Scielo RSS <![CDATA[SA Orthopaedic Journal]]> vol. 13 num. 1 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>'Money makes the world go round'</b>]]> <![CDATA[<b>Expanding the teaching platform</b>]]> <![CDATA[<b>The classification of chronic osteomyelitis</b>]]> As a result of the heterogeneous nature of chronic osteomyelitis and the complexity of management strategy formulation, more than ten classification systems have been published over the past 40 years. Historical systems, used in the classification of chronic osteomyelitis, remain useful in terms of the description of the nature and origin of the disease. They fail, however, to provide the user with sufficient information in order to select the appropriate treatment strategy. As a result, more comprehensive classifications have subsequently been proposed. Accurate host stratification, in particular, is considered to be essential. The physiological status of the host serves as the primary indicator of the patient's ability to effect healing of bone and soft tissues, as well as their ability to launch an effective immune response in conjunction with antibiotic therapy. Despite the development of more comprehensive classification systems, many shortcomings remain within the domain of disease classification and host stratification. <![CDATA[<b>Chronic kidney disease and the skeleton: Pathogenesis, complications and principles of management</b>]]> Skeletal and extra-skeletal changes in chronic kidney disease are the result of deteriorating mineral homeostasis with disruption of the concentrations of phosphorous, calcium and circulating hormones. With the improved survival brought about by modern management strategies, early recognition of the prognostic determinants is of paramount importance in improving the morbidity and quality of life of renal patients. The aim of this review is to provide a skeletal perspective on the pathogenesis, radiological appearances, complications and principles of management of patients with chronic kidney disease. <![CDATA[<b>Pre-hospital antibiotics for open fractures: Is there time?</b>]]> Early administration of intravenous (IV) antibiotics providing cover against Gram positive and negative organisms can be argued to be the single most important factor in reducing infection rate in patients with open (compound) fractures. By examining trends in the time period from injury to ultimate administration of IV antibiotics, the authors aim to clarify if there would be opportunity for pre-hospital antibiotic administration to significantly shorten the delay. A retrospective and prospective descriptive study was conducted of all patients with open fractures of the limbs or girdles arriving via ambulance at a single district hospital in a suburban area in KwaZulu-Natal, South Africa. Thirty-eight patients were identified from May to December 2012. The median time from injury to antibiotics was 465 minutes (7.75 hours) (first quartile = 230 minutes, third quartile = 615). Administration of antibiotics was delayed beyond 3 hours in 78.9% (95% confidence interval [CI] 65.3-92.52) of patients and beyond 6 hours in 60.5% (95% CI 44.2-76.8). Although much of the delay occurred due to clinic and in-hospital delays, there is also a hypothetical window available to pre-hospital healthcare providers where antibiotics could be administered. This would potentially decrease the delay and bypass many of the difficulties encountered in-hospital. <![CDATA[<b>Giant cell tumour of the tendon sheath (GCT-TS) in the foot</b>: <b>A case report</b>]]> Giant cell tumour of the tendon sheath (GCT-TS) has been described as the most common tumour of the hand following ganglion cysts. In contrast it is much rarer in the foot, with only 3-10% of GCT-TS being described in the foot. A PubMed and Medline search of the topic has revealed two case series and 12 case studies. It is therefore an uncommon condition, but should be considered as part of a differential diagnosis for a mass in the foot. We present the case of a 42-year-old male who presented with a large painful mass in in the third web space of his left foot, which was 7 cm in length in vivo. It crossed the anatomical compartments of the forefoot and midfoot. Our case report showed the typical findings of a GCT-TS. Along with this we also present a review of the literature. <![CDATA[<b>Instrumentation of the paediatric cervical spine</b>]]> BACKGROUND: Paediatric cervical fusion surgery is challenging. Traditional techniques such as external stabilisation, onlay fusions and wiring techniques resulted in unsatisfactory outcomes due to inferior biomechanical stability. METHODS: A retrospective review was performed of paediatric patients who underwent instrumented cervical fusion surgery under 16 years of age. Fusion rates, blood loss, levels fused, theatre time, technique and complications were assessed. RESULTS: An average of 2.5 levels was fused, with an estimated blood loss of 428 ml and surgical duration of 159 min. Anterior procedures had an average of one level fused with blood loss of 117 ml and surgical duration of 98 min. Posterior procedures had an average number of 1.9 levels fused, blood loss of 306 ml and surgical time of 131 min. Combined procedures had an average of 5.5 levels fused, blood loss 810 ml and surgical duration of 241 min. Four surgery-related complications were encountered. These consisted of dural leaks and wound sepsis which were all treated effectively. All patients achieved radiological fusion. CONCLUSION: The use of modern segmental spinal instrumentation in the paediatric cervical spine is a viable option. Although the study sample was small we are able to demonstrate that no major surgical complications were encountered due to the use of adult cervical spinal instrumentation techniques in the paediatric group. <![CDATA[<b>A possible role of synovial fluid in bone healing</b>]]> BACKGROUND: The aim of the study was to study the rate of intra-articular fracture healing in baboons. It is postulated that this could correlate with fracture healing in the human model of the scaphoid, as this fracture healing takes place in an intra-articular environment. METHODS: Five baboons were used. Segments of iliac crest were divided along the cancellous zone and fixed together by means of cerclage wire with the cancellous surfaces facing each other. The conjoined blocks of bone were sutured into the joint capsule of the suprapatellar pouch of the animal from which they were obtained. Control specimens were fixed submuscularly to the outer cortex of the iliac crest. Specimens were harvested at two, three and four weeks. After decalcification, samples were examined histologically. RESULTS: All specimens were found to be viable. A firm union was noted at two weeks, a greater union at three weeks, and a substantial union at four weeks. Some of the specimens had a covering of synovial membrane, due to the fact that the specimen was sutured into the joint lining. It appeared to have no effect on bone survival or the rate of union. CONCLUSION: The results suggest that synovial fluid may nourish bone and promote union. This is in contradiction to the theory that synovial fluid may hamper bone healing, specifically in the scaphoid model in humans. <![CDATA[<b>Uncemented primary total hip arthroplasty in patients aged 55 years or younger: Results at a minimum of 5 years in a consecutive series</b>]]> INTRODUCTION: Surgical management of younger patients requiring primary total hip arthroplasty is challenging due to increased activity levels, physical demands, and the need for longevity of implanted components. There is debate regarding the most suitable component type, and the optimal fixation, should a stemmed component be utilised. MATERIALS AND METHODS: We retrospectively reviewed a sequential group of patients, aged 55 years or younger at the time of surgery, who underwent uncemented primary total hip arthroplasty, and are currently at a minimum of 5 years post operation. Eighty-eight primary uncemented total hip replacements were performed between January 2004 and December 2006. The patient ages ranged from 18 to 55 years with a mean of 43.1 years at time of operation. At last review, eight patients (ten hips) had demised of unrelated causes and 16 patients (20 hips) were lost before completing 5 years of follow-up. RESULTS: Complications included one peri-operative mortality, ten intra-operative femoral calcar fractures, two revisions for sepsis, one dislocation and one deep vein thrombosis. All stems achieved bony fixation as per Engh's criteria. At a minimum of 5 years post operation, there were no revisions for aseptic loosening. CONCLUSION: We present our radiological results, complications, and survivorship of uncemented primary total hip replacements in patients 55 years or younger. <![CDATA[<b>Stress fracture of the femoral neck (SFFN) as a consequence of an unusual occupation: A case report and review of the literature</b>]]> Stress fractures of the femoral neck are as old as mankind.ยน They affect all ages, young and old. They mostly affect those who are physically active such as military recruits, athletes, especially marathon runners, as well as dancers. We are reporting a case of a femoral neck stress fracture in a 33-year-old male working as a pneumatic drill operator. See also Figure 1. <![CDATA[<b>The influence of posterior condylar offset on maximum knee flexion: a retrospective analytical study</b>]]> BACKGROUND: Achieving maximum knee flexion following total knee replacement (TKR) remains a major goal for every knee arthroplasty surgeon. Studies to understand the kinematics of the knee therefore remain of utmost importance. Speculation remains regarding what the correct posterior condylar ratio should be after surgery and whether a change in posterior condylar offset will have an impact on the amount of flexion achieved. OBJECTIVES: The aim of this study was to determine the role of the posterior condylar offset on knee flexion and whether a change in posterior condylar offset influenced the amount of flexion achieved. Since multiple causes for a change in knee flexion have been identified before, we have tried to eliminate as many variables as possible to keep our focus on the influence on posterior condylar offset on knee flexion. METHODS: Our study was unique in that all our surgery was performed using computer-assisted surgery (CAS), which ensured our measurements were very accurate and allowed us to eliminate more of the variables that could influence the results. Pre- and post-operative flexion were determined and compared to the pre- and postoperative posterior condylar offset ratio (PCOR) as measured by the Bristol knee group. RESULTS: We found an almost uniform increase in the posterior condylar offset post surgery, although a poor correlation between the pre- and post-operative flexion achieved was observed. CONCLUSION: An increase in PCOR after surgery does not lead to an increase in flexion achieved post-surgically. The pre-operative flexion a patient has is still the benchmark in predicting post-surgical outcome.