Scielo RSS <![CDATA[SA Orthopaedic Journal]]> http://www.scielo.org.za/rss.php?pid=1681-150X20130005&lang=pt vol. 12 num. 4 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Are we under attack?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2013000500001&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>The pathophysiology of chronic osteomyelitis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2013000500002&lng=pt&nrm=iso&tlng=pt Chronic osteomyelitis is a biofilm-based infection of bone where the majority of causative microorganisms are sessile in nature, rendering them less sensitive to systemic antibiotic agents and making routine culture techniques unreliable. Biofilms are the characteristic growth pattern for most bacteria and are now understood to consist of interactive communities with the ability to alter their gene expression in order to ensure survival. Our knowledge of the host's response to infection is also rapidly expanding. The discovery that osteoclastic and osteoblastic cells play a central role in the immune response of bone has resulted in a better understanding of osteo-immunology. This expansion of knowledge has created new opportunities in terms of the development of novel treatment strategies in the management of chronic osteomyelitis and periprosthetic infections. <![CDATA[<b>Biomarkers in rheumatoid arthritis - the old and new</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2013000500003&lng=pt&nrm=iso&tlng=pt Rheumatoid arthritis (RA) is the prototype autoimmune disease but related mechanisms are involved in numerous other physiological and pathological conditions such as ageing, osteoporosis, chronic osteomyelitis and fracture healing. This article is a review of cellular and molecular components of the immune-inflammatory response in RA with a focus on candidate novel biomarkers that may take us one step closer to the modern quest for personalised medicine. <![CDATA[<b>The epidemiology of femur shaft fractures in children</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2013000500004&lng=pt&nrm=iso&tlng=pt Femur shaft fractures constitute 21.9% of the orthopaedic fractures seen in our unit. The epidemiology is well described in literature from developed countries. To assess the epidemiology in a developing country and to identify socio-demographic risk factors, we did a retrospective study of 759 children with femur fractures treated over a 5-year period. We utilised the Census of 2011 to calculate the annual incidence. The socio-economic status was determined by means of a social deprivation category based on the parental occupation obtained from the Census as per the parental address. The mean annual incidence of 152 patients with femur fractures extrapolated to 0.25 per 1 000 children per year. The commonest mechanism of injury was a fall (39%) with a peak at 2 to 3 years of age, followed by motor vehicle accident (MVA) (33.7%), of which 88% were pedestrian (PVA). Ninety per cent of the patients were from the lowest two socioeconomic classes. The peak incidence at 4 to 5 years due to a PVA was younger than the &gt;6 years reported from developed countries. Children at 4 to 5 years have not developed the cognitive and perceptuo-motor abilities to adapt to a traffic environment. The peak of 4 to 5 years due to PVAs is the result of lack of guided parental training, adequate supervision and play area in the lower socio-economic classes. In children <1 year of age, 59.3% were due to non-accidental injury (NAI) and 23.7% due to osteogenesis imperfecta. <![CDATA[<b>The effect of two different plastering techniques on the rate of major surgery in idiopathic clubfoot</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2013000500005&lng=pt&nrm=iso&tlng=pt BACKGROUND: The Ponseti technique of clubfoot manipulation and casting is reported to have almost eliminated the need for extensive surgery (posterior and posteromedial release) and surgical decision-making is now largely based on clinical assessment, as opposed to pre-operative radiographs. The Ponseti method of manipulation and casting was introduced at our institution in 2002, prior to which we used the Kite method. Both prior to, and following the introduction of Ponseti casting, surgical decision-making was based on pre-operative radiology, and intra-operative clinical assessment. METHODS: A retrospective comparative study was performed to compare the incidence of radical surgery following the use of the Kite method versus the Ponseti method. In addition, the accuracy of measured radiographic parameters in predicting which surgery was to be performed was investigated. RESULTS: The incidence of radical surgery decreased from 40% with the Kite method to zero with the Ponseti method. Of the four routinely measured radiographic angles, only the tibiocalcaneal angle and the talometatarsal angle significantly correlated with the extent of surgery performed. CONCLUSIONS: Using the Ponseti method greatly decreases the need for radical surgery in idiopathic clubfoot. Radiographic measurements do not influence surgical decision-making significantly. <![CDATA[<b>A practical way to calibrate digital radiographs in hip arthroplasty</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2013000500006&lng=pt&nrm=iso&tlng=pt BACKGROUND: Accurate calibration of digital radiographs in arthroplasty is essential for pre-operative planning. Our study was designed to evaluate the accuracy of using a 20 mm spherical radio-opaque calibration marker placed between the legs during an AP pelvis X-ray. The marker is then used to calibrate the size of the digital radiograph and measurements can be taken. Using an AP pelvis view including both hips is desirable as this allows the use of the contralateral hip for templating. We used a 20 mm ball bearing in a clear plastic tube as a marker positioned at the same depth as the greater trochanter, but between the patient's legs. Placing the marker between the patient's legs prevents the problem of the marker disappearing off the side of the image, as is seen when placing the marker at the side of the obese patient. METHOD: One-hundred-and-one selected post-operative radiographs were used. The radiographs were calibrated according to the known head size of the femoral prosthesis, which was obtained from the operation report. The marker between the legs was then measured to assess the accuracy for its use as a calibration tool. RESULTS: There was a mean difference of less than 0.1 mm between the measured size of the marker and actual size (20 mm), with a range of 1.9 mm. CONCLUSION: This is a cost-effective, accurate and repeatable method of calibrating the size of digital radiographs. <![CDATA[<b>Is there a role for prolonged post-operative antibiotic use in primary total hip arthroplasty in the African setting?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2013000500007&lng=pt&nrm=iso&tlng=pt INTRODUCTION: The use of prophylactic antibiotics to reduce the risk of surgical site infection (SSI) is recommended for up to 24 hours post-operatively. Surgeons in Africa have been using antibiotics for prolonged periods of time because of perceived higher infection rates. We conducted a study to determine the incidence of early post-operative SSI and to determine if the use of antibiotics beyond 24 hours post-operatively resulted in any difference in this incidence after primary total hip arthroplasties. METHODS: A retrospective cohort study was conducted of all primary total hip arthroplasties done from 1998 to 2011. Patients had a prophylactic administered 30-60 minutes prior to surgical incision and the post-operative antibiotic regime was surgeon-dependent. The study was approved by the hospital Ethics Committee. RESULTS: The overall incidence of post-operative SSI was 1.5%. The duration of prophylactic antibiotic use among patients who were not treated for an SSI averaged 3.39 days (SD 7.496) and ranged from 0 to 65 days. There was no statistical difference in the incidence of post-operative SSI in patients who received prophylactic antibiotics for up to 24 hours (1.4%) and in patients who received antibiotics for longer than 24 hours (2%) (p=0.706). CONCLUSION: The risk of post-operative SSI after total hip arthroplasties is low. There is no evidence to support the use of prophylactic antibiotics for longer than 24 hours even in the African setting. <![CDATA[<b>Focal full thickness articular cartilage lesions treated with an articular resurfacing prosthesis in the middle-aged</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2013000500008&lng=pt&nrm=iso&tlng=pt INTRODUCTION: Localised full thickness articular defects of the knee are common and disabling in the middle-aged. There are numerous treatment options for articular defects, the results of which are unpredictable in this age group. The purpose of this study was to evaluate a focal articular resurfacing prosthesis used in the treatment of these defects. METHODS: A consecutive series of patients treated between 2005 and 2010 with a HemiCAP® resurfacing procedure were retrospectively reviewed. Follow-up scores of the KOOS, IKDC, SF-36 and patient satisfaction were obtained. Radiographic evaluation was also obtained. RESULTS: Twenty-two patients met the inclusion criteria. Nineteen patients were followed-up 4.7 ± 5.9 years after surgery. Three patients had revision surgery and were not followed up. The patients were 44.7 ± 5.9 years old. The follow-up KOOS scores demonstrated comparable scores on the pain and activities of daily living sub-scales when compared to normative data; however, the sports (P<0.001) and quality of life (P=0.001) sub-scales scores were lower in the HemiCAP® patients when compared to normative data. Only the physical functioning sub-scale score of the SF-36, and not the other seven sub-scale scores, was lower (P=0.016) in the HemiCAP® patients when compared to normative data. General patient satisfaction revealed that 79% considered their result as very good or excellent. CONCLUSION: HemiCAP® articular resurfacing is an effective treatment option for pain in the middle-aged patient with a focal articular cartilage defect in the knee. <![CDATA[<b>Synovial haemangioma as a cause for atraumatic haemarthrosis of the knee - a case report</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2013000500009&lng=pt&nrm=iso&tlng=pt An adult patient presented with repeated episodes of haemarthrosis of the knee. No trauma history could be elicited. An arthroscopy of his knee was performed and a lesion identified. Histologic examination showed it to be a synovial haemangioma (capillary type). <![CDATA[<b>Open tibial bone transport following a failed bi-Masquelet procedure -a case report</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2013000500010&lng=pt&nrm=iso&tlng=pt Large bone defects are challenging to reconstruct and require specialised techniques, multiple surgeries, and long treatment periods. When these bony defects are associated with large soft tissue defects, it complicates the management further, necessitating soft tissue reconstruction in the form of local or free flaps. We report a case of a 25-year-old male, where a failed bi-Masquelet procedure resulted in a large bone and soft tissue defect of the tibia. Local or free flap reconstruction was not possible due to the extensive scarring and lack of vascular donor vessels. Open bone transport, using distraction histogenesis, was successful in reconstructing both the bone and soft tissue defects. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2013000500011&lng=pt&nrm=iso&tlng=pt