Scielo RSS <![CDATA[SA Orthopaedic Journal]]> http://www.scielo.org.za/rss.php?pid=1681-150X20150001&lang=en vol. 14 num. 1 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Acceptance Speech</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000100001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Are we oversupplying the orthopaedic surgical market?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000100002&lng=en&nrm=iso&tlng=en <![CDATA[<b>Private practice (RWOPS) and overtime for state-employed specialists</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000100003&lng=en&nrm=iso&tlng=en <![CDATA[<b>Biceps pulley lesions associated with subscapularis tears and subacromial impingement: The triad of the rotator interval lesion</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000100004&lng=en&nrm=iso&tlng=en AIM: The aim of this study was to describe the association of biceps pulley lesions with subscapularis tendon tears and subacromial impingement, and present the outcome of surgical management METHODS: Twenty-six consecutive patients with a mean age of 55 years (range 16-77) were included in this study. All of the patients were arthroscopically diagnosed with pulley lesions and associated subscapularis tears. The data was collected prospectively. Subacromial impingement was evident in 22 patients (92%). A final postoperative evaluation was carried out after a mean of 43 months RESULTS: Ninety-two per cent of patients with pulley lesions and subscapularis tears showed subacromial impingement. Twelve cases (46%) had a selective tenodesis to treat partial tears or subluxations of the long head of the biceps (LHB). Subscapularis tears were repaired in 22 patients (85%) and debrided in four cases (15%). Associated SSP tears were sutured in nine and debrided in four of 13 patients. The Constant score improved from a mean of 64.8 points pre-operatively to 84.7 points post-operatively (P=0.003 CONCLUSION: There is a high association of pulley lesions with subscapularis tears and subacromial impingement. Rotator cuff repair and subacromial decompression led to favourable results in the treatment of these patients. LHB tenodesis is recommended if partial tears or subluxations of the biceps tendon are encountered <![CDATA[<b>Reverse total shoulder arthroplasty for complex proximal humeral fractures in the elderly: How to improve outcomes and avoid complications</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000100005&lng=en&nrm=iso&tlng=en The use of reverse total shoulder arthroplasty for the management of complex proximal humerus fractures has gained popularity in the last five to ten years. We present a concise review of conservative and surgical treatment of proximal humerus fractures and a more detailed review of published series of reverse shoulder arthroplasty for fracture treatment. We discuss ways of optimising results and avoiding complications. <![CDATA[<b>Gunshot face as a cause of hyperextension central cord syndrome in a young patient</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000100006&lng=en&nrm=iso&tlng=en Central cord syndrome (CCS) is a syndrome where the patient's upper limbs are more severely affected than the lower limbs in terms of neurological deficit. This is typically found in an elderly patient with pre-existing spondylosis and a minor hyperextension injury. This case report highlights an unusual cause of CCS in a young patient with pre-existing congenital cervical canal stenosis and acute hyperextension induced by a facial gunshot. The aetiology and management dilemmas are discussed. <![CDATA[<b><i>Pantoea agglomerans </i>as a rare cause of cervical spondylodiscitis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000100007&lng=en&nrm=iso&tlng=en OBJECTIVE: To present a case report of a rare cause for cervical spondylodiscitis caused by Pantoea agglomerans. CASE PRESENTATION AND INTERVENTION: A 10-year-old girl presented with a destructive lesion of the C4 vertebral body with raised infective markers and a radiological picture suggestive of tuberculosis spondylodiscitis. Further investigations revealed multiple sites of involvement. No evidence of tuberculosis was found. Histology after biopsy showed focal granuloma formation in response to necrotic bone fragments and on tissue cultures in which Pantoea bacteria was isolated. The patient was successfully treated with a six-week course of co-amoxiclav. On follow-up the cervical lesion as well as the other sites of involvement showed signs of resolution CONCLUSION: Pantoea agglomerans is a rare pathogen in the aetiology of spondylodiscitis. The organism is usually associated with penetrating trauma by plant material or contaminated intravenous products. Neither of these factors was present in this case <![CDATA[<b>Tibial non-union treated with the TL-Hex: A case report</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000100008&lng=en&nrm=iso&tlng=en Tibial non-unions are difficult to treat, even for the experienced orthopaedic trauma surgeon. Despite being relatively common problems, controversy exists regarding their ideal management. We report a case of a stiff oligotrophic tibial non-union successfully treated with the new TL-Hex (Orthofix, Verona, Italy) circular external fixator. Closed gradual distraction was effective to correct all deformities and stimulate bone formation without the need for a tibial osteotomy or bone graft. <![CDATA[<b>Synovial chondromatosis: A review of the literature and report of two cases</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000100009&lng=en&nrm=iso&tlng=en Synovial chondromatosis is a rare benign condition which develops in the synovial tissue of a joint, bursa or tenosynovial sheath. It is characterised by formation of cartilaginous nodules which may enlarge and grow into larger masses. Although radiological imaging contributes to a differential diagnosis, a final diagnosis can only be established with histological examination. Meticulous examination of the lesions is essential in ruling out sarcomatous change. We present a review of the literature and report two cases of synovial chondromatosis of the knee joints diagnosed over a ten-year period in the orthopaedic unit of a tertiary hospital serving mainly an urban- and peri-urban population sample. <![CDATA[<b>Early excision of heterotopic ossification for pain control: A case report</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000100010&lng=en&nrm=iso&tlng=en BACKGROUND: Heterotopic ossification rarely presents with pain as the primary symptom CASE: A 31-year-old soldier presented with severe right hip pain 2.5 months after a craniectomy following a penetrating brain injury. Examination revealed a right-sided hemiplegia and a stiff hip with the patient resisting any passive movements due to severe pain. A hip X-ray confirmed massive heterotopic ossification of the right hip. Pain was so severe that he required management by the pain control team who administered analgesics including the use of several epidural catheters and femoral nerve blocks. There was also significant restriction in activity, including physiotherapy, due to pain. Exploration and excision of the heterotopic bone at the right hip 2.5 months after diagnosis revealed significant compression and stretching of the sciatic nerve by the heterotopic bone. The massive heterotopic bone was excised followed by radiotherapy using 800 cGy within 24 hours of surgery. Post-operatively pain control was significantly improved with only simple analgesics being required CONCLUSION: Heterotopic ossification at the hip can be associated with significant pain when compression of the sciatic nerve is involved. Early surgical excision is indicated, instead of waiting until maturity of heterotopic bone, for the main purpose of achieving pain control <![CDATA[<b>Perspectives on Legg-Calvé-Perthes disease</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000100011&lng=en&nrm=iso&tlng=en The world of Legg-Calvé-Perthes disease (LCP) has been full of activity but there has been little progress made. We are as unsure of the indications for treatment now as we were half a century ago and, in fact, the evidence that any treatment is effective is weak. Our understanding of the disease is incomplete; nevertheless each of us, as a surgeon, must develop a working approach to the problem in order to deal with the patients who present with this condition. This article, therefore, will not attempt to provide recommendations for management, but will present ideas and a framework that might help orthopaedic surgeons to gather their thoughts about this condition, and to develop their own working approach. <![CDATA[<b>Expert Opinion on Published Articles</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000100012&lng=en&nrm=iso&tlng=en The world of Legg-Calvé-Perthes disease (LCP) has been full of activity but there has been little progress made. We are as unsure of the indications for treatment now as we were half a century ago and, in fact, the evidence that any treatment is effective is weak. Our understanding of the disease is incomplete; nevertheless each of us, as a surgeon, must develop a working approach to the problem in order to deal with the patients who present with this condition. This article, therefore, will not attempt to provide recommendations for management, but will present ideas and a framework that might help orthopaedic surgeons to gather their thoughts about this condition, and to develop their own working approach.