Scielo RSS <![CDATA[SA Orthopaedic Journal]]> http://www.scielo.org.za/rss.php?pid=1681-150X20140004&lang=es vol. 13 num. 4 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Peer review - a perfect process or semi-flawed?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2014000400001&lng=es&nrm=iso&tlng=es <![CDATA[<b>Interrater reliability assessment of pre-reduction MRI features identifying hazardous disc disruption in distractive-flexion cervical spine injuries</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2014000400002&lng=es&nrm=iso&tlng=es AIM: This study assessed the interrater reliability of MRI when radiologists and orthopaedic surgeons assess intervertebral disc injury characteristics in distraction flexion (DF) injuries in the cervical spine. The most reliable MRI features of intervertebral disc injury are identified for future use METHODS: Pre-reduction MRI scans of 110 consecutive DF injuries were reviewed independently by a radiology and an orthopaedic surgical team. All cases were managed at a single tertiary referral unit over a ten-year period. Variables included for assessment were: disc herniation (posterior to the inferior vertebrae or above the level of the superior vertebrae's endplate), disc disruption, posterior longitudinal ligament disruption and disc containment. A double data entry method was used. Cohen's kappa value was used to determine interrater reliability RESULTS: Perfect agreement was never achieved between the two teams. The variables that had the highest interrater agreement were posterior disc prolapse and impression of containment. When disagreement occurred, the radiology team would tend to define the lesions as more severe than the orthopaedic team CONCLUSION: MRI assessment of disc injury characteristics carries moderate to fair interrater reliability at best. We conclude that the treating surgeon should review scan images personally prior to choosing a treatment algorithm, not relying solely on a written report. Posterior herniation and disc containment carry the highest interrater reliability. <![CDATA[<b>Retrospective analysis of adverse reactions to metal-on-metal lumbar disc arthroplasties in 378 consecutive patients</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2014000400003&lng=es&nrm=iso&tlng=es BACKGROUND: Spinal disc arthroplasty implants are primarily manufactured from metal/polymer materials. Biological reaction to wear debris ultimately requires clinical studies for assessment. Research into biological reaction of metal-on-polyethylene and metal-on-metal wear debris of knee and hip arthroplasties is well progressed as opposed to similar research on spinal arthroplasties. MATERIALS AND METHOD: The Swedish Spine Register provides a resource for the evaluation of adverse events and clinical outcome to lumbar metal-on-metal total disc replacements. The resource will be used for a retrospective analysis of the cases in this study. The material reviewed consists of a total of 378 Swedish patients treated between October 2003 and May 2009 (181 male, 197 female); average age was 39.2 years. By means of a questionnaire, 94% of the patients were followed up after two years and 88% after five years RESULTS: No reported cases were found of suspected or confirmed metal hypersensitivity or pseudotumors. This may be due to symptom-producing pseudotumors being extremely rare and the difficulty to form questions which would be able to indicate the presence of the adverse outcome CONCLUSION: Based on the results from this study, it can be concluded that the results do not exclude the possibility that patients might have non-symptomatic pseudotumors, but being non-symptomatic, the authors doubt the importance and relevance of further investigating those isolated cases <![CDATA[<b>The safety and efficacy of percutaneous sacroiliac joint screw fixation</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2014000400004&lng=es&nrm=iso&tlng=es PURPOSE OF STUDY: Percutaneous screw fixation of sacroiliac joint dislocations, fracture-dislocations and sacral fractures is a well-recognised technique first described by Routt and has increasingly gained popularity in recent times. This method is biomechanically comparable to open reduction and internal fixation with plates and screws but offers the advantages of minimally invasive surgical techniques. It is however a technically demanding procedure with reported complications including hardware failure, misplacement of screws, nerve injury and poor posterior reduction. The purpose of the study is to report clinical and radiological results of patients treated with closed reduction and percutaneous iliosacral screw fixation for unstable pelvic ring fractures. METHODS: A retrospective review of clinical notes and radiological studies was performed on all patients who had percutaneous sacroiliac fixation between 2009 and 2012. Forty-five percutaneous sacroiliac screws were inserted in 41 patients with a mean age of 25.6 years (range 17-62). Fracture types included 15 AO type B, and 26 AO type C. RESULTS: All patients had a satisfactory initial reduction. One patient (2.4%) had screw misplacement with resultant temporary neurological fallout. One patient (2.4%) had screw misplacement without neurological fallout. Both these patients initially had two screws inserted and the misplaced screws were removed and not resited. One patient (2.4%) had screw cut-out with loss of reduction. This screw was removed, open reduction performed, and the screw was reinserted. CONCLUSION: The use of percutaneous sacroiliac screws provides a safe and effective technique for the management of unstable posterior pelvic ring injuries. Our combined complication rate compares favourably with published literature. <![CDATA[<b>A unique case of a radius shaft fracture with proximal radio-ulnar joint dislocation</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2014000400005&lng=es&nrm=iso&tlng=es We present a previously undescribed lesion of a fractured proximal radius associated with a proximal radio-ulnar joint dislocation. Compression plating was performed via the Thompson approach and closed reduction of the proximal radio-ulnar joint (PRUJ) was attained. At one-year follow-up he had united fully and regained full use of his arm. Clinicians need to be aware of this possible variation when confronted with proximal radius fracture. <![CDATA[<b>The shelf life of sterile medical devices</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2014000400006&lng=es&nrm=iso&tlng=es The issues of the shelf life of sterile medical devices and the concept of end-product sterility testing of a sample of devices to prove the sterility of a batch of sterile devices are discussed against the background of the probabilistic approach to sterility and sterilisation. The particular role that the sterilisation technique and the packaging materials used play in maintaining sterility are discussed against the background that sterility and the maintenance thereof is event- and not time-related, and the implications thereof on the shelf life of sterile medical devices. <![CDATA[<b>Hepatitis C virus and the risk to the healthcare worker</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2014000400007&lng=es&nrm=iso&tlng=es The risk of hepatitis C virus (HCV) transmission is six times higher per needle-stick exposure than is the risk of HIV infection (1.8% vs 0.3%). The prevalence of HCV in South Africa is not known but estimated to be between 0.1 and 0.7%. Genotype 5 is predominantly found in South Africa. Currently there is no protocol in place for HCV exposure. The treatment cost of HCV is expensive. Currently none of the insurance companies covers post-HCV exposure. <![CDATA[<b>Imaging diagnosis of muscle herniation of the forearm</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2014000400008&lng=es&nrm=iso&tlng=es Muscle herniation is defined as a protrusion of muscle through an acquired or congenital defect of enclosing fascia. There have been 19 cases of symptomatic forearm muscle herniation reported in the literature. In this article we present a case of a 26-year-old factory worker who developed a traumatic forearm muscle herniation diagnosed on ultrasound and MRI, and we review the imaging of muscle hernias. <![CDATA[<b>Glenoid hypoplasia: A case series of ten shoulders</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2014000400009&lng=es&nrm=iso&tlng=es The terms 'glenoid hypoplasia', 'glenoid dysplasia' and 'dentate glenoid' refer to an uncommon developmental abnormality of the lower glenoid and scapular neck. The presenting symptoms are variable depending on the age at presentation, and in many cases the diagnosis is made incidentally on X-ray. The exact incidence is unknown, but is estimated in cadaveric and MRI studies to be in the region of 14.3% to 35% depending on the ethnic population studied.12 Current orthopaedic literature consists of case reports and small case series, with some of the more recent papers focusing on the arthroplasty management and implications.3-5 <![CDATA[<b>Expert Opinion on Published Articles</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2014000400010&lng=es&nrm=iso&tlng=es The terms 'glenoid hypoplasia', 'glenoid dysplasia' and 'dentate glenoid' refer to an uncommon developmental abnormality of the lower glenoid and scapular neck. The presenting symptoms are variable depending on the age at presentation, and in many cases the diagnosis is made incidentally on X-ray. The exact incidence is unknown, but is estimated in cadaveric and MRI studies to be in the region of 14.3% to 35% depending on the ethnic population studied.12 Current orthopaedic literature consists of case reports and small case series, with some of the more recent papers focusing on the arthroplasty management and implications.3-5