Pub Date : 2021-08-31DOI: 10.17159/2309-8309/2021/v20n3a2
Nicolaas P Van der Watt, O. Koch, T. Roux, J. G. Meijer, H. McLoughlin
ABSTRACT BACKGROUND: Distal femoral tumour resections are mostly performed through a medial or anteromedial approach. The lateral parapatellar approach is an alternative method. This case series assessed vascular complications during the resection of malignant distal femoral tumours via the lateral parapatellar approach METHODS: A retrospective case series at a private practice in Pretoria was performed. All patients who underwent malignant distal femoral tumour resections through a lateral parapatellar approach between 2001 and 2019 were included in the study. All cases were performed by a single surgeon. An analysis of the patients' files was performed, to determine if there were any intraoperative or immediately postoperative vascular complications RESULTS: Thirty-six patients were identified who underwent resection of their malignant distal femoral tumours via the lateral parapatellar approach. Osteosarcoma was the most prevalent bone tumour (81%). All resection margins were clear on histology reports. The vascular complication rate was 3% (95% CI 0-8%). Twelve patients demised over the 18-year period (33% CONCLUSION: The findings suggest that a low risk of vascular complications can be expected when resecting malignant distal femoral tumours through a lateral parapatellar approach. This rate of vascular injury is comparable to other studies that also performed distal femoral tumour resections through other approaches Level of evidence: Level 4 Keywords: malignant distal femoral tumours, lateral parapatellar approach, vascular complications, tumour resection, endoprosthesis
背景:股骨远端肿瘤切除术大多通过内侧或前内侧入路进行。外侧髌旁入路是另一种方法。本病例系列评估了经外侧髌旁入路切除股骨远端恶性肿瘤期间的血管并发症方法:回顾性分析了比勒陀利亚一家私人诊所的病例系列。所有在2001年至2019年期间通过外侧髌旁入路进行股骨远端恶性肿瘤切除术的患者都被纳入该研究。所有病例均由一名外科医生完成。对患者的档案进行分析，以确定是否有任何术中或术后立即血管并发症。结果:36例患者经外侧髌旁入路行股骨远端恶性肿瘤切除术。骨肉瘤是最常见的骨肿瘤(81%)。组织学报告显示所有切除边缘清晰。血管并发症发生率为3% (95% CI 0-8%)。结论:研究结果表明，经外侧髌旁入路切除股骨远端恶性肿瘤的血管并发症风险较低。该血管损伤率与其他通过其他入路进行股骨远端肿瘤切除术的研究相当证据等级:4级关键词:股骨远端恶性肿瘤，外侧髌旁入路，血管并发症，肿瘤切除术，假体内假体
{"title":"The prevalence of vascular injury utilising the lateral parapatellar approach for malignant distal femoral tumour resections: a case series","authors":"Nicolaas P Van der Watt, O. Koch, T. Roux, J. G. Meijer, H. McLoughlin","doi":"10.17159/2309-8309/2021/v20n3a2","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n3a2","url":null,"abstract":"ABSTRACT BACKGROUND: Distal femoral tumour resections are mostly performed through a medial or anteromedial approach. The lateral parapatellar approach is an alternative method. This case series assessed vascular complications during the resection of malignant distal femoral tumours via the lateral parapatellar approach METHODS: A retrospective case series at a private practice in Pretoria was performed. All patients who underwent malignant distal femoral tumour resections through a lateral parapatellar approach between 2001 and 2019 were included in the study. All cases were performed by a single surgeon. An analysis of the patients' files was performed, to determine if there were any intraoperative or immediately postoperative vascular complications RESULTS: Thirty-six patients were identified who underwent resection of their malignant distal femoral tumours via the lateral parapatellar approach. Osteosarcoma was the most prevalent bone tumour (81%). All resection margins were clear on histology reports. The vascular complication rate was 3% (95% CI 0-8%). Twelve patients demised over the 18-year period (33% CONCLUSION: The findings suggest that a low risk of vascular complications can be expected when resecting malignant distal femoral tumours through a lateral parapatellar approach. This rate of vascular injury is comparable to other studies that also performed distal femoral tumour resections through other approaches Level of evidence: Level 4 Keywords: malignant distal femoral tumours, lateral parapatellar approach, vascular complications, tumour resection, endoprosthesis","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":"47383667","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/v20n3a7
R. Wadee, Z. Linda, A. Ismail
ABSTRACT BACKGROUND: Phosphaturic mesenchymal tumours are uncommon neoplasms, usually associated with tumour-induced osteomalacia, that occur in middle-aged adults but have been reported at the extremes of age. The 'non-phosphaturic' variant is even rarer METHODS: Herein, we describe the non-phosphaturic variant in a 12-year-old male who presented to the Department of Orthopaedic Surgery with a six-month history of painful progressive swelling of his right forearm in the absence of trauma. He had no other significant symptoms RESULTS: The patient had normal serum calcium and phosphate levels on biochemical analysis. An inci-sional biopsy was performed and a histopathological diagnosis of a phosphaturic mesenchymal tumour, non-phosphaturic variant, was rendered. Six weeks later, he underwent surgical excision of a 15x15 cm soft tissue mass from his right forearm. He had an uneventful postoperative period and was discharged. He has been followed up at the outpatient department and has been free of tumour recurrence for over 18 months since his surgery with no evidence of osteomalacia and no other tumours CONCLUSION: Phosphaturic mesenchymal tumours are rare mesenchymal neoplasms and their microscopically identical counterpart without phosphaturia, known as the 'non-phosphaturic' variant, is even more uncommon and may prove a greater diagnostic challenge. While the diagnosis may be confirmed by hypophosphataemia and phosphaturia secondary to the paraneoplastic phenomenon of tumour-induced osteomalacia, there may be instances, such as with our patient, where tumour-induced osteomalacia is absent. This case underscores the importance of clinicopathological correlation together with a wide differential diagnosis required to arrive at a correct diagnosis to facilitate appropriate patient management Level of evidence: Level 5 Keywords: phosphaturic mesenchymal tumours, non-phosphaturic variant
{"title":"Phosphaturie mesenchymal tumour, 'non-phosphaturic' variant: a case report and review of the literature","authors":"R. Wadee, Z. Linda, A. Ismail","doi":"10.17159/2309-8309/2021/v20n3a7","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n3a7","url":null,"abstract":"ABSTRACT BACKGROUND: Phosphaturic mesenchymal tumours are uncommon neoplasms, usually associated with tumour-induced osteomalacia, that occur in middle-aged adults but have been reported at the extremes of age. The 'non-phosphaturic' variant is even rarer METHODS: Herein, we describe the non-phosphaturic variant in a 12-year-old male who presented to the Department of Orthopaedic Surgery with a six-month history of painful progressive swelling of his right forearm in the absence of trauma. He had no other significant symptoms RESULTS: The patient had normal serum calcium and phosphate levels on biochemical analysis. An inci-sional biopsy was performed and a histopathological diagnosis of a phosphaturic mesenchymal tumour, non-phosphaturic variant, was rendered. Six weeks later, he underwent surgical excision of a 15x15 cm soft tissue mass from his right forearm. He had an uneventful postoperative period and was discharged. He has been followed up at the outpatient department and has been free of tumour recurrence for over 18 months since his surgery with no evidence of osteomalacia and no other tumours CONCLUSION: Phosphaturic mesenchymal tumours are rare mesenchymal neoplasms and their microscopically identical counterpart without phosphaturia, known as the 'non-phosphaturic' variant, is even more uncommon and may prove a greater diagnostic challenge. While the diagnosis may be confirmed by hypophosphataemia and phosphaturia secondary to the paraneoplastic phenomenon of tumour-induced osteomalacia, there may be instances, such as with our patient, where tumour-induced osteomalacia is absent. This case underscores the importance of clinicopathological correlation together with a wide differential diagnosis required to arrive at a correct diagnosis to facilitate appropriate patient management Level of evidence: Level 5 Keywords: phosphaturic mesenchymal tumours, non-phosphaturic variant","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":"44980012","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/v20n3l1
T. Hilton, H. Bauer
Clinical registries have become a normality in virtually all fields of medicine. Orthopaedics has in many ways led this development with early registries of knee and hip arthroplasties. The South African Orthopaedic Registry (SAOR) is an ambitious undertaking to register all orthopaedic procedures performed in South Africa and will provide valuable data for quality assessment, teaching and allocation of resources.1
{"title":"Proposal for a South African sarcoma registry","authors":"T. Hilton, H. Bauer","doi":"10.17159/2309-8309/2021/v20n3l1","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n3l1","url":null,"abstract":"Clinical registries have become a normality in virtually all fields of medicine. Orthopaedics has in many ways led this development with early registries of knee and hip arthroplasties. The South African Orthopaedic Registry (SAOR) is an ambitious undertaking to register all orthopaedic procedures performed in South Africa and will provide valuable data for quality assessment, teaching and allocation of resources.1","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42871733","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 : 2021-05-22DOI: 10.17159/2309-8309/2021/V20N2A4
P. Mare, D. Thompson, L. Marais
BackgroundThis study aimed to determine whether the addition of a lateral proximal tibial tension band plate, combined with proximal tibial dome realignment osteotomy, would decrease the recurrence rate in a group of children younger than 7 years with infantile Blount’s disease (IBD) and high recurrence risk, defined as a medial physeal slope ≥60°. MethodsWe reviewed the records of 14 children (22 limbs) under the age of 7 years with IBD and a medial physeal slope ≥60° that were treated with a combination of tibial osteotomy and tension band plates (group 2) to determine the recurrence rate and time to reoperation. These results were compared with a matched group of eight children (12 limbs) with IBD and a medial physeal slope≥60° that were treated previously with tibial osteotomy alone (group 1). ResultsThe two groups were matched in terms of age, sex, obesity, Langenskiold stage, tibio-femoral angle and medial physeal slope. The recurrence rate was 92% (11/12) in group 1 and 77% (17/22) in group 2 (odds ratio 0.31; 95% CI 0.03–3.01, p=0.312). The mean time to reoperation was 2.4 years in group 1 and 1.9 years in group 2 (p=0.319). There were two implant-related complications: one broken screw and one case of epiphyseal fixation failure in the tension band plate group, both in cases of recurrence. ConclusionThe addition of a lateral tension band plate to a proximal tibial realignment osteotomy may be an option to consider in children younger than 7 years with IBD and a high risk of recurrence. Further research is required to determine recurrence risk in IBD and to develop and evaluate surgical strategies to mitigate this risk with well-designed, multicentre controlled trials. Level of evidence: Level 4
本研究旨在确定在7岁以下患有婴儿布朗特病(IBD)且复发风险高(内侧骨骺斜度≥60°)的儿童中增加外侧胫骨近端张力带钢板并联合胫骨近端圆顶复位是否会降低复发率。方法回顾性分析14例7岁以下、内侧骨骺斜度≥60°的IBD患儿(22条肢体)，采用胫骨截骨联合张力带钢板治疗(2组)，观察复发率和再手术时间。结果与先前单独行胫骨截骨治疗的IBD患儿8例(12肢)进行比较。结果两组在年龄、性别、肥胖程度、Langenskiold分期、胫骨-股骨角和内侧骨骺斜度等方面相匹配。1组复发率为92%(11/12)，2组复发率为77%(17/22)(优势比0.31;95% CI 0.03-3.01, p=0.312)。1组患者平均再手术时间为2.4年，2组患者平均再手术时间为1.9年(p=0.319)。张力带钢板组出现2例与植入物相关的并发症:1例螺钉断裂，1例骨骺固定失败，均复发。结论:对于7岁以下、复发风险高的IBD患儿，在胫骨近端骨切开术中加入外侧张力带钢板可能是一种可考虑的选择。需要进一步的研究来确定IBD的复发风险，并制定和评估手术策略，以通过精心设计的多中心对照试验来降低这种风险。证据等级:四级
{"title":"Growth modulation may decrease recurrence when used as an adjunct to osteotomy in infantile Blount’s disease","authors":"P. Mare, D. Thompson, L. Marais","doi":"10.17159/2309-8309/2021/V20N2A4","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/V20N2A4","url":null,"abstract":"BackgroundThis study aimed to determine whether the addition of a lateral proximal tibial tension band plate, combined with proximal tibial dome realignment osteotomy, would decrease the recurrence rate in a group of children younger than 7 years with infantile Blount’s disease (IBD) and high recurrence risk, defined as a medial physeal slope ≥60°.\u0000MethodsWe reviewed the records of 14 children (22 limbs) under the age of 7 years with IBD and a medial physeal slope ≥60° that were treated with a combination of tibial osteotomy and tension band plates (group 2) to determine the recurrence rate and time to reoperation. These results were compared with a matched group of eight children (12 limbs) with IBD and a medial physeal slope≥60° that were treated previously with tibial osteotomy alone (group 1).\u0000ResultsThe two groups were matched in terms of age, sex, obesity, Langenskiold stage, tibio-femoral angle and medial physeal slope. The recurrence rate was 92% (11/12) in group 1 and 77% (17/22) in group 2 (odds ratio 0.31; 95% CI 0.03–3.01, p=0.312). The mean time to reoperation was 2.4 years in group 1 and 1.9 years in group 2 (p=0.319). There were two implant-related complications: one broken screw and one case of epiphyseal fixation failure in the tension band plate group, both in cases of recurrence.\u0000ConclusionThe addition of a lateral tension band plate to a proximal tibial realignment osteotomy may be an option to consider in children younger than 7 years with IBD and a high risk of recurrence. Further research is required to determine recurrence risk in IBD and to develop and evaluate surgical strategies to mitigate this risk with well-designed, multicentre controlled trials.\u0000Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"20 1","pages":"88-92"},"PeriodicalIF":0.0,"publicationDate":"2021-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45788220","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 : 2021-03-01DOI: 10.17159/2309-8309/2021/V20N1A3
L. J. D. Jager, Pieter Η Mare, Dana Statton Thompson, L. Marais
Children with osteogenesis imperfecta suffer from frequent fractures and deformities due to skeletal fragility. Stabilisation of fractures, correction of deformity and intramedullary rodding result in decreased pain and improved function. Modern expandable intramedullary rods aim to provide lasting stability during growth, without an increase in complications. The aim of our study was to determine and compare the outcome of static Rush rods and expandable Fassier-Duval rods in terms of complications and reoperation rate.
{"title":"Short-term comparison of the use of static and expandable intramedullary rods in the lower limbs of children with osteogenesis imperfecta","authors":"L. J. D. Jager, Pieter Η Mare, Dana Statton Thompson, L. Marais","doi":"10.17159/2309-8309/2021/V20N1A3","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/V20N1A3","url":null,"abstract":"Children with osteogenesis imperfecta suffer from frequent fractures and deformities due to skeletal fragility. Stabilisation of fractures, correction of deformity and intramedullary rodding result in decreased pain and improved function. Modern expandable intramedullary rods aim to provide lasting stability during growth, without an increase in complications. The aim of our study was to determine and compare the outcome of static Rush rods and expandable Fassier-Duval rods in terms of complications and reoperation rate.","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"20 1","pages":"27-32"},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47463958","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 : 2021-01-01DOI: 10.17159/2309-8309/2021/v20n4a1
C. Oosthuizen, I. Maposa, S. Magobotha, H. Pandit
ABSTRACT BACKGROUND: Medial unicompartmental knee arthroplasty (UKA) is advocated for treating symptomatic anteromedial osteoarthritis (AMOA). Correctable mediolateral tibiofemoral (TF) subluxation can be safely ignored according to the UKA enthusiasts. However, no clinical studies compare the results in AMOA patients with and without subluxation. This study reports the early prospective clinical outcomes of medial UKA in AMOA, with and without correctable mediolateral TF subluxation and the comparison to the retrospective larger patient cohort. METHODS: The results of an initial retrospective study (R) consisting of 436 consecutive UKA cases (patients treated from May 2012 to October 2017) were compared to a prospective study (P) consisting of 272 consecutive UKA cases in 248 patients with AMOA (evaluated from November 2017 to May 2020). All patients in both cohorts underwent cementless Oxford UKA and were classified into two groups: group 1 (AMOA without mediolateral subluxation) and group 2 (AMOA with mediolateral subluxation) on anteroposterior (AP) radiological knee stress views. Survival analysis methods (Kaplan-Meier and logrank test) were utilised to compare implant survival between the two groups (1 and 2) and the cohorts (R and P). The multivariable Cox proportional hazards model was used to determine risk factors for time to revision. RESULTS: The two cohorts, R and P, had patient groups (group 1 vs group 2) matched for age, sex, wear pattern, preoperative Oxford Knee Score and follow-up period. The overall implant survival for the P cohort that had at least 20 months of follow-up was 98%. The overall implant survival for group 1 (99%) was significantly better compared to group 2 (93%). These results are amplified in the R cohort with an average follow-up of 54 months, and with the group 1 survival at 97% and group 2 at 86%. Subsequent months of follow-up show more failures in group 2 compared to group 1. Patient-reported outcome measures (PROMs) and range of movement were similar for both groups. CONCLUSION: Patients with AMOA and correctable mediolateral TF subluxation have a significantly higher risk of implant failure compared to those without subluxation. This study establishes this association, which has an important implication on patient selection, but does not confirm causality. Level of evidence: Level 4. Keywords: unicompartmental knee arthroplasty, partial, osteoarthritis, X-ray, implant
{"title":"Impact of correctable mediolateral tibiofemoral subluxation on unicompartmental knee arthroplasty implant survival in patients with anteromedial osteoarthritis","authors":"C. Oosthuizen, I. Maposa, S. Magobotha, H. Pandit","doi":"10.17159/2309-8309/2021/v20n4a1","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n4a1","url":null,"abstract":"ABSTRACT BACKGROUND: Medial unicompartmental knee arthroplasty (UKA) is advocated for treating symptomatic anteromedial osteoarthritis (AMOA). Correctable mediolateral tibiofemoral (TF) subluxation can be safely ignored according to the UKA enthusiasts. However, no clinical studies compare the results in AMOA patients with and without subluxation. This study reports the early prospective clinical outcomes of medial UKA in AMOA, with and without correctable mediolateral TF subluxation and the comparison to the retrospective larger patient cohort. METHODS: The results of an initial retrospective study (R) consisting of 436 consecutive UKA cases (patients treated from May 2012 to October 2017) were compared to a prospective study (P) consisting of 272 consecutive UKA cases in 248 patients with AMOA (evaluated from November 2017 to May 2020). All patients in both cohorts underwent cementless Oxford UKA and were classified into two groups: group 1 (AMOA without mediolateral subluxation) and group 2 (AMOA with mediolateral subluxation) on anteroposterior (AP) radiological knee stress views. Survival analysis methods (Kaplan-Meier and logrank test) were utilised to compare implant survival between the two groups (1 and 2) and the cohorts (R and P). The multivariable Cox proportional hazards model was used to determine risk factors for time to revision. RESULTS: The two cohorts, R and P, had patient groups (group 1 vs group 2) matched for age, sex, wear pattern, preoperative Oxford Knee Score and follow-up period. The overall implant survival for the P cohort that had at least 20 months of follow-up was 98%. The overall implant survival for group 1 (99%) was significantly better compared to group 2 (93%). These results are amplified in the R cohort with an average follow-up of 54 months, and with the group 1 survival at 97% and group 2 at 86%. Subsequent months of follow-up show more failures in group 2 compared to group 1. Patient-reported outcome measures (PROMs) and range of movement were similar for both groups. CONCLUSION: Patients with AMOA and correctable mediolateral TF subluxation have a significantly higher risk of implant failure compared to those without subluxation. This study establishes this association, which has an important implication on patient selection, but does not confirm causality. Level of evidence: Level 4. Keywords: unicompartmental knee arthroplasty, partial, osteoarthritis, X-ray, implant","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"97 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67480852","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 : 2021-01-01DOI: 10.17159/2309-8309/2021/v20n4a8
Sven Strydom, C. H. Snyckers
ABSTRACT BACKGROUND: As our population ages, the incidence of pelvic fragility fractures will rise accordingly. Despite these fractures having similar mortality rates to proximal femur fractures, there exist discrepancies between the management of these injuries. Although a number of pelvic fragility fractures can be treated successfully with conservative means, early treatment with appropriate surgical means should be considered in those failing conservative treatment or with unstable fracture patterns. CASE REPORT: We present an 84-year-old female who sustained a pelvic fragility fracture after a low-energy fall. Despite adequate conservative treatment, she was unable to mobilise. She was taken for anterior and posterior fixation, using our modified minimally invasive subcutaneous technique (the Bridging Infix) for anterior fixation. At the six-week follow-up she had regained full independent mobility. She had three syncope-related falls during this period, but radiographs revealed no sign of implant displacement. One year after her surgery she had complete union of her fracture, good function and no desire to have the implant removed. DISCUSSION: With the expected increase in pelvic fragility fractures due to the growing elderly population, our understanding of these injuries has begun to change. Occult posterior ring injuries have been described in up to 80% of cases, while fracture progression to unstable patterns can occur in up to 15% of stable patterns. Despite conservative management being the primary treatment of choice, these patients suffer morbidity and mortality rates comparable to proximal femur fractures. Early appropriate surgical management should be considered in patients failing to mobilise. Various surgical techniques have been described, each with their own advantages and disadvantages. Newer minimally invasive techniques are gaining favour, especially for use in elderly patients. These constructs combine the low profile benefits of internal plate fixation with ex-fix principles. CONCLUSION: The Bridging Infix is a modified technique for minimally invasive subcutaneous anterior pelvic fixation. Its use can strongly be considered by even the general orthopaedic surgeon in cases where patients are too frail for extensive or invasive surgeries, such as open reduction and internal fixation with plate and screws. Level of evidence: Level 5 Keywords: pelvic fracture, anterior pelvic fixation, elderly, minimally invasive
{"title":"Minimally invasive subcutaneous anterior fixation of pelvic fractures in the elderly: case report and literature review","authors":"Sven Strydom, C. H. Snyckers","doi":"10.17159/2309-8309/2021/v20n4a8","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n4a8","url":null,"abstract":"ABSTRACT BACKGROUND: As our population ages, the incidence of pelvic fragility fractures will rise accordingly. Despite these fractures having similar mortality rates to proximal femur fractures, there exist discrepancies between the management of these injuries. Although a number of pelvic fragility fractures can be treated successfully with conservative means, early treatment with appropriate surgical means should be considered in those failing conservative treatment or with unstable fracture patterns. CASE REPORT: We present an 84-year-old female who sustained a pelvic fragility fracture after a low-energy fall. Despite adequate conservative treatment, she was unable to mobilise. She was taken for anterior and posterior fixation, using our modified minimally invasive subcutaneous technique (the Bridging Infix) for anterior fixation. At the six-week follow-up she had regained full independent mobility. She had three syncope-related falls during this period, but radiographs revealed no sign of implant displacement. One year after her surgery she had complete union of her fracture, good function and no desire to have the implant removed. DISCUSSION: With the expected increase in pelvic fragility fractures due to the growing elderly population, our understanding of these injuries has begun to change. Occult posterior ring injuries have been described in up to 80% of cases, while fracture progression to unstable patterns can occur in up to 15% of stable patterns. Despite conservative management being the primary treatment of choice, these patients suffer morbidity and mortality rates comparable to proximal femur fractures. Early appropriate surgical management should be considered in patients failing to mobilise. Various surgical techniques have been described, each with their own advantages and disadvantages. Newer minimally invasive techniques are gaining favour, especially for use in elderly patients. These constructs combine the low profile benefits of internal plate fixation with ex-fix principles. CONCLUSION: The Bridging Infix is a modified technique for minimally invasive subcutaneous anterior pelvic fixation. Its use can strongly be considered by even the general orthopaedic surgeon in cases where patients are too frail for extensive or invasive surgeries, such as open reduction and internal fixation with plate and screws. Level of evidence: Level 5 Keywords: pelvic fracture, anterior pelvic fixation, elderly, minimally invasive","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67480882","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 : 2021-01-01DOI: 10.17159/2309-8309/2021/V20N1A7
A. R. Sekeitto, Kaeriann van der Jagt, N. Sikhauli, L. Mokete, D. Jagt
The dual mobility cup (DMC) was initially design in 1974. It was designed to offer additional stability in total hip arthroplasty (THA) and to prevent dislocations. The dissociation of a DMC has been termed an intraprosthetic dislocation (IPD) and is a rare complication. It is defined as separation of the articulation between the polyethylene and head articulation in the DMC. As the utilisation of DMCs in orthopaedic surgery increases, we can expect an increase in this rare complication. We report a case of an IPD in the setting of revision hip arthroplasty in a 72-yearold female.
{"title":"Intraprosthetic dislocation after a revision hip replacement: a case report","authors":"A. R. Sekeitto, Kaeriann van der Jagt, N. Sikhauli, L. Mokete, D. Jagt","doi":"10.17159/2309-8309/2021/V20N1A7","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/V20N1A7","url":null,"abstract":"The dual mobility cup (DMC) was initially design in 1974. It was designed to offer additional stability in total hip arthroplasty (THA) and to prevent dislocations. The dissociation of a DMC has been termed an intraprosthetic dislocation (IPD) and is a rare complication. It is defined as separation of the articulation between the polyethylene and head articulation in the DMC. As the utilisation of DMCs in orthopaedic surgery increases, we can expect an increase in this rare complication. We report a case of an IPD in the setting of revision hip arthroplasty in a 72-yearold female.","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67480669","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 : 2021-01-01DOI: 10.17159/2309-8309/2021/V20N1A4
R. Venter, Y. Tanwar, Jan-Petrus Grey, N. Ferreira
Sixty patients (75%) presented with fracture-related infections, 17 patients (21%) developed chronic osteomyelitis following haematogenous spread and three (4%) from contiguous wounds. According to the Cierny and Mader classification, 21 patients presented with anatomical type I, 14 with type II, 24 with type III and 21 with type IV chronic osteomyelitis. Positive microbial cultures were obtained in 63 (79%) cases. Follow-up for the cohort ranged from 1 to 29 months, with a mean follow-up of 10.4 months. The overall complication rate for the cohort was 6% and included sterile drainage from the surgical site after management with bioactive glass (S53P4), refracture after hardware removal, and development of non-union. Five patients experienced recurrence after the initial procedure to eradicate infection, resulting in an overall resolution rate of 94%.
{"title":"The management of chronic osteomyelitis in adults: outcomes of an integrated approach","authors":"R. Venter, Y. Tanwar, Jan-Petrus Grey, N. Ferreira","doi":"10.17159/2309-8309/2021/V20N1A4","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/V20N1A4","url":null,"abstract":"Sixty patients (75%) presented with fracture-related infections, 17 patients (21%) developed chronic osteomyelitis following haematogenous spread and three (4%) from contiguous wounds. According to the Cierny and Mader classification, 21 patients presented with anatomical type I, 14 with type II, 24 with type III and 21 with type IV chronic osteomyelitis. Positive microbial cultures were obtained in 63 (79%) cases. Follow-up for the cohort ranged from 1 to 29 months, with a mean follow-up of 10.4 months. The overall complication rate for the cohort was 6% and included sterile drainage from the surgical site after management with bioactive glass (S53P4), refracture after hardware removal, and development of non-union. Five patients experienced recurrence after the initial procedure to eradicate infection, resulting in an overall resolution rate of 94%.","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67480598","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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