either a carpal tunnel or trigger finger release. The patients' pain experience was documented on the visual analogue scale (VAS) for the local anaesthetic injection and the surgical procedure. Overall experience was assessed on the patient's preference to have the procedure performed by the WALANT method or the conventional method RESULTS: One hundred patients were included, of which 67 had medical comorbidities. The mean VAS score was 1.5 (SD±1.6) with pain on injection. The mean VAS pain score during the surgical procedure was 0.2 (SD±0.7). One hundred per cent of patients (100/100) felt they would do the WALANT outpatient procedure again instead of admission to hospital and surgery in the theatre. Two complications occurred related to wound care problems, and were successfully managed. None of the patients required reoperations for incomplete release of the carpal tunnel or trigger finger surgery CONCLUSION: The results of this study suggest that minor hand surgery using the WALANT protocol can be performed effectively and with high patient satisfaction rates in the orthopaedic outpatient clinic, and is a useful tool in the skillset of a hand surgeon Level of evidence: Level 4 Keywords: WALANT, hand surgery, trigger finger, carpal tunnel release","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48039614","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 : 2021-08-31DOI: 10.17159/2309-8309/2021/v20n3a0
L. Marais
With Yuval Noah Harari’s ‘I told you so’ still ringing in our ears and the battlefield still ablaze, one cannot help but wonder what the next microorganism assault on humankind is going to involve.1 While we are still fully engaged on our main front, another old enemy is gathering strength on our flanks. Bacterial resistance has been described as the single most important threat to public health in the 21st century.2 The United Nations interagency group on bacterial resistance estimates that drug-resistant disease could rise from a current figure of around 700 000 deaths per annum to around 10 million a year by 2050, if we don’t act.3 The six most common bacterial pathogens in orthopaedics are currently all on the CDC (Centers for Disease Control and Prevention) ‘Urgent’ or ‘Serious’ threat list.4 A meta-analysis estimated that 39% to 51% of surgical site infection in the USA was caused by bacteria that are resistant to the standard prophylactic antibiotics.5 Our primary tool against resistance is antibiotic stewardship programmes. But wil it solve the problem?
{"title":"Antibiotic resistance - Netflix, HAL 9000 and the $100 billion question","authors":"L. Marais","doi":"10.17159/2309-8309/2021/v20n3a0","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n3a0","url":null,"abstract":"With Yuval Noah Harari’s ‘I told you so’ still ringing in our ears and the battlefield still ablaze, one cannot help but wonder what the next microorganism assault on humankind is going to involve.1 While we are still fully engaged on our main front, another old enemy is gathering strength on our flanks. Bacterial resistance has been described as the single most important threat to public health in the 21st century.2 The United Nations interagency group on bacterial resistance estimates that drug-resistant disease could rise from a current figure of around 700 000 deaths per annum to around 10 million a year by 2050, if we don’t act.3 The six most common bacterial pathogens in orthopaedics are currently all on the CDC (Centers for Disease Control and Prevention) ‘Urgent’ or ‘Serious’ threat list.4 A meta-analysis estimated that 39% to 51% of surgical site infection in the USA was caused by bacteria that are resistant to the standard prophylactic antibiotics.5 Our primary tool against resistance is antibiotic stewardship programmes. But wil it solve the problem?","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48929731","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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