Pub Date : 2021-01-01DOI: 10.17159/2309-8309/2021/V20N1A0
S. Roche
The duties and responsibilities of orthopaedic surgeons obliges us to be an advocate on multiple levels within our society. The American Medical Association stated in 2009 that ‘Physicians must advocate for the social, economic, educational, and political changes that ameliorate suffering and contribute to human wellbeing’. In our troubled South African society, exacerbated by the current Covid-19 crisis, our advocacy is needed even more than ever. We should already be advocates for transformation/diversity, alleviation of hunger, access to healthcare, the eradication of the scourge of gender-based violence, reduction of road deaths and gunshots, among others.
{"title":"Advocacy for sporting injury prevention and care","authors":"S. Roche","doi":"10.17159/2309-8309/2021/V20N1A0","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/V20N1A0","url":null,"abstract":"The duties and responsibilities of orthopaedic surgeons obliges us to be an advocate on multiple levels within our society. The American Medical Association stated in 2009 that ‘Physicians must advocate for the social, economic, educational, and political changes that ameliorate suffering and contribute to human wellbeing’. In our troubled South African society, exacerbated by the current Covid-19 crisis, our advocacy is needed even more than ever. We should already be advocates for transformation/diversity, alleviation of hunger, access to healthcare, the eradication of the scourge of gender-based violence, reduction of road deaths and gunshots, among others.","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":"67480975","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/v20n4a5
T. Mniki, P. Mare, L. Marais, D. Thompson
ABSTRACT BACKGROUND: The management of end-stage hip disease in children and adolescents is a challenging clinical problem. While total hip replacement (THR) offers the benefit of improved mobility, this is offset by the risk of multiple revisions. Hip arthrodesis remains a salvage option to relieve pain and restore function at the cost of hip movement. This study aimed to determine the short- to medium-term outcome of hip arthrodesis in paediatric and adolescent patients in a developing world setting. METHODS: All children and adolescents under the age of 18 years who underwent hip arthrodesis between 2010 and 2014 were included in the study. Measurements included diagnosis, preoperative deformity, fusion position, fusion rate and functional outcomes. Our surgery involved transarticular compression screw fixation and subtrochanteric osteotomy. Postoperative skeletal traction maintained optimal limb position for two weeks, after which spica cast immobilisation was used. RESULTS: Nineteen patients (11 female) had hip fusions at a mean age of 12 years (range 5-18). The mean follow-up period was 5 years (range 1-8). Most cases were due to end-stage TB arthritis (12/19; 63%). Other causes were septic arthritis (3/19; 16%); neglected slipped capital femoral epiphysis (1/19; 5%); post-traumatic avascular necrosis (1/19; 5%); and idiopathic chondrolysis (2/19; 11%). Primary fusion was achieved in 68% (13/19) of cases. Six patients developed complications. Complications included adduction drift (3/19), failed fusion (3/19), screw malpositioning (1/19) and screw breakage (1/19). Eight reoperations were required in six patients. In two of these patients, one additional surgery had to be performed to achieve fusion or correct limb position. The mean fusion position was 31° (range 20 to 50) flexion, 2° (range 10 to -10) abduction, and 1° (range 10 to -10) external rotation. Mean leg length discrepancy was 1.8 cm (range 0 to 4.5) of shortening. All except one patient reported relief of hip pain and satisfaction with the procedure. CONCLUSION: While hip arthrodesis is a technically challenging procedure, high fusion rates and reliable pain relief may be expected in these patients. However, complications should be anticipated, and reoperation may be required to achieve fusion and an optimal limb position Level of evidence: Level 4 Keywords: end-stage hip arthritis, TB hip, hip arthrodesis, hip fusion, subtrochanteric osteotomy
{"title":"The short-term outcomes of hip arthrodesis in children and adolescents with end-stage hip disease","authors":"T. Mniki, P. Mare, L. Marais, D. Thompson","doi":"10.17159/2309-8309/2021/v20n4a5","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/v20n4a5","url":null,"abstract":"ABSTRACT BACKGROUND: The management of end-stage hip disease in children and adolescents is a challenging clinical problem. While total hip replacement (THR) offers the benefit of improved mobility, this is offset by the risk of multiple revisions. Hip arthrodesis remains a salvage option to relieve pain and restore function at the cost of hip movement. This study aimed to determine the short- to medium-term outcome of hip arthrodesis in paediatric and adolescent patients in a developing world setting. METHODS: All children and adolescents under the age of 18 years who underwent hip arthrodesis between 2010 and 2014 were included in the study. Measurements included diagnosis, preoperative deformity, fusion position, fusion rate and functional outcomes. Our surgery involved transarticular compression screw fixation and subtrochanteric osteotomy. Postoperative skeletal traction maintained optimal limb position for two weeks, after which spica cast immobilisation was used. RESULTS: Nineteen patients (11 female) had hip fusions at a mean age of 12 years (range 5-18). The mean follow-up period was 5 years (range 1-8). Most cases were due to end-stage TB arthritis (12/19; 63%). Other causes were septic arthritis (3/19; 16%); neglected slipped capital femoral epiphysis (1/19; 5%); post-traumatic avascular necrosis (1/19; 5%); and idiopathic chondrolysis (2/19; 11%). Primary fusion was achieved in 68% (13/19) of cases. Six patients developed complications. Complications included adduction drift (3/19), failed fusion (3/19), screw malpositioning (1/19) and screw breakage (1/19). Eight reoperations were required in six patients. In two of these patients, one additional surgery had to be performed to achieve fusion or correct limb position. The mean fusion position was 31° (range 20 to 50) flexion, 2° (range 10 to -10) abduction, and 1° (range 10 to -10) external rotation. Mean leg length discrepancy was 1.8 cm (range 0 to 4.5) of shortening. All except one patient reported relief of hip pain and satisfaction with the procedure. CONCLUSION: While hip arthrodesis is a technically challenging procedure, high fusion rates and reliable pain relief may be expected in these patients. However, complications should be anticipated, and reoperation may be required to achieve fusion and an optimal limb position Level of evidence: Level 4 Keywords: end-stage hip arthritis, TB hip, hip arthrodesis, hip fusion, subtrochanteric osteotomy","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":"67480921","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/V20N1A6
Manish R. Shah, M. M. Shah, A. Agrawal, M. Shah, Sarvang M. Desai
ABSTRACT BACKGROUND: Management of malignant bone tumours has changed dramatically in recent years. Neoadjuvant chemotherapy, irradiation and conservative surgery have improved local control as well as functional outcome. Depending on the histology of the lesion, other modalities like chemotherapeutic agents or radiation can be selected in place of surgical intervention. Operative intervention is the main modality with wide marginal excision and fixation of bone graft from different sources or mega prosthesis to maintain congruity of the bone anatomy. Reconstruction, optimum fit and stability at the affected site are the major areas of concern with this modality. Radiation given outside the body to kill the tumour cells in the bone is called extracorporeal radiotherapy (ECRT). After resection of the bone, it is cleaned of all the surrounding soft tissue and marrow contents and placed in a container. It is then subjected to 50 Gy of radiation which kills all the tumour cells. METHODS: The study was conducted from June 2014 to May 2020, and included 15 patients (out of 18) diagnosed with either Ewing's sarcoma or osteosarcoma. They were followed up for an average of 4.44 years, up to May 2020. All 15 cases were analysed for bony union at the osteotomy sites. Cases reported with poorly differentiated sarcomas (total three) were subjected to immunohistochemistry and managed with other modalities of treatment. RESULTS: The average time for union of irradiated bone was 8.1 months (range 5-10; the metaphyseal end united faster than the diaphyseal end). At the final follow-up, the functional status was determined using the Musculoskeletal Tumour Society (MSTS) scoring system. Ninety-three per cent of patients had involvement of the lower limb (14 out of 15). All patients (except one who developed recurrence) did not have symptoms of the disease and no one had died at last follow-up. CONCLUSION: Biological limb salvage procedures are considered a successful treatment and a welcome alternative for patients who either cannot afford or be treated with an endoprosthesis. Early diagnosis and referral to specialised unit is of vital importance. This procedure can be used for selected patients with malignant bone tumours. Cost factors, and social and cultural considerations also play a role Level of evidence: Level 4. Keywords: ECRT, extracorporeal radiation therapy, malignant bone tumours, bone sarcoma, osteosarcoma, Ewing's sarcoma
{"title":"Intra-operative extracorporeal radiation therapy for skeletally immature patients with malignant bone tumours","authors":"Manish R. Shah, M. M. Shah, A. Agrawal, M. Shah, Sarvang M. Desai","doi":"10.17159/2309-8309/2021/V20N1A6","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/V20N1A6","url":null,"abstract":"ABSTRACT BACKGROUND: Management of malignant bone tumours has changed dramatically in recent years. Neoadjuvant chemotherapy, irradiation and conservative surgery have improved local control as well as functional outcome. Depending on the histology of the lesion, other modalities like chemotherapeutic agents or radiation can be selected in place of surgical intervention. Operative intervention is the main modality with wide marginal excision and fixation of bone graft from different sources or mega prosthesis to maintain congruity of the bone anatomy. Reconstruction, optimum fit and stability at the affected site are the major areas of concern with this modality. Radiation given outside the body to kill the tumour cells in the bone is called extracorporeal radiotherapy (ECRT). After resection of the bone, it is cleaned of all the surrounding soft tissue and marrow contents and placed in a container. It is then subjected to 50 Gy of radiation which kills all the tumour cells. METHODS: The study was conducted from June 2014 to May 2020, and included 15 patients (out of 18) diagnosed with either Ewing's sarcoma or osteosarcoma. They were followed up for an average of 4.44 years, up to May 2020. All 15 cases were analysed for bony union at the osteotomy sites. Cases reported with poorly differentiated sarcomas (total three) were subjected to immunohistochemistry and managed with other modalities of treatment. RESULTS: The average time for union of irradiated bone was 8.1 months (range 5-10; the metaphyseal end united faster than the diaphyseal end). At the final follow-up, the functional status was determined using the Musculoskeletal Tumour Society (MSTS) scoring system. Ninety-three per cent of patients had involvement of the lower limb (14 out of 15). All patients (except one who developed recurrence) did not have symptoms of the disease and no one had died at last follow-up. CONCLUSION: Biological limb salvage procedures are considered a successful treatment and a welcome alternative for patients who either cannot afford or be treated with an endoprosthesis. Early diagnosis and referral to specialised unit is of vital importance. This procedure can be used for selected patients with malignant bone tumours. Cost factors, and social and cultural considerations also play a role Level of evidence: Level 4. Keywords: ECRT, extracorporeal radiation therapy, malignant bone tumours, bone sarcoma, osteosarcoma, Ewing's sarcoma","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":"67480654","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/V20N2A3
Goud DD Ayik, Takura Mukabeta, G. Nyandoro, C. Osborne, N. Kruger
The study was a retrospective review of patients who presented to our institution with cervical dislocation injuries and who were managed with closed reduction. The patient records of acute cervical spine dislocations from 2015 to 2018, data from the Acute Spinal Cord Injury database along with patient’s demographic information were gathered and compared. Participants within the study time frame were diagnosed with a cervical facet dislocation based on clinical examination findings and radiological confirmation. Patients who had reduction performed at other referring hospitals were excluded from the study.
{"title":"Adherence to a standard operating procedure for patients with acute cervical spine dislocations: review of a tertiary, referral, academic hospital in South Africa","authors":"Goud DD Ayik, Takura Mukabeta, G. Nyandoro, C. Osborne, N. Kruger","doi":"10.17159/2309-8309/2021/V20N2A3","DOIUrl":"https://doi.org/10.17159/2309-8309/2021/V20N2A3","url":null,"abstract":"The study was a retrospective review of patients who presented to our institution with cervical dislocation injuries and who were managed with closed reduction. The patient records of acute cervical spine dislocations from 2015 to 2018, data from the Acute Spinal Cord Injury database along with patient’s demographic information were gathered and compared. Participants within the study time frame were diagnosed with a cervical facet dislocation based on clinical examination findings and radiological confirmation. Patients who had reduction performed at other referring hospitals were excluded from the study.","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"20 1","pages":"81-87"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67480716","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 : 2020-11-17DOI: 10.17159/2309-8309/2020/V19N4A2
Z. Moonda, M. Nortje, R. Dey
Background: This study aims to analyse the accuracy of the Vertical Measurement System™ (VMS) in assessing the leg length correction (LLC) during total hip arthroplasty (THA) by comparing the intra-operative measurements to the radiographic measurements obtained six weeks post-operatively. Patients and methods: A prospective cohort study was conducted in which patients undergoing primary THA were enrolled at two centres in Cape Town, over a period of 19 weeks. THAs were performed by four surgeons. Pre-operative leg length discrepancy (LLD) measurements were obtained in 92 patients. The VMS was used to predict intra-operative LLC, and this measurement was compared to the post-operative LLC measured on the six-week follow-up X-ray. These measurements were statistically compared using the Mann–Whitney U test. Results: The difference between the intra-operative VMS calculation and the six-week radiological measurement was not significant (p>0.05), with the difference in their mean values being 0.1±3.3 mm. In the cohort, 82% of the patients (n=75) were within 5 mm of the target LLC, and 96% of patients (n=88) were within 10 mm of the target LLC. The mean absolute residual LLD at six weeks was 3.2±3.1 mm. Conclusion: The intra-operative LLC measurement obtained using the VMS accurately predicts the six-week post-operative radiographic LLC measurement. Level of evidence: Level 4
{"title":"Does the intra-operatively measured leg length correction compare to the post-operative radiograph in total hip replacement surgery?","authors":"Z. Moonda, M. Nortje, R. Dey","doi":"10.17159/2309-8309/2020/V19N4A2","DOIUrl":"https://doi.org/10.17159/2309-8309/2020/V19N4A2","url":null,"abstract":"Background: This study aims to analyse the accuracy of the Vertical Measurement System™ (VMS) in assessing the leg length correction (LLC) during total hip arthroplasty (THA) by comparing the intra-operative measurements to the radiographic measurements obtained six weeks post-operatively. \u0000Patients and methods: A prospective cohort study was conducted in which patients undergoing primary THA were enrolled at two centres in Cape Town, over a period of 19 weeks. THAs were performed by four surgeons. Pre-operative leg length discrepancy (LLD) measurements were obtained in 92 patients. The VMS was used to predict intra-operative LLC, and this measurement was compared to the post-operative LLC measured on the six-week follow-up X-ray. These measurements were statistically compared using the Mann–Whitney U test. \u0000Results: The difference between the intra-operative VMS calculation and the six-week radiological measurement was not significant (p>0.05), with the difference in their mean values being 0.1±3.3 mm. In the cohort, 82% of the patients (n=75) were within 5 mm of the target LLC, and 96% of patients (n=88) were within 10 mm of the target LLC. The mean absolute residual LLD at six weeks was 3.2±3.1 mm. \u0000Conclusion: The intra-operative LLC measurement obtained using the VMS accurately predicts the six-week post-operative radiographic LLC measurement. \u0000Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"19 1","pages":"206-211"},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47402339","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 : 2020-11-17DOI: 10.17159/2309-8309/2020/V19N4A6
S M H Phonela, R. Goller, M. Karsas
Osteogenesis imperfecta (OI) is a metabolic bone disorder commonly encountered in orthopaedic practice within the context of a multidisciplinary team. Although relatively rare, it is among the most researched of the skeletal dysplasias, making it challenging for the general orthopaedic surgeon to keep abreast with current evidence. The aim of this review article is to provide a comprehensive overview of OI for the general orthopaedic surgeon. It touches on the relevant epidemiology, pathology and clinical aspects of the condition. A discussion of the background and current topical issues surrounding the classification systems, and the medical and orthopaedic management aspects follows. The main focus of this review is on the peri-operative orthopaedic care of the appendicular musculoskeletal system. We trust it will equip the general orthopaedic surgeon with concise, up-to-date and relevant information to efficiently manage affected patients and caregivers in South Africa. Level of evidence: Level 5
{"title":"Osteogenesis imperfecta: an overview","authors":"S M H Phonela, R. Goller, M. Karsas","doi":"10.17159/2309-8309/2020/V19N4A6","DOIUrl":"https://doi.org/10.17159/2309-8309/2020/V19N4A6","url":null,"abstract":"Osteogenesis imperfecta (OI) is a metabolic bone disorder commonly encountered in orthopaedic practice within the context of a multidisciplinary team. Although relatively rare, it is among the most researched of the skeletal dysplasias, making it challenging for the general orthopaedic surgeon to keep abreast with current evidence. The aim of this review article is to provide a comprehensive overview of OI for the general orthopaedic surgeon. It touches on the relevant epidemiology, pathology and clinical aspects of the condition. A discussion of the background and current topical issues surrounding the classification systems, and the medical and orthopaedic management aspects follows. The main focus of this review is on the peri-operative orthopaedic care of the appendicular musculoskeletal system. We trust it will equip the general orthopaedic surgeon with concise, up-to-date and relevant information to efficiently manage affected patients and caregivers in South Africa. \u0000Level of evidence: Level 5","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"19 1","pages":"229-234"},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49286971","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 : 2020-11-17DOI: 10.17159/2309-8309/2020/V19N4A5
S C Phillias, M. Ngcelwane, L. Marais
Background: The aim of this study was to compare the initial tumour volume in patients with and without pulmonary and/or skeletal metastases at time of presentation. The secondary aim was to compare the value of tumour volume in the prediction of metastases at time of presentation with known predictive factors, namely serum alkaline phosphatase (ALP) and lactate dehydrogenase (LDH). Materials and methods: A retrospective cross-sectional analysis was performed comparing the primary tumour volume in patients with and without metastases. All patients with histologically confirmed high-grade conventional osteosarcoma over a five-year period were included. Results: The study comprised 61 patients. The mean age was 21 years (SD: 11.9, range 5–56) with an equal distribution of males and females (51% vs 49%). There was no correlation between tumour volume and age at presentation (p=0.31). There was no evidence of metastases in only 20% (n=12) of patients. Skeletal metastases were present in 28% (n=16) of the patients and pulmonary metastases were present in 44 cases (72%). There was no significant difference in the tumour volume at presentation beteen patients with and without pulmonary metastases (p=0.11). However, tumour volume did appear to predict the presence of skeletal metastases (p=0.02). A tumour volume of 1 383 cm³ had a negative predictive value (NPV) of 92% and positive predictive value (PPV) of 55% for the presence of skeletal metastases (area under curve [AUC]=0.76; sensitivity 66%; specificity 87%). A tumour volume of 480 cm³ had a 100% NPV for the presence of skeletal metastases (AUC=0.74). A tumour volume ≥1 380 cm³ had an odds ratio (OR) of 13.6 (p<0.01; 95% CI 2.6–72.5) as an independent variable in relation to skeletal metastases. Multivariate analysis (with ALP and LDH) of tumour volume ≥1 380 cm³ yielded an OR of 8.6 (p=0.04; 95% CI 1.1–67) for presence of skeletal metastases. Conclusion: In this series of conventional high-grade osteosarcoma of the extremities, we found a very high rate of metastases at time of diagnosis. While there was no association with pulmonary metastases, increased tumour volume was associated with an increased risk for the presence of skeletal metastases. More studies in the developing world clinical setting are required to investigate this further; the high rate of metastases seen at time of diagnosis also requires further investigation. Level of evidence: Level 4
{"title":"Tumour volume as a predictor of metastases in patients presenting with high-grade conventional osteosarcoma of the extremities","authors":"S C Phillias, M. Ngcelwane, L. Marais","doi":"10.17159/2309-8309/2020/V19N4A5","DOIUrl":"https://doi.org/10.17159/2309-8309/2020/V19N4A5","url":null,"abstract":"Background: The aim of this study was to compare the initial tumour volume in patients with and without pulmonary and/or skeletal metastases at time of presentation. The secondary aim was to compare the value of tumour volume in the prediction of metastases at time of presentation with known predictive factors, namely serum alkaline phosphatase (ALP) and lactate dehydrogenase (LDH). \u0000Materials and methods: A retrospective cross-sectional analysis was performed comparing the primary tumour volume in patients with and without metastases. All patients with histologically confirmed high-grade conventional osteosarcoma over a five-year period were included. \u0000Results: The study comprised 61 patients. The mean age was 21 years (SD: 11.9, range 5–56) with an equal distribution of males and females (51% vs 49%). There was no correlation between tumour volume and age at presentation (p=0.31). There was no evidence of metastases in only 20% (n=12) of patients. Skeletal metastases were present in 28% (n=16) of the patients and pulmonary metastases were present in 44 cases (72%). There was no significant difference in the tumour volume at presentation beteen patients with and without pulmonary metastases (p=0.11). However, tumour volume did appear to predict the presence of skeletal metastases (p=0.02). A tumour volume of 1 383 cm³ had a negative predictive value (NPV) of 92% and positive predictive value (PPV) of 55% for the presence of skeletal metastases (area under curve [AUC]=0.76; sensitivity 66%; specificity 87%). A tumour volume of 480 cm³ had a 100% NPV for the presence of skeletal metastases (AUC=0.74). A tumour volume ≥1 380 cm³ had an odds ratio (OR) of 13.6 (p<0.01; 95% CI 2.6–72.5) as an independent variable in relation to skeletal metastases. Multivariate analysis (with ALP and LDH) of tumour volume ≥1 380 cm³ yielded an OR of 8.6 (p=0.04; 95% CI 1.1–67) for presence of skeletal metastases. \u0000Conclusion: In this series of conventional high-grade osteosarcoma of the extremities, we found a very high rate of metastases at time of diagnosis. While there was no association with pulmonary metastases, increased tumour volume was associated with an increased risk for the presence of skeletal metastases. More studies in the developing world clinical setting are required to investigate this further; the high rate of metastases seen at time of diagnosis also requires further investigation. \u0000Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"19 1","pages":"223-228"},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42256919","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 : 2020-11-17DOI: 10.17159/2309-8309/2020/V19N4A1
N. Ferreira, K. Jordaan, G. D. Preez, M. Burger
Background: The management of femoral neck fractures in the younger patient remains contentious, with high failure rates being reported in the literature. Patient age usually plays a major role during decision-making with regard to head-sparing versus head-sacrificing surgical strategies. The aim of this study was to review the outcomes of fixation of femoral neck fractures in patients younger than 65 years in an attempt to identify factors that might predict fixation failure. Methods: A retrospective study, evaluating the outcome of fixation of femoral neck fractures in patients younger than 65 years of age was conducted. Factors affecting the outcome of treatment were explored in an attempt to identify variables that might predict fixation failure. Results: The final cohort comprised 51 men (76%) and 16 women (24%) with a mean age of 43.9±12.2 years (95% CI 41.0–46.8; range 23–64) and a median follow-up of 8.7 months (IQR 6.2–17.4). Thirteen patients (19%) presented with undisplaced (Garden I and II) fractures while 54 (81%) presented with displaced (Garden III and IV) fractures. Twenty-four patients (36%) met the definition of failure. These included 15 cases (22%) of non-union, seven cases (10%) of femoral neck collapse and two cases (3%) of avascular necrosis. Sixteen patients (24%) underwent conversion to total hip arthroplasty. All cases of failure occurred in patients who presented with Garden III and IV displaced fractures. Factors associated with failure included the presence of fracture comminution (p 0.999) nor alcohol abuse (p=0.528) was associated with failure. Conclusion: The incidence of fixation failure following surgical management of femoral neck fractures in patients younger than 65 years of age remains high. While undisplaced fractures heal readily regardless of time from injury to surgery, mechanism of injury or fixation method, displaced fractures remain a difficult problem to solve. In our series, fixation failure was observed in one in three patients, while one in four required revision to total hip arthroplasty. Level of evidence: Level 4
{"title":"Fixation of femoral neck fractures in patients younger than 65 years: a retrospective descriptive study at a high-volume trauma centre","authors":"N. Ferreira, K. Jordaan, G. D. Preez, M. Burger","doi":"10.17159/2309-8309/2020/V19N4A1","DOIUrl":"https://doi.org/10.17159/2309-8309/2020/V19N4A1","url":null,"abstract":"Background: The management of femoral neck fractures in the younger patient remains contentious, with high failure rates being reported in the literature. Patient age usually plays a major role during decision-making with regard to head-sparing versus head-sacrificing surgical strategies. The aim of this study was to review the outcomes of fixation of femoral neck fractures in patients younger than 65 years in an attempt to identify factors that might predict fixation failure. \u0000Methods: A retrospective study, evaluating the outcome of fixation of femoral neck fractures in patients younger than 65 years of age was conducted. Factors affecting the outcome of treatment were explored in an attempt to identify variables that might predict fixation failure. \u0000Results: The final cohort comprised 51 men (76%) and 16 women (24%) with a mean age of 43.9±12.2 years (95% CI 41.0–46.8; range 23–64) and a median follow-up of 8.7 months (IQR 6.2–17.4). Thirteen patients (19%) presented with undisplaced (Garden I and II) fractures while 54 (81%) presented with displaced (Garden III and IV) fractures. Twenty-four patients (36%) met the definition of failure. These included 15 cases (22%) of non-union, seven cases (10%) of femoral neck collapse and two cases (3%) of avascular necrosis. Sixteen patients (24%) underwent conversion to total hip arthroplasty. All cases of failure occurred in patients who presented with Garden III and IV displaced fractures. Factors associated with failure included the presence of fracture comminution (p 0.999) nor alcohol abuse (p=0.528) was associated with failure. \u0000Conclusion: The incidence of fixation failure following surgical management of femoral neck fractures in patients younger than 65 years of age remains high. While undisplaced fractures heal readily regardless of time from injury to surgery, mechanism of injury or fixation method, displaced fractures remain a difficult problem to solve. In our series, fixation failure was observed in one in three patients, while one in four required revision to total hip arthroplasty. \u0000Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"19 1","pages":"200-205"},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49164226","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 : 2020-11-17DOI: 10.17159/2309-8309/2020/V19N4A7
W. Greeff, R. Greeff, C. Frey, V. Singh
Introduction: Reports of fatigue failure of the femoral component of a total knee arthroplasty (TKA) is scanty in the literature. As a result, there are no clearly defined risk factors to aid us in predicting fatigue failure of an implant. Furthermore, these patients may present with non-specific knee pain, which may or may not be well tolerated, depending on the stability of the implant. We report a case of fatigue failure of a poorly cemented femoral component of a TKA in a 72-year-old female, approximately seven years after the initial surgery. Case report: A 72-year-old female presented to our tertiary level arthroplasty unit with new-onset knee pain approximately seven years after undergoing a TKA at our unit. She reported hearing a crack six months earlier, while standing up from a seated position. She had initially presented to her local clinic, but the pathology was missed. She received revision surgery at our institution and was doing well at early follow-up. Discussion: We reviewed the literature on fatigue failure of femoral components in TKA in an attempt to define risk factors. We also summarised all cases of femoral component fatigue failure in the English literature. Conclusion: Although femoral component fatigue failure in TKA is rare, the majority of cases have attributed the failure to poor surgical technique. Despite this, certain implants have been failing more often than others, and proposed mechanisms for this exist. Orthopaedic surgeons need to be aware of which implant designs are prone to failure, as well as how meticulous surgical technique can reduce the chances of fatigue failure. Level of evidence: Level 5
{"title":"Fatigue failure of the femoral component of a total knee arthroplasty: a case report and review of the literature","authors":"W. Greeff, R. Greeff, C. Frey, V. Singh","doi":"10.17159/2309-8309/2020/V19N4A7","DOIUrl":"https://doi.org/10.17159/2309-8309/2020/V19N4A7","url":null,"abstract":"Introduction: Reports of fatigue failure of the femoral component of a total knee arthroplasty (TKA) is scanty in the literature. As a result, there are no clearly defined risk factors to aid us in predicting fatigue failure of an implant. Furthermore, these patients may present with non-specific knee pain, which may or may not be well tolerated, depending on the stability of the implant. We report a case of fatigue failure of a poorly cemented femoral component of a TKA in a 72-year-old female, approximately seven years after the initial surgery. \u0000Case report: A 72-year-old female presented to our tertiary level arthroplasty unit with new-onset knee pain approximately seven years after undergoing a TKA at our unit. She reported hearing a crack six months earlier, while standing up from a seated position. She had initially presented to her local clinic, but the pathology was missed. She received revision surgery at our institution and was doing well at early follow-up. \u0000Discussion: We reviewed the literature on fatigue failure of femoral components in TKA in an attempt to define risk factors. We also summarised all cases of femoral component fatigue failure in the English literature. \u0000Conclusion: Although femoral component fatigue failure in TKA is rare, the majority of cases have attributed the failure to poor surgical technique. Despite this, certain implants have been failing more often than others, and proposed mechanisms for this exist. Orthopaedic surgeons need to be aware of which implant designs are prone to failure, as well as how meticulous surgical technique can reduce the chances of fatigue failure. \u0000Level of evidence: Level 5","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"19 1","pages":"235-238"},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47255479","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 : 2020-11-17DOI: 10.17159/2309-8309/2020/V19N4A3
R. Dey, S. Patnaik, Gokul Nair, S. Steiner, S. Sivarasu
Background: The aim of this study was to design and test a device to guide medial patellofemoral reconstruction surgeries. Materials and methods: A three-dimensional (3D) printed, modular and cost-effective medial patellofemoral ligament (MPFL) reconstruction guide, Pat-Rig, was designed with parallel holes running in the medio-lateral direction. This device was manufactured using a commercial additive manufacturing facility, and bench tested using a custom-built test rig. CT scans of patella bones were reconstructed, and the device was tested on four 3D-printed patellas of various sizes. Results: The device was successful in guiding the surgical drill into the patella to drill parallel holes adhering to the current surgical requirements and specifications. The device was augmented with an innovative radiopaque scale which can allow the surgeon to accurately predict the landmarks to drill and measure the drill depth of the tunnels. Conclusion: There are no devices on the market that accurately predict the drill locations on the patella during MPFL reconstruction surgeries. The device, Pat-Rig, was found to overcome the current limitations of the MPFL surgeries and was able to provide satisfactory surgical guidance during the reconstruction. Level of evidence: Level 5
{"title":"An intra-operative device for parallel drilling and femoral landmark estimation during medial patellofemoral ligament reconstructive surgery","authors":"R. Dey, S. Patnaik, Gokul Nair, S. Steiner, S. Sivarasu","doi":"10.17159/2309-8309/2020/V19N4A3","DOIUrl":"https://doi.org/10.17159/2309-8309/2020/V19N4A3","url":null,"abstract":"Background: The aim of this study was to design and test a device to guide medial patellofemoral reconstruction surgeries. \u0000Materials and methods: A three-dimensional (3D) printed, modular and cost-effective medial patellofemoral ligament (MPFL) reconstruction guide, Pat-Rig, was designed with parallel holes running in the medio-lateral direction. This device was manufactured using a commercial additive manufacturing facility, and bench tested using a custom-built test rig. CT scans of patella bones were reconstructed, and the device was tested on four 3D-printed patellas of various sizes. \u0000Results: The device was successful in guiding the surgical drill into the patella to drill parallel holes adhering to the current surgical requirements and specifications. The device was augmented with an innovative radiopaque scale which can allow the surgeon to accurately predict the landmarks to drill and measure the drill depth of the tunnels. \u0000Conclusion: There are no devices on the market that accurately predict the drill locations on the patella during MPFL reconstruction surgeries. The device, Pat-Rig, was found to overcome the current limitations of the MPFL surgeries and was able to provide satisfactory surgical guidance during the reconstruction. \u0000Level of evidence: Level 5","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"19 1","pages":"212-217"},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49174226","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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