Pub Date : 2021-01-01DOI: 10.17159/2309-8309/2021/v20n3a6
Benjamin R. Garrett, M. L. Grundill
ABSTRACT Lateral patellar dislocation affects young, active patients with an incidence rate of 5.8 per 100 000. The management of first episode dislocations is non-surgical in the majority of cases, unless associated pathology dictates surgical intervention. Approximately 40% of cases that are treated non-surgically will develop recurrent patellofemoral instability. Evidence supports surgical intervention in these cases; however, the best approach is debatable. Most research and consensus statements agree that medial patellofemoral ligament reconstruction (MPFLR) should be performed in most cases. Additional procedures can be used 'a la carte' according to certain conditions or pathology. A tibial tubercle osteotomy (TTO) is usually indicated in patients with maltracking and/or patella alta, but the direction and degree of correction must be carefully considered. Trochleoplasty is technically demanding and should be reserved for a select few patients with severe trochlear dysplasia. It should be performed by an experienced knee surgeon due to the high risk of inadvertent complications. Level of evidence: Level 5 Keywords: patellofemoral instability, patellar dislocation
{"title":"Patella dislocations and patellofemoral instability: a current concepts review","authors":"Benjamin R. Garrett, M. L. Grundill","doi":"10.17159/2309-8309/2021/v20n3a6","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n3a6","url":null,"abstract":"ABSTRACT Lateral patellar dislocation affects young, active patients with an incidence rate of 5.8 per 100 000. The management of first episode dislocations is non-surgical in the majority of cases, unless associated pathology dictates surgical intervention. Approximately 40% of cases that are treated non-surgically will develop recurrent patellofemoral instability. Evidence supports surgical intervention in these cases; however, the best approach is debatable. Most research and consensus statements agree that medial patellofemoral ligament reconstruction (MPFLR) should be performed in most cases. Additional procedures can be used 'a la carte' according to certain conditions or pathology. A tibial tubercle osteotomy (TTO) is usually indicated in patients with maltracking and/or patella alta, but the direction and degree of correction must be carefully considered. Trochleoplasty is technically demanding and should be reserved for a select few patients with severe trochlear dysplasia. It should be performed by an experienced knee surgeon due to the high risk of inadvertent complications. Level of evidence: Level 5 Keywords: patellofemoral instability, patellar dislocation","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":"67480770","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/v20n4a2
Z. Maharaj, Tristan Pillay, L. Mokete, J. Pietrzak
ABSTRACT BACKGROUND: Periprosthetic joint infections (PJIs) are a leading cause of revision for total hip arthroplasty (THA) and total knee arthroplasty (TKA), worldwide. Asymptomatic bacteriuria (ASB) is an independent risk factor for PJIs; however, a paucity of data relevant to developing countries exists. The aim of this study was to describe the prevalence of preoperative ASB and the subsequent incidence of PJIs in patients undergoing total joint arthroplasty (TJA) in South Africa. METHODS: We retrospectively reviewed primary THA and TKA patients. All patients were screened for ASB preoperatively. Patients with positive urinalysis for ASB were identified and treated prior to surgery (treated-ASB). The primary outcome was ASB prevalence and the incidence of PJIs and other perioperative complications. Secondary outcomes included risk factors for ASB and subsequent PJIs in treated-ASB patients, respectively, compared to those with no evidence of ASB (non-ASB). Lastly, we aimed to compare the infective microorganisms cultured from preoperative urinalysis and perioperative sampling of PJIs. RESULTS: We included 179 patients (67 THA; 80% female) with mean follow-up of 2.45 years. ASB prevalence was 22% (n = 39). Patients older than 70 years were 3.5 times more likely to have ASB compared to younger patients (p = 0.005). The prevalence of ASB was 22% (n = 10) for human immunodeficiency virus (HIV) positive and 22% (n = 29) for HIV-negative patients (p = 0.084). PJI incidence was 8% (n = 3) in the treated-ASB and 1% (n = 1) in non-ASB. Treated-ASB patients had an 11.6-fold increased likelihood of PJIs than non-ASB patients (p = 0.046). pJi microorganisms cultured did not correlate to isolates from urine cultures. CONCLUSION: The prevalence of ASB in a TJA population in South Africa is 22% which is higher than reported findings worldwide. Although the value of preoperative antibiotic therapy for ASB remains controversial, there is a role for routine urinalysis preoperatively to identify patients predisposed to PJI. This is of specific significance in the management of HIV-positive patients and in developing countries to guide healthcare providers in resource-constrained environments. Level of evidence: Level 2. Keywords: total hip arthroplasty, total knee arthroplasty, asymptomatic bacteriuria, periprosthetic joint infection, developing country
{"title":"Preoperative asymptomatic bacteriuria in patients undergoing total joint arthroplasty in South Africa","authors":"Z. Maharaj, Tristan Pillay, L. Mokete, J. Pietrzak","doi":"10.17159/2309-8309/2021/v20n4a2","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n4a2","url":null,"abstract":"ABSTRACT BACKGROUND: Periprosthetic joint infections (PJIs) are a leading cause of revision for total hip arthroplasty (THA) and total knee arthroplasty (TKA), worldwide. Asymptomatic bacteriuria (ASB) is an independent risk factor for PJIs; however, a paucity of data relevant to developing countries exists. The aim of this study was to describe the prevalence of preoperative ASB and the subsequent incidence of PJIs in patients undergoing total joint arthroplasty (TJA) in South Africa. METHODS: We retrospectively reviewed primary THA and TKA patients. All patients were screened for ASB preoperatively. Patients with positive urinalysis for ASB were identified and treated prior to surgery (treated-ASB). The primary outcome was ASB prevalence and the incidence of PJIs and other perioperative complications. Secondary outcomes included risk factors for ASB and subsequent PJIs in treated-ASB patients, respectively, compared to those with no evidence of ASB (non-ASB). Lastly, we aimed to compare the infective microorganisms cultured from preoperative urinalysis and perioperative sampling of PJIs. RESULTS: We included 179 patients (67 THA; 80% female) with mean follow-up of 2.45 years. ASB prevalence was 22% (n = 39). Patients older than 70 years were 3.5 times more likely to have ASB compared to younger patients (p = 0.005). The prevalence of ASB was 22% (n = 10) for human immunodeficiency virus (HIV) positive and 22% (n = 29) for HIV-negative patients (p = 0.084). PJI incidence was 8% (n = 3) in the treated-ASB and 1% (n = 1) in non-ASB. Treated-ASB patients had an 11.6-fold increased likelihood of PJIs than non-ASB patients (p = 0.046). pJi microorganisms cultured did not correlate to isolates from urine cultures. CONCLUSION: The prevalence of ASB in a TJA population in South Africa is 22% which is higher than reported findings worldwide. Although the value of preoperative antibiotic therapy for ASB remains controversial, there is a role for routine urinalysis preoperatively to identify patients predisposed to PJI. This is of specific significance in the management of HIV-positive patients and in developing countries to guide healthcare providers in resource-constrained environments. Level of evidence: Level 2. Keywords: total hip arthroplasty, total knee arthroplasty, asymptomatic bacteriuria, periprosthetic joint infection, developing country","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"87 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67480888","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/V20N1A5
Jonathan Vogel, Shaun de Villiers, Walid Mug la, J. McCaul, Keith Hosking, T. Hilton
Six patients met the inclusion criteria. One patient was excluded as the minimum follow-up time of six months was not met. Of the five patients that were analysed, all five sustained transverse, subtrochanteric femur fractures. Prior to definitive treatment with a proximal femoral replacement, three patients were treated with standard trauma instrumentation prior to referral to the unit, and one patient was treated with a vascularised fibular graft as their initial treatment while at the unit. One patient was treated with an endoprosthetic replacement as their first procedure at the unit. Among the three patients treated with standard trauma fixation and the one patient treated with a vascularised fibular graft, there was a 100% failure rate. One standard trauma instrumentation patient had an ablation due to free musculocutaneous flap failure and periprosthetic infection after endoprosthetic replacement. This was the only complication of endoprosthetic replacement. At a median follow-up of 15 months (min 7, max 55) the median Musculoskeletal Tumour Society score was 74% (min 63%, max 93%).
{"title":"Radiation-induced pathological fractures of the proximal femur: a case series considering an endoprosthetic solution","authors":"Jonathan Vogel, Shaun de Villiers, Walid Mug la, J. McCaul, Keith Hosking, T. Hilton","doi":"10.17159/2309-8309/2021/V20N1A5","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/V20N1A5","url":null,"abstract":"Six patients met the inclusion criteria. One patient was excluded as the minimum follow-up time of six months was not met. Of the five patients that were analysed, all five sustained transverse, subtrochanteric femur fractures. Prior to definitive treatment with a proximal femoral replacement, three patients were treated with standard trauma instrumentation prior to referral to the unit, and one patient was treated with a vascularised fibular graft as their initial treatment while at the unit. One patient was treated with an endoprosthetic replacement as their first procedure at the unit. Among the three patients treated with standard trauma fixation and the one patient treated with a vascularised fibular graft, there was a 100% failure rate. One standard trauma instrumentation patient had an ablation due to free musculocutaneous flap failure and periprosthetic infection after endoprosthetic replacement. This was the only complication of endoprosthetic replacement. At a median follow-up of 15 months (min 7, max 55) the median Musculoskeletal Tumour Society score was 74% (min 63%, max 93%).","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67480605","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/v20n3a3
A. Saini, N. Ferreira
ABSTRACT BACKGROUND: Malignant tumours commonly metastasise to bone. When this occurs in the femur, surgical intervention is required to reduce pain and restore mobility post fracture, or as a prophylactic measure when fracture is anticipated. This is typically in the form of replacement with hemi- or total arthroplasty or stabilisation with an intramedullary device. The indications for one modality over the other are debatable and the reported outcomes and complications are varied. The purpose of this study is to assess the management algorithm for bony metastasis of the femur at a tertiary bone tumour unit, and the outcomes of the surgical strategies employed METHODS: A retrospective cohort study was performed of all patients presenting to our institution with femoral metastasis, both with and without pathological fracture, who were managed surgically from April 2016 to February 2020. Fractures of the femoral neck were managed with cemented arthroplasty. All other fractures were managed with intramedullary nailing, as were all lesions requiring prophylactic stabilisation. Data was recorded regarding demographics, primary pathology, location of lesion, type of surgery, and implant used. The incidence of complications including radiological failure of fixation, infection, thromboembolic phenomena, re-operation and mortality were recorded RESULTS: Eighty-five femurs in 77 patients were included (mean age 61 years, range 20-90). Lesions were located in the femoral neck (19/85, 22%), intertrochanteric (20/85, 24%), subtrochanteric (40/85, 47%), diaphyseal (2/85, 2%) and metaphyseal/per-condylar (4/85, 5%) regions of the femur. A total of 64/85 (753%) procedures were performed for fractures and 21/85 (25%) prophylactically. Eighteen of the 85 (21%) underwent long-stemmed cemented bipolar hemiarthroplasty, 1/85 (1%) long-stemmed cemented total hip replacement (THR), 62/85 (73%) cephalomedullary nailing, and 4/85 (5%) retrograde femoral intramedullary nailing. Mean follow-up was eight months (range 1-36). There were no dislocations or periprosthetic fractures in the arthroplasty group. One failure (1/66, 2%) of fixation occurred in the intramedullary nailing group. Six deaths occurred in the arthroplasty group (6/64, 9%) and 24 in the nailing group (24/66, 36%) during the study period. Four patients suffered from thromboembolic phenomena (4/77, 5%). Of the 13 patients who sustained a pathological fracture and were managed with intramedullary nailing and followed up for at least one year, all had achieved clinical and radiological union CONCLUSION: Femoral metastasis can be appropriately managed with intramedullary nailing, both prophylac-tically and in the event of fracture, with a low rate of implant failure and an expectation that healing will occur once stabilised. Intracapsular fractures can be managed with long-stemmed cemented arthroplasty with a low risk of subsequent fracture or dislocation Level of evidence: Level 4 Keywords: bone metastasis,
{"title":"The surgical management of metastatic lesions of the femur","authors":"A. Saini, N. Ferreira","doi":"10.17159/2309-8309/2021/v20n3a3","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n3a3","url":null,"abstract":"ABSTRACT BACKGROUND: Malignant tumours commonly metastasise to bone. When this occurs in the femur, surgical intervention is required to reduce pain and restore mobility post fracture, or as a prophylactic measure when fracture is anticipated. This is typically in the form of replacement with hemi- or total arthroplasty or stabilisation with an intramedullary device. The indications for one modality over the other are debatable and the reported outcomes and complications are varied. The purpose of this study is to assess the management algorithm for bony metastasis of the femur at a tertiary bone tumour unit, and the outcomes of the surgical strategies employed METHODS: A retrospective cohort study was performed of all patients presenting to our institution with femoral metastasis, both with and without pathological fracture, who were managed surgically from April 2016 to February 2020. Fractures of the femoral neck were managed with cemented arthroplasty. All other fractures were managed with intramedullary nailing, as were all lesions requiring prophylactic stabilisation. Data was recorded regarding demographics, primary pathology, location of lesion, type of surgery, and implant used. The incidence of complications including radiological failure of fixation, infection, thromboembolic phenomena, re-operation and mortality were recorded RESULTS: Eighty-five femurs in 77 patients were included (mean age 61 years, range 20-90). Lesions were located in the femoral neck (19/85, 22%), intertrochanteric (20/85, 24%), subtrochanteric (40/85, 47%), diaphyseal (2/85, 2%) and metaphyseal/per-condylar (4/85, 5%) regions of the femur. A total of 64/85 (753%) procedures were performed for fractures and 21/85 (25%) prophylactically. Eighteen of the 85 (21%) underwent long-stemmed cemented bipolar hemiarthroplasty, 1/85 (1%) long-stemmed cemented total hip replacement (THR), 62/85 (73%) cephalomedullary nailing, and 4/85 (5%) retrograde femoral intramedullary nailing. Mean follow-up was eight months (range 1-36). There were no dislocations or periprosthetic fractures in the arthroplasty group. One failure (1/66, 2%) of fixation occurred in the intramedullary nailing group. Six deaths occurred in the arthroplasty group (6/64, 9%) and 24 in the nailing group (24/66, 36%) during the study period. Four patients suffered from thromboembolic phenomena (4/77, 5%). Of the 13 patients who sustained a pathological fracture and were managed with intramedullary nailing and followed up for at least one year, all had achieved clinical and radiological union CONCLUSION: Femoral metastasis can be appropriately managed with intramedullary nailing, both prophylac-tically and in the event of fracture, with a low rate of implant failure and an expectation that healing will occur once stabilised. Intracapsular fractures can be managed with long-stemmed cemented arthroplasty with a low risk of subsequent fracture or dislocation Level of evidence: Level 4 Keywords: bone metastasis, ","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":"67480728","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/V20N1A1
Suhayl Khan, Naweed Wadee, M. Burger, N. Ferreira, J. Jordaan
This study aimed to determine the prevalence of pathological neck of femur (NOF) fractures at a tertiary referral hospital through histological examination of specimens in all NOF fracture patients undergoing hip arthroplasty. A secondary aim was to determine whether the current practice of sending all femoral heads for histological evaluation, to avoid missing unsuspected malignancies, is financially warranted.
{"title":"Prevalence of pathological neck of femur fractures in patients undergoing arthroplasty at a tertiary referral hospital","authors":"Suhayl Khan, Naweed Wadee, M. Burger, N. Ferreira, J. Jordaan","doi":"10.17159/2309-8309/2021/V20N1A1","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/V20N1A1","url":null,"abstract":"This study aimed to determine the prevalence of pathological neck of femur (NOF) fractures at a tertiary referral hospital through histological examination of specimens in all NOF fracture patients undergoing hip arthroplasty. A secondary aim was to determine whether the current practice of sending all femoral heads for histological evaluation, to avoid missing unsuspected malignancies, is financially warranted.","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":"67481027","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/V20N1A2
Sravya P. Vajapey
Musculoskeletal tuberculosis (MSK TB) is a disease entity that often mimics other orthopaedic conditions in its radiographic and clinical presentation, which can delay diagnosis and treatment. The purpose of this study is to examine the clinical and radiographic presentation as well as the accuracy of various diagnostic tests, treatment, complications and outcome in paediatric patients diagnosed with MSK TB. We aim to provide insight into typical presenting features in order to expedite diagnosis in this perplexing disease.
{"title":"Tuberculosis of the extra-axial skeleton in paediatric patients","authors":"Sravya P. Vajapey","doi":"10.17159/2309-8309/2021/V20N1A2","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/V20N1A2","url":null,"abstract":"Musculoskeletal tuberculosis (MSK TB) is a disease entity that often mimics other orthopaedic conditions in its radiographic and clinical presentation, which can delay diagnosis and treatment. The purpose of this study is to examine the clinical and radiographic presentation as well as the accuracy of various diagnostic tests, treatment, complications and outcome in paediatric patients diagnosed with MSK TB. We aim to provide insight into typical presenting features in order to expedite diagnosis in this perplexing disease.","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":"67481035","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/v20n4a6
Michael Abramson, S. Maqungo, R. Dey, M. Laubscher
ABSTRACT BACKGROUND: Intramedullary nail fixation is an option to manage highly comminuted fractures of the radius shaft resulting from gunshot wounds. However, complications including nail migration and malunion are well documented. We have noticed some patients presenting to our clinic with radiological shortening following nail fixation. This may result in chronic pain, reduced pronation and supination, poor grip strength and early onset arthrosis. This study aimed to quantify the incidence of radiological shortening following fixation of isolated gunshot wound (GSW) fractures of the radius with an intramedullary nail. Our secondary objectives were to identify if length of the zone of comminution and anatomical location of the fractures were risk factors for shortening, and to assess whether shortening was a result of surgical error, or whether shortening occurred over time. METHODS: We performed a retrospective review of all (n = 40) isolated radius nails performed between January 2012 and January 2019. Two doctors assessed the latest anterior-posterior forearm X-ray of every patient, using the rule of perpendiculars to calculate ulnar variance (UV). Shortening was defined as a UV > 5.0 mm. If the radius was deemed shortened by consensus, then the immediate postoperative X-ray was also assessed to gauge when shortening occurred. Anatomical location in thirds and length of comminution (mm) were also assessed. RESULTS: Forty patients with a mean age of 32 years (range 15-59) were included. Twelve patients' radiuses were assessed as radiologically short. All 12 were deemed to have been fixed short. One case shortened further over time. We found the incidence of shortening being dependent on the fracture location (p = 0.03), with the fractures occurring in the middle third of the arm shortening more. The measured zone of comminution between the shortened and non-shortened groups was not found to be statistically significant (p = 0.55). CONCLUSION: The radius nail remains useful to manage comminuted radius shaft fractures following GSW. Meticulous technique is needed to avoid radiological shortening, seen in 30% of our series. This can lead to chronic pain, reduced grip strength and early onset arthrosis. We found no evidence that shortening develops over time. We found that the incidence of shortening is dependent on fracture position but did not And any causative relationship between length of the zone of fracture comminution and shortening. Level of evidence: Level 4 Keywords: radial nail, shortening, gunshot
{"title":"Incidence of radius shortening following intramedullary nail fixation for gunshot fractures: a retrospective radiological audit","authors":"Michael Abramson, S. Maqungo, R. Dey, M. Laubscher","doi":"10.17159/2309-8309/2021/v20n4a6","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n4a6","url":null,"abstract":"ABSTRACT BACKGROUND: Intramedullary nail fixation is an option to manage highly comminuted fractures of the radius shaft resulting from gunshot wounds. However, complications including nail migration and malunion are well documented. We have noticed some patients presenting to our clinic with radiological shortening following nail fixation. This may result in chronic pain, reduced pronation and supination, poor grip strength and early onset arthrosis. This study aimed to quantify the incidence of radiological shortening following fixation of isolated gunshot wound (GSW) fractures of the radius with an intramedullary nail. Our secondary objectives were to identify if length of the zone of comminution and anatomical location of the fractures were risk factors for shortening, and to assess whether shortening was a result of surgical error, or whether shortening occurred over time. METHODS: We performed a retrospective review of all (n = 40) isolated radius nails performed between January 2012 and January 2019. Two doctors assessed the latest anterior-posterior forearm X-ray of every patient, using the rule of perpendiculars to calculate ulnar variance (UV). Shortening was defined as a UV > 5.0 mm. If the radius was deemed shortened by consensus, then the immediate postoperative X-ray was also assessed to gauge when shortening occurred. Anatomical location in thirds and length of comminution (mm) were also assessed. RESULTS: Forty patients with a mean age of 32 years (range 15-59) were included. Twelve patients' radiuses were assessed as radiologically short. All 12 were deemed to have been fixed short. One case shortened further over time. We found the incidence of shortening being dependent on the fracture location (p = 0.03), with the fractures occurring in the middle third of the arm shortening more. The measured zone of comminution between the shortened and non-shortened groups was not found to be statistically significant (p = 0.55). CONCLUSION: The radius nail remains useful to manage comminuted radius shaft fractures following GSW. Meticulous technique is needed to avoid radiological shortening, seen in 30% of our series. This can lead to chronic pain, reduced grip strength and early onset arthrosis. We found no evidence that shortening develops over time. We found that the incidence of shortening is dependent on fracture position but did not And any causative relationship between length of the zone of fracture comminution and shortening. Level of evidence: Level 4 Keywords: radial nail, shortening, gunshot","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":"67480683","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/v20n4a4
J. D. de Wet, R. Dey, B. Vrettos, J. Du Plessis, C. Anley, P. Rachuene, Leanne C Haworth, Habtamu M. Yimam, S. Sivarasu, S. Roche
ABSTRACT BACKGROUND: The surgical management of scapula body, neck and glenoid fractures remains a challenge. This study focuses on templating an available anatomical pre-contoured plating system using three-dimensional (3D)-printed scapulae to assess the ability of these plates to address the aforementioned fractures and to determine consensus on classifying scapula body, neck and glenoid fractures. METHODS: We used a cohort of 22 3D-printed scapulae prototypes and an available anatomical pre-contoured plating system to determine anatomical congruency and fit. Nine investigators templated the scapulae using four pre-contoured plates, and the investigators classified the 22 scapulae using the Ideberg and AO/OTA classification system. RESULTS: Eleven out of 22 fractures were found to be fixable using the plates under study. The long lateral plate addressed 83% of fractures involving the lateral border, while the glenoid plate was unable to adequately address any glenoid fractures. We observed good to excellent (p < 0.001) interobserver reliability for three of the four plates. The interobserver reliability was moderate (ICC = 0.74) for the AO/OTA classification and good (ICC = 0.88) for the Ideberg classification. CONCLUSION: We believe that the anatomical pre-contoured plating system does not address all the fracture patterns encountered in clinical practice and further development in plate design is required. There is good to moderate interobserver reliability using the Ideberg fracture classification for intra-articular fractures and the AO/OTA classification for extra-articular fractures involving the body. Level of evidence: Level 3 Keywords: scapula fracture, open reduction and internal fixation (ORIF), South Africa, scapula plate analysis, 3D printing, fracture classification
{"title":"Do anatomical contoured plates address scapula body, neck and glenoid fractures? A multi-observer consensus study","authors":"J. D. de Wet, R. Dey, B. Vrettos, J. Du Plessis, C. Anley, P. Rachuene, Leanne C Haworth, Habtamu M. Yimam, S. Sivarasu, S. Roche","doi":"10.17159/2309-8309/2021/v20n4a4","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n4a4","url":null,"abstract":"ABSTRACT BACKGROUND: The surgical management of scapula body, neck and glenoid fractures remains a challenge. This study focuses on templating an available anatomical pre-contoured plating system using three-dimensional (3D)-printed scapulae to assess the ability of these plates to address the aforementioned fractures and to determine consensus on classifying scapula body, neck and glenoid fractures. METHODS: We used a cohort of 22 3D-printed scapulae prototypes and an available anatomical pre-contoured plating system to determine anatomical congruency and fit. Nine investigators templated the scapulae using four pre-contoured plates, and the investigators classified the 22 scapulae using the Ideberg and AO/OTA classification system. RESULTS: Eleven out of 22 fractures were found to be fixable using the plates under study. The long lateral plate addressed 83% of fractures involving the lateral border, while the glenoid plate was unable to adequately address any glenoid fractures. We observed good to excellent (p < 0.001) interobserver reliability for three of the four plates. The interobserver reliability was moderate (ICC = 0.74) for the AO/OTA classification and good (ICC = 0.88) for the Ideberg classification. CONCLUSION: We believe that the anatomical pre-contoured plating system does not address all the fracture patterns encountered in clinical practice and further development in plate design is required. There is good to moderate interobserver reliability using the Ideberg fracture classification for intra-articular fractures and the AO/OTA classification for extra-articular fractures involving the body. Level of evidence: Level 3 Keywords: scapula fracture, open reduction and internal fixation (ORIF), South Africa, scapula plate analysis, 3D printing, fracture classification","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67480912","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/v20n4a7
P. Rachuene, Frederick J du Toit, Gladwell Κ Tsolo, Sivesonke M Khanyile, M. Tladi, Sikheto S Goleie
ABSTRACT Distal radius fractures (DRFs) are commonly encountered in the elderly population, secondary to low-energy injury mechanisms. In the younger population, DRFs are mainly secondary to high-energy trauma. Stable DRFs can be treated conservatively. However, in the elderly population group, DRFs are often unstable and are likely to benefit from surgical intervention. They are often compounded by comorbid medical conditions requiring optimisation. When treating the elderly group, one should be aware of sarcopaenia, as this may have a bearing on return to function. Recent literature reports an increasing trend in the surgical management of these fractures. Current classification systems fail to consistently guide the management of these fractures. Although evidence is still limited in guiding decision-making in the treatment of these fractures, one should consider the economic implications of prolonged immobilisation in young patients in addition to defined indications for surgery. Improvement in implants allows safe dorsal fixation in patients with dorsal comminution, with low complication rates reported. This narrative review summarises current trends and the body of evidence. Level of evidence: Level 5 Keywords: distal radius, fracture management, osteoporosis
{"title":"Distal radius fractures: current concepts","authors":"P. Rachuene, Frederick J du Toit, Gladwell Κ Tsolo, Sivesonke M Khanyile, M. Tladi, Sikheto S Goleie","doi":"10.17159/2309-8309/2021/v20n4a7","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n4a7","url":null,"abstract":"ABSTRACT Distal radius fractures (DRFs) are commonly encountered in the elderly population, secondary to low-energy injury mechanisms. In the younger population, DRFs are mainly secondary to high-energy trauma. Stable DRFs can be treated conservatively. However, in the elderly population group, DRFs are often unstable and are likely to benefit from surgical intervention. They are often compounded by comorbid medical conditions requiring optimisation. When treating the elderly group, one should be aware of sarcopaenia, as this may have a bearing on return to function. Recent literature reports an increasing trend in the surgical management of these fractures. Current classification systems fail to consistently guide the management of these fractures. Although evidence is still limited in guiding decision-making in the treatment of these fractures, one should consider the economic implications of prolonged immobilisation in young patients in addition to defined indications for surgery. Improvement in implants allows safe dorsal fixation in patients with dorsal comminution, with low complication rates reported. This narrative review summarises current trends and the body of evidence. Level of evidence: Level 5 Keywords: distal radius, fracture management, osteoporosis","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":"67480865","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/v20n4a3
Alwich Alexander, N. P. Saragas, P. Ferrao
ABSTRACT BACKGROUND: Plantar incisions may be used in a variety of surgical procedures. Despite numerous studies reporting on procedures which use plantar incisions and thus inadvertently demonstrating good results with plantar incisions, most surgeons still avoid this approach due to the fear of developing a painful plantar scar. There is a shortage of studies demonstrating a clear correlation between plantar scar formation and poor patient-reported outcomes. The aim of this study is to assess the clinical outcome of plantar incisions in various procedures. METHODS: In this retrospective study we identified all patients who underwent surgery using a plantar incision between January 2000 and December 2019. A total of 23 patients were available for assessment. Three common procedures were identified: lesser metatarsal head resection, plantar fibromatosis excision and lateral sesamoidectomy. Demographic data was collected, and clinical outcome was assessed using the Self-Reported Foot and Ankle Score (SEFAS) questionnaire. Twenty-one female (22 feet) and two male patients (two feet) were included. The mean follow-up was 124 (range 8-231) months in the plantar fibromatosis group, 111.5 (range 28-177) months in the lateral sesamoidectomy group and 106.3 (range 42-157) months in the lesser metatarsal head excision group. The study included 12 patients in the sesamoidectomy, nine patients in the plantar fibromatosis and two patients in the lesser metatarsal head excision groups. The mean age of the study population was 45 (range 20-71) years. RESULTS: The mean postoperative SEFAS score in our series was 44 (range 22-48). Nineteen (82%) patients scored as excellent, two (10%) patients as good, one (4%) patient as fair and one (4%) as poor. All wounds healed well with no symptomatic callosities on clinical examination requiring revision. CONCLUSION: This study demonstrates that plantar incisions, irrespective of indication and orientation (21 longitudinal and three transverse), heal well and with good patient-reported outcomes. We believe that it would be erroneous to 'avoid plantar incisions at all costs' and that plantar incisions must be considered if deemed technically superior and with less risk than a dorsal approach. Level of evidence: Level 4 Keywords: plantar incisions, patient-reported outcome
{"title":"Patient-reported outcomes following plantar incisions in foot surgery","authors":"Alwich Alexander, N. P. Saragas, P. Ferrao","doi":"10.17159/2309-8309/2021/v20n4a3","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n4a3","url":null,"abstract":"ABSTRACT BACKGROUND: Plantar incisions may be used in a variety of surgical procedures. Despite numerous studies reporting on procedures which use plantar incisions and thus inadvertently demonstrating good results with plantar incisions, most surgeons still avoid this approach due to the fear of developing a painful plantar scar. There is a shortage of studies demonstrating a clear correlation between plantar scar formation and poor patient-reported outcomes. The aim of this study is to assess the clinical outcome of plantar incisions in various procedures. METHODS: In this retrospective study we identified all patients who underwent surgery using a plantar incision between January 2000 and December 2019. A total of 23 patients were available for assessment. Three common procedures were identified: lesser metatarsal head resection, plantar fibromatosis excision and lateral sesamoidectomy. Demographic data was collected, and clinical outcome was assessed using the Self-Reported Foot and Ankle Score (SEFAS) questionnaire. Twenty-one female (22 feet) and two male patients (two feet) were included. The mean follow-up was 124 (range 8-231) months in the plantar fibromatosis group, 111.5 (range 28-177) months in the lateral sesamoidectomy group and 106.3 (range 42-157) months in the lesser metatarsal head excision group. The study included 12 patients in the sesamoidectomy, nine patients in the plantar fibromatosis and two patients in the lesser metatarsal head excision groups. The mean age of the study population was 45 (range 20-71) years. RESULTS: The mean postoperative SEFAS score in our series was 44 (range 22-48). Nineteen (82%) patients scored as excellent, two (10%) patients as good, one (4%) patient as fair and one (4%) as poor. All wounds healed well with no symptomatic callosities on clinical examination requiring revision. CONCLUSION: This study demonstrates that plantar incisions, irrespective of indication and orientation (21 longitudinal and three transverse), heal well and with good patient-reported outcomes. We believe that it would be erroneous to 'avoid plantar incisions at all costs' and that plantar incisions must be considered if deemed technically superior and with less risk than a dorsal approach. Level of evidence: Level 4 Keywords: plantar incisions, patient-reported outcome","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":"67480904","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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