Scielo RSS <![CDATA[SA Orthopaedic Journal]]> http://www.scielo.org.za/rss.php?pid=1681-150X20150003&lang=es vol. 14 num. 3 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Aspirations and expectations</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000300001&lng=es&nrm=iso&tlng=es <![CDATA[<b>Osseous manifestations of non-Hodgkin's lymphoma in Human Immunodeficiency Virus (HIV) infection and Acquired Immunodeficiency Syndrome (AIDS)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000300002&lng=es&nrm=iso&tlng=es BACKGROUND: Lymphoma is the second most common Acquired Human Immunodeficiency Syndrome (AIDS)-associated neoplasm, the commonest being Kaposi sarcoma. The diagnosis and treatment of bone lymphoma still remains a challenge in our environment. MATERIALS AND METHODS: This is a retrospective chart review of 105 patients who were diagnosed histopathologi-cally with lymphoma involving the bone over a period of 11 years in six local hospitals. RESULTS: Forty-five (42.9%) patients with bone lesions and who were positive for Human Immunodeficiency Virus (HIV) formed the cohort. Clinical manifestations varied from swelling and pain in all patients to pathological fractures (n = 5, 11.1%) and paraplegia (n = 11, 24.4%) due to cord compression. Common sites included the spine, pelvis, femur, humerus, ribs, tibia and mandible. Treatment included chemotherapy and radiation, splinting or surgical fixation of pathological fractures and decompression of the spine with or without fusion. CONCLUSION: Bone lymphoma should be considered in any HIV-positive patient presenting with unexplained swelling and pain. The radiological picture may mimic bone infections like chronic pyogenic osteomyelitis, tuberculosis and fungal infections, other systemic disorders like Paget's disease, blood-related tumours such as leukaemia and other primary and metastatic bone neoplasms. <![CDATA[<b>Achilles tendinopathy - Part 1: Aetiology, diagnosis and non-surgical management</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000300003&lng=es&nrm=iso&tlng=es Non-insertional Achilles tendinopathy is by far the most common condition affecting this strong tendon and the incidence is on the rise due to increasing participation in recreational sports worldwide. Although the exact aetiology of Achilles tendinopathy is poorly understood, recent advances in understanding the pathophysiology of this condition have aided clinicians in developing improved methods of preventing and treating this painful, ubiquitous problem. Several contributing factors have been identified but repetitive microtrauma and inadequate, pathological healing appear to be the main culprits. Diagnosis is clinical but can be aided by the judicious use of imaging in equivocal cases. Activity modification and non-surgical modalities form the mainstay of treatment, with eccentric exercise programmes showing the best outcomes in prospective series. Several other non-surgical modalities exist and many show promising preliminary results. Surgical treatment options are discussed in Part 2 of this review, which will be published in Vol 14 No 4 of this journal. <![CDATA[<b>Technical difficulty in component sizing and positioning in humeral resurfacing: Relationship to clinical outcomes</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000300004&lng=es&nrm=iso&tlng=es INTRODUCTION: Resurfacing of the glenohumeral joint has gained popularity since its first introduction. Among other advantages, it is reported to allow closer replication of individual anatomy - failure of which may produce inferior clinical results. We review a cohort of patients who had undergone proximal humeral resurfacing, to evaluate certain radiological parameters of component sizing and positioning, and to correlate these with the clinical outcomes. MATERIALS AND METHODS: From January 2000 to March 2011, 51 humeral resurfacing procedures were performed in 49 patients. Patients were contacted for review, and assessed using patient-reported outcome measures. An Oxford Shoulder Score (OSS) as well as a subjective satisfaction and outcome questionnaire were completed, as well as details regarding further surgery or revision. Radiographs were evaluated for component size, offset, inclination and height. Two patients had demised, ten patients were not contactable, and in four the medical files had been lost. In the remaining 35 shoulders, the average follow-up was 5.43 years. The mean age at time of surgery was 64.8 years (range 36 to 84). RESULTS: Complications included eight revisions (average 2.4 years post-surgery), while a further one patient awaits revision. The mean OSS in the unrevised shoulders was 36.1 (range 10 to 48). There was no difference between the revised and unrevised group for peri-operative variables (pre-op diagnosis, smoking status, age, gender, surgeon involved), or any of the radiographic variables (inclination, offset, prosthesis height, increase in head size). In the unrevised group, there was no correlation between the OSS and radiographic measurements of offset, inclination or head height. Prostheses that subjectively appeared mal-sized or mal-positioned obtained better OSSs and subjective satisfaction scores. Revised cases were all subjectively satisfied post revision to stemmed total shoulder replacement. CONCLUSION: We have demonstrated difficulties in correct sizing and component placement as evident by the post-operative radiographic analysis, but are unable to correlate these with clinical scores. We have encountered a wide range of patient-reported shoulder scores and levels of satisfaction which, however unexplainably, have shown better scores for subjectively mal-sized and mal-positioned prostheses. <![CDATA[<b>Intra-osseous calcifying tendinitis of the infraspinatus tendon with erosion into the greater tuberosity</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000300005&lng=es&nrm=iso&tlng=es Calcific tendinitis is a condition characterised by the abnormal deposition of calcium hydroxyapatite crystals within the tendons of the rotator cuff. The characteristic appearance is that of acute or chronic shoulder pain combined with radiographic evidence of calcifications within the rotator cuff tendons. It is a specific disease entity which needs to be differentiated from other causes of rotator cuff calcium deposition. We present a case of calcific tendinitis with secondary erosion at the humeral insertion of the infraspinatus tendon. Conventional radiography proved unsuccessful in the initial diagnosis of the condition. Advanced modalities including both computed tomography (CT) and magnetic resonance imaging (MRI) proved to be both diagnostic and pivotal in the further management of the patient. <![CDATA[<b>Simple bilateral anterior shoulder dislocation: A case report and review of the literature</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000300006&lng=es&nrm=iso&tlng=es Bilateral shoulder dislocations are usually of the posterior type, which is commonly associated with seizures, electrocution or electroconvulsive therapy. Bilateral anterior shoulder dislocations are very rare and usually result from significant trauma. Simple bilateral anterior shoulder dislocations without associated fracture are much rarer and not many cases have been reported in the literature. We present a traumatic bilateral simple anterior shoulder dislocation in a 24-year-old male without any features of ligamentous laxity, and review the international literature on simple bilateral anterior shoulder dislocations. From the review we conclude that seizures are as important an aetiology of simple bilateral anterior shoulder dislocation as is trauma. Moreover, this injury is not as rare as was considered in the past. <![CDATA[<b>Prevention of periprosthetic joint infection: Pre-, intra-, and post-operative strategies</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000300007&lng=es&nrm=iso&tlng=es Prosthetic joint infection (PJI) is a calamitous complication with high morbidity and substantial cost. The reported incidence is low but it is probably underestimated due to the difficulty in diagnosis. PJI has challenged the orthopaedic community for several years and despite all the advances in this field, it is still a real concern with immense impact on patients and the healthcare system. Numerous factors can predispose patients to PJI. In this review we have summarised the effective prevention strategies along with the recommendations of a recent International Consensus Meeting on Surgical Site and Periprosthetic Joint Infection. <![CDATA[<b>The X-Ray Knee instability and Degenerative Score (X-KIDS) to determine the preference for a partial or a total knee arthroplasty (PKA/TKA)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000300008&lng=es&nrm=iso&tlng=es The X-ray Knee Instability and Degenerative Score (X-KIDS) was developed as a tool based on the degenerative and instability patterns seen on routine X-ray views of the weight-bearing compartments and tested on 336 knees, average age 64 years and followed up for 24 months. It is a study to evaluate the X-KIDS scoring method, which quantifies whether a PKA or TKA is the procedure of choice, comparing it to the surgical procedure done and to a stress X-ray evaluation as a stand-alone when contemplating knee arthroplasty. Points are allocated to the following features: narrowing (N), osteophytes (O), and subluxations (S). The assessed score is out of 10. A patient with a score of at least 3 but less than 5 is suitable for a PKA, a score of 5 could be suitable for a PKA or a TKA and a score exceeding 5 requires a TKA. There was a 95.82% (321) evaluator consensus with the X-KIDS on the X-ray sequence for a PKA or TKA. 92.3% (310) received the procedure assessed by X-KIDS and 2.98% (10) could have received the procedure evaluated. 90.78% of the stress views indicated the preferred procedure and is not as reliable as X-KIDS to determine the procedure. <![CDATA[<b>Intramedullary nail after Masquelet bone graft fracture: A case report</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000300009&lng=es&nrm=iso&tlng=es Large bone defects are challenging to reconstruct and often require specialised treatment strategies, multiple surgeries and long treatment periods. When these bone defects are the result of chronic infection the complexity of the reconstructive process increases exponentially. In the subtrochanteric area of the femur, bone defects secondary to infection are especially challenging as skeletal stabilisation is difficult and internal fixation is considered with caution due to the risk of recurrent infection. We report a case of a 24-year-old male who was successfully treated with an intramedullary nail after a fracture through a subtrochanteric Masquelet bone graft site. <![CDATA[<b>Early application of the Thomas splint for femur shaft fractures in a Level 1 Trauma Unit</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000300010&lng=es&nrm=iso&tlng=es AIMS: To measure the compliance of our prehospital service and trauma unit with international guidelines relating to the early application of the Thomas splint in patients with a femur shaft fracture on clinical examination. MATERIALS AND METHODS: Level IV retrospective review of clinical and radiological records of patients presenting from 01 January 2012 to 31 December 2012 at a Level 1 Trauma Unit. We included all patients with femur shaft fractures independently of their mechanism of injury. Exclusion criteria were: ipsilateral fracture of the lower limb, neck and supracondylar femur fractures, pathological, periprosthetic and incomplete fractures. The database available for review included demographic information, mechanism of injury, side injured and time when a radiological study (Lodox® and/or X-ray) was performed. RESULTS: We identified 160 fractures. Sixty of these (37.5%) were correctly immobilised with a Thomas splint prior to the first radiological examination being either a Lodox® or an X-ray. Seventeen fractures (45.9%) out of the 37 fractures not splinted or not correctly splinted at the time of the first radiological exam were then correctly splinted before the second radiological exam. CONCLUSION: Only 37.5% of patients presenting to our trauma unit with a femur shaft fracture have a Thomas splint applied before radiological examinations are performed. This deficiency needs to be addressed at all levels of healthcare, i.e. prehospital, peripheral and tertiary hospitals. <![CDATA[<b>Stand-alone cage neck fusions: A long-term review</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000300011&lng=es&nrm=iso&tlng=es BACKGROUND: Anterior cervical decompression and fusion (ACDF) is a well-known treatment for persistent cervical radiculopathy or myelopathy. Fusion is performed to stabilise the segment, maintain foraminal height, and maintain the normal sagittal profile. The stand-alone cage concept, initiated by Bagby, has been used in the human spine since 1988. There are some concerns with stand-alone cages regarding expulsion and migration of the cage. AIM: To review the long-term outcome of stand-alone cage fusions done from 2000-2010 at 1 Military Hospital and describe our experience with this procedure. METHODS: A retrospective review of stand-alone cage neck fusion of 55 levels in 35 patients performed between January 2000 and December 2010 at 1 Military Hospital was done. Clinical notes and X-rays were reviewed. Fusion rate was assessed using standard X-rays with flexion/extension views. RESULTS: Seven patients (14%) had a non-union, giving a fusion rate of 86%. Five non-unions were painful. One patient had a revision for a painful non-union (NDI score: 35/50). One patient refused to have a revision at last visit despite having significant pain (NDI score: 27/50). One patient with a double level non-union has phaeochromocytoma with significant risk to revision and chose not to have the surgery (NDI score: 14/50). Two patients are on the waiting list for a revision in the near future (NDI scores: 24/50 and 19/50). The two remaining patients with non-unions are asymptomatic (NDI scores: 0/50 and 7/50. CONCLUSION: Stand-alone cage fusion is a safe and effective procedure providing a favourable clinical and radiological outcome. Good fusion rates can be obtained (86% in our study) with this method. <![CDATA[<b>Expert Opinion on Published Articles</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000300012&lng=es&nrm=iso&tlng=es BACKGROUND: Anterior cervical decompression and fusion (ACDF) is a well-known treatment for persistent cervical radiculopathy or myelopathy. Fusion is performed to stabilise the segment, maintain foraminal height, and maintain the normal sagittal profile. The stand-alone cage concept, initiated by Bagby, has been used in the human spine since 1988. There are some concerns with stand-alone cages regarding expulsion and migration of the cage. AIM: To review the long-term outcome of stand-alone cage fusions done from 2000-2010 at 1 Military Hospital and describe our experience with this procedure. METHODS: A retrospective review of stand-alone cage neck fusion of 55 levels in 35 patients performed between January 2000 and December 2010 at 1 Military Hospital was done. Clinical notes and X-rays were reviewed. Fusion rate was assessed using standard X-rays with flexion/extension views. RESULTS: Seven patients (14%) had a non-union, giving a fusion rate of 86%. Five non-unions were painful. One patient had a revision for a painful non-union (NDI score: 35/50). One patient refused to have a revision at last visit despite having significant pain (NDI score: 27/50). One patient with a double level non-union has phaeochromocytoma with significant risk to revision and chose not to have the surgery (NDI score: 14/50). Two patients are on the waiting list for a revision in the near future (NDI scores: 24/50 and 19/50). The two remaining patients with non-unions are asymptomatic (NDI scores: 0/50 and 7/50. CONCLUSION: Stand-alone cage fusion is a safe and effective procedure providing a favourable clinical and radiological outcome. Good fusion rates can be obtained (86% in our study) with this method.