Scielo RSS <![CDATA[SA Orthopaedic Journal]]> vol. 21 num. 4 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>Where are they now?</b>]]> <link></link> <description/> </item> <item> <title><![CDATA[<b>Access gate-related lower limb fractures in children and adolescents: a review of injury patterns and evaluation of associated injuries</b>]]> BACKGROUND: Lower limb fractures occurring in and around the home environment and caused by collapsing access gates present frequently to our emergency unit. There is currently limited literature evaluating injuries resulting from access gate accidents. The aim of this study was to evaluate the patterns of lower limb fractures, management options offered and concomitant injuries in children as well as adolescents presenting with access gate-related lower limb traumas. METHODS: A retrospective cross-sectional review of 43 children with 46 lower limb fractures was conducted between 1 January 2017 and 31 December 2020. Hospital records and radiology archives of all children and adolescents under 12 years of age (24 males and 8 females) with lower limb fractures sustained following an access gate injury were reviewed and included for analysis. Data was analysed descriptively using SAS (SAS Institute Inc, Carey, NC, USA), Release 9.4. RESULTS: The prevalence of access gate-related injuries for all lower limb fractures in children and adolescents treated during the four-year period was 11%. The findings revealed that femur fractures are more common, accounting for 50.0% of the cases. The majority of cases were of patients younger than 6 years (71.9%), and predominantly affecting males (3:1). The fractures occurred in a home environment and were commonly related to non-motorised gates, in 93.8% of cases. The oblique fracture patterns comprised 40.6% of the fractures, and 68.8% of the fractures were located in the diaphysis. Open fractures constituted 50.0% of the tibia fractures. Mild head injuries associated with lower limb fractures were observed in 12.5% of the cases. CONCLUSION: The results demonstrated the prevalence of lower limb fractures above all injuries related to access gates. The majority of the injuries observed in this study occurred in manually operated gates, and commonly affected younger patients. In light of these findings, further studies are required into the reasons for these injuries and preventative measures Level of evidence: Level 4. <![CDATA[<b>An audit on the accuracy of freehand acetabular cup positioning in total hip arthroplasty with the direct lateral approach at a tertiary institution over seven years</b>]]> BACKGROUND: The direct lateral approach for total hip replacement has been traditionally reserved and described for neck of femur fractures. Advantages of this approach include technically easy access to the acetabulum and femur and low incidence of hip dislocation. Imperfect positioning of the acetabular component leads to increased risk for dislocations, accelerated wear, reduced range of motion and increased revision rate. Freehand technique has been the gold standard for many decades, but newer technologies like computer navigation and robotic-assisted surgery have shown to improve the accuracy of cup placement. This study reports on the accuracy of freehand cup positioning via the direct lateral approach with mention of the dislocation rate METHODS: We retrospectively reviewed 253 patients who had total hip replacements done via the direct lateral approach. The patients' files were evaluated for patient parameters, demographic details, aetiology of hip pathology, confirmation of approach used, comorbidities and history of previous relevant surgery. The postoperative radiographs were analysed for acetabular component position inclination and anteversion. Dislocation rates were calculated as a secondary objective RESULTS: The radiographic analysis was performed using the Liaw method based on trigonometry of the eclipse generated. This showed a mean cup inclination of 42.3° (95% CI: 41.3-43.3°) and anteversion of 12.7° (95% CI: 12.0-13.7°). A total of 57% of the acetabular cups were within the safe zones described by Lewinnek. Of them, 78% were in the 30-50° range for inclination and 73% in the 5-25° range for anteversion. There were ten dislocations within one year from the index procedure: a dislocation rate of 4.0% (95% CI: 2.8-8.5% CONCLUSION: The freehand technique using the direct lateral approach for acetabular cup placement produces a poor overall accuracy of only 57%. Although our study only commented on ten dislocations, the rate (4%) is significantly worse compared to the 0.43% reported in literature for the direct lateral approach. The radiographic results for inclination and anteversion are comparable to other freehand techniques, regardless of the approach used, but significantly worse than results achieved with navigation and robotics Level of evidence: Level 4 <![CDATA[<b>A retrospective comparative study of complications after total knee replacement in rheumatoid arthritis and osteoarthritis patients</b>]]> BACKGROUND: Total knee arthroplasty (TKA) rates have significantly increased over the past few decades; consequently, so too have the absolute number of complications. International literature expounds on complications in the rheumatoid arthritis (RA) and osteoarthritis (OA) subgroups from the developed context, but these findings cannot be generalised to the developing world, where access to medication, medical facilities and patient characteristics may differ. The purpose of this study was to determine the comparative rates and nature of complications that occur post total knee arthroplasty in RA and OA patients at a single South African quaternary hospital. METHODS: This was a retrospective comparative study of complication rates in two groups following TKA at Inkosi Albert Luthuli Central Hospital (IALCH) arthroplasty unit, between 1 January 2014 and 29 February 2020. The data was collected retrospectively, utilising the digitised patient management system at the hospital. Data extraction included patient demographics, time to surgery, indication for surgery and early complication rates. Descriptive analysis was performed to quantify complications, comparing the two groups. RESULTS: The chart review yielded 332 cases, comprising 41 RA and 291 OA patients. The mean age of the combined participant group was 65 years (standard deviation [SD] 8). Most cases were female (87%, 289 of 332), with males comprising 13% (43 of 332). Concomitant human immunodeficiency virus (HIV) was present in 6% of patients (20 of 332), and 24% (80 of 332) had diabetes mellitus (DM). The absolute number of complications was greater in the OA group, where revision surgery was performed in 3% (8 of 291) of cases, infection occurred in 1% (3 of 291), mechanical complications in 3% (10 of 291), and deep vein thrombosis (DVT) in 1% (2 of 291) of cases. There was one complication, a DVT, in the RA group (2%, 1 of 41). CONCLUSION: In the current study, complications after TKA occurred predominantly in the OA group, 8% (23 of 291) as compared to the RA group, 2% (1 of 41). Complications included DVT, revision surgery, infection and mechanical complications. The study was underpowered to detect significant differences between the groups. Further large-scale investigation will be required to determine if differences in complication rate are significant when low complication incidence is anticipated. Level of evidence: Level 4. <![CDATA[<b>Retrospective audit of serum vitamin D levels in patients who underwent Latarjet procedure for anterior shoulder instability</b>]]> BACKGROUND: The aim of this study was to review vitamin D levels in patients who underwent Latarjet procedures at a tertiary teaching hospital and a private clinic. METHODS: A retrospective review of clinical and radiological records was performed for 22 patients who underwent Latarjet procedure between November 2017 and June 2019. Postoperative vitamin D levels were retrieved and classified into sufficient (&gt; 75 nmol/L), insufficient (25-75 nmol/L), and deficient (< 25 nmol/L) groups. Two observers assessed radiographic images of the patients at six weeks and three months after surgery. Any bone resorption, fracture and nonunion were reported, and interobserver reliability was analysed using the intraclass correlation coefficient (ICC). RESULTS: The median age was 20.5 years and was predominantly male. A little more than two-thirds (68.1%) of the patients were found to have insufficient or deficient levels of vitamin D. One patient from the insufficient group had postoperative bone resorption. Good interobserver reliability was observed with the ICC value being 0.86. CONCLUSION: This study found a prevalence of insufficient/deficient vitamin D levels in young patients undergoing a Latarjet procedure. This study serves as a reminder to orthopaedic surgeons that vitamin D deficiency is prevalent among patients undergoing Latarjet Level of evidence: Level 4. <![CDATA[<b>The burden of road traffic accident-related trauma to orthopaedic healthcare and resource utilisation at a South African tertiary hospital: a cost analysis study</b>]]> BACKGROUND: Road traffic accidents (RTAs), the second commonest cause of trauma in South Africa (SA), are on the rise. It is therefore important to study and understand the burden of RTA-related injuries on our orthopaedic healthcare and healthcare in general, in order to devise new prevention strategies to minimise the number of RTAs METHODS: A retrospective analysis of data from orthopaedic trauma intake records was done for patients admitted with RTA-related injuries to the orthopaedic department at a South African tertiary hospital between February 2019 and January 2020. Hospital records and the PAC (picture archiving and communication) system were analysed for radiological studies done. The Uniform Patient Fee Schedule (UPFS) was analysed for individual costing of all variables being studied RESULTS: There were 642 patients seen and managed with RTA-related injuries included in this study. Seventy-one per cent of them were males, with an average age of 35 years. The majority (76.2%) were motor vehicle occupants, whereas 17% were pedestrians. Seventeen per cent of them had polytrauma. Four hundred and sixty-two (76%) patients required some form of surgical intervention and spent an average of 171 minutes in theatre per procedure. Ten per cent of these patients required ICU/HCU admission for an average of 13 days. The total length of hospital stay was an average of 21.8 days. The majority of patients (67%) had some form of orthopaedic implant inserted, with an average of 1.3 implants per patient. The average cost per patient was R92 737.39. The major cost drivers were hospital stay, ICU/HCU stay, implant cost, radiological studies and theatre utilisation, respectively CONCLUSION: Management of RTA-related trauma puts a significant burden on orthopaedic healthcare management and resource utilisation. While we may not be able to directly influence other contributing factors to high costs, reducing the use of temporary external fixators may help reduce the cost of managing RTA victims These findings provide scientific data which will help support the implementation of preventative measures aimed at minimising the numbers of RTAs we see on our roads, thereby minimising the burden this puts on our healthcare system. Level of evidence: Level 3 <![CDATA[<b>The mechanical testing of a novel interlocking forearm nail</b>]]> BACKGROUND: Mechanical testing of newly designed implants provides valuable insight into their mechanical properties. This provides surgeons with information about implant choice for the treatment of fractures and the effect of the implant's mechanical properties on fracture healing METHODS: A novel interlocking forearm nail was subjected to standardised mechanical testing according to the Standard Specification and Test Methods for Intramedullary Fixation Devices (ATSM 126416), using static and dynamic four-point bending and static torsion (ASTM STP 588). Three nails were used for the static bending and torsion and nine for the dynamic bending tests. All nails were catalogued, numbered and photographed before testing RESULTS: The mechanical testing results showed a mean force yield (Fy) of 566 ± 20 N, a moment of yield (My) 10.75 ± 0.37 Nm, a stiffness of 67.10 ± 2 N/mm and structural stiffness of 1.53 ± 0.50 m². The torsional stiffness of the nail was 0.088 ± 0.002 Nm/°. The four-point dynamic bending test showed a fatigue strength of 5.23 Nm. This value was determined using the semi-log moment/ number of cycles (M-N) diagram and showed a 50% failure at a million cycles. If the moment were reduced to 4.4 Nm, mathematically, the survival rate would improve to 90% CONCLUSION: The results from this mechanical testing show that this novel intramedullary forearm nail can resist mechanical forces experienced during fracture healing and could potentially be used in future clinical studies Level of evidence: Level 4 <![CDATA[<b>Truth or DAIR? A review of debridement, antibiotics and implant retention</b>]]> Debridement, antibiotics and implant retention (DAIR) is a viable treatment option in early postoperative and acute haematogenous periprosthetic joint infections (PJIs) with a stable implant. Despite lower success rates compared to one- and two-stage revisions, DAIR maintains satisfactory outcomes in selected patient groups and, if successful, has similar functional outcomes to primary arthroplasty. DAIR remains an attractive treatment option, providing satisfactory outcomes with decreased healthcare costs, reduced surgical burden on the patient and shorter hospital stays. With success rates of 37-90%, various factors need to be considered when deciding on DAIR as the appropriate treatment option for PJI. The risk of DAIR failure needs to be weighed against the potential benefits of DAIR success. Factors that increase success rates include an open DAIR procedure performed for a low-virulence, antibiotic-sensitive organism, within a short duration between symptom onset and/or index surgery and DAIR. The procedure involves intraoperative exchange of mobile components and copious wound irrigation, followed by an appropriate antibiotic regimen for a minimum of six weeks that can be administered either intravenously or orally in a well-optimised host, without significant soft tissue defects or contraindications to surgery. Factors increasing the risk for DAIR failure include chronic/late PJIs with resistant organisms, especially methicillin-resistant Staphylococcus aureus (MRSA) in poor hosts with significant comorbidities, such as chronic obstructive pulmonary disease (COPD), liver cirrhosis, rheumatoid arthritis, advanced age > 80 years, patients with fracture indications for arthroplasty and those who cannot tolerate rifampicin- and fluoroquinolone-based antibiotic regimens. Unfortunately, there is no definitive factor to serve as an indication of whether DAIR will be successful, but with recent data showing that a failed DAIR procedure does not lower success in future staged revisions, then even in the face of a 50% success rate, DAIR can maintain its role as an initial treatment option in the management of PJIs. Level of evidence: Level 5