Scielo RSS <![CDATA[SA Orthopaedic Journal]]> http://www.scielo.org.za/rss.php?pid=1681-150X20080002&lang=en vol. 7 num. 2 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>The ethics of research and publishing</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000200001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Editorial</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000200002&lng=en&nrm=iso&tlng=en <![CDATA[<b>Lumbar fusion - indications and surgical options</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000200003&lng=en&nrm=iso&tlng=en The sacrifice of motion to achieve spinal stability and pain relief has been practised since the early 20th century by means of iatrogenically induced ankylosis or fusion. Initially this was practised in the management of Pott's disease and indications have been expanded over the years to include trauma, deformity and degenerative conditions. In the last few decades there has been a proliferation of options as regards surgical technique and instrumentation. This often overwhelms the surgeon where more is perceived to be better, yet there is limited evidence that this is in fact so. <![CDATA[<b>An approach to failed lumbar surgery</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000200004&lng=en&nrm=iso&tlng=en With the rising rate of spinal surgery, the need to manage cases of failed operations is on the increase. A systematic approach is essential to identify the causes of persistent or recurrent symptoms, and the first step is a detailed and thorough history and examination. MRI is often the most valuable special investigation. Further surgery is only justified when clinical findings are consistent with significant radiological pathology which can be treated surgically with a probability of success and little risk. <![CDATA[<b>A philosophy and technique for reconstruction of the medial patellofemoral ligament</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000200005&lng=en&nrm=iso&tlng=en Our philosophy is to restore the patella to its original position and stability prior to dislocation and rupture of the medial patellofemoral ligament (MPFL). This approach is based on the established principle that "form follows function''. <![CDATA[<b>Can active conservative intervention limit lumbar-spinal surgery?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000200006&lng=en&nrm=iso&tlng=en The objective of this study was to ascertain the effectiveness of an inter-disciplinary, cognitive and exercise-based active treatment programme to reduce the incidence of lumbar-spinal surgery. Patients were treated using internationally validated treatment protocols. A total of 234 patients, already advised to undergo lumbar-spinal surgery, were treated conservatively from 2005 until 2007. After an initial 6 weeks of active treatment, patients were put on a maintenance programme. Nineteen patients required lumbar-spinal surgery. The authors concluded that an active, inter-disciplinary and cognitive exercise-based treatment programme limited lumbar-spinal surgery to 8% in a case-controlled cohort of patients who had already been advised to undergo surgery. <![CDATA[<b>Morel-Lavallée lesion: A review</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000200007&lng=en&nrm=iso&tlng=en Morel-Lavallée lesions are a relatively rare clinical problem, referring to closed degloving injuries around the pelvis or proximal femur, but have also been described in other areas of the body. The pathology involves a shearing of the hypodermis from the underlying fascia, with disruption of the perforating arteries and lymphatic plexus. In the early stages, there is predominantly accumulation of haematoma in the newly formed cavity, which is later reabsorbed and replaced by slow-leaking lymph. The diagnosis of an acute Morel-Lavallée lesion is clinical. The chronic Morel-Lavallée lesion, however, can pose diagnostic difficulties due to its resemblance to other soft tissue tumours. <![CDATA[<b>Lumbar spinal stenosis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000200008&lng=en&nrm=iso&tlng=en Lumbar spinal stenosis is diagnosed by the clinical picture of radiculopathy and / or spinal claudication caused by narrowing of the spinal canal. Anatomical and radiological features correlate poorly with the clinical features, and are of little prognostic value. The natural history is very benign with fluctuating levels and types of symptoms. Indications for surgery must be individualized, but decompression is effective in the short and medium term. Fusion is only indicated in the case of instability. <![CDATA[<b>Degenerative spondylolisthesis: Part of the normal ageing process</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000200009&lng=en&nrm=iso&tlng=en Degenerative spondylolisthesis is a condition that occurs in the middle decades of a person's life and mainly affects the L4 and L5 level, especially in women. A good history, a clinical examination, well-planned special investigations and a definite diagnosis are mandatory. Various risk factors have been identified. A thorough investigation, a definite diagnosis and adequate conservative management remain the gold standard for treatment. The majority of patients can be managed conservatively. Only about 10 to 15 per cent need surgery. Indications for surgery include severe mechanical backache with an unstable segment and radicular pain as well as progressive neurological deficit. Various forms of surgery and types of instrumentation are available, but the gold standard remains a posterior decompression, intertransverse fusion and pedicular instrumentation resulting in a solid intertransverse fusion. Other surgical modalities do exist, but they are associated with higher cost and morbidity. For some of these no long-term results are available. Conservative treatment and decompressive surgery, where correctly indicated, and a solid fusion can increase a patient's quality of life considerably. Informed consent must be obtained and the patient must be informed that degeneration is an ongoing process. The same condition may recur at a higher level, in which case the surgery must not be regarded as a failure. <![CDATA[<b>Letter to the editor</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000200010&lng=en&nrm=iso&tlng=en Degenerative spondylolisthesis is a condition that occurs in the middle decades of a person's life and mainly affects the L4 and L5 level, especially in women. A good history, a clinical examination, well-planned special investigations and a definite diagnosis are mandatory. Various risk factors have been identified. A thorough investigation, a definite diagnosis and adequate conservative management remain the gold standard for treatment. The majority of patients can be managed conservatively. Only about 10 to 15 per cent need surgery. Indications for surgery include severe mechanical backache with an unstable segment and radicular pain as well as progressive neurological deficit. Various forms of surgery and types of instrumentation are available, but the gold standard remains a posterior decompression, intertransverse fusion and pedicular instrumentation resulting in a solid intertransverse fusion. Other surgical modalities do exist, but they are associated with higher cost and morbidity. For some of these no long-term results are available. Conservative treatment and decompressive surgery, where correctly indicated, and a solid fusion can increase a patient's quality of life considerably. Informed consent must be obtained and the patient must be informed that degeneration is an ongoing process. The same condition may recur at a higher level, in which case the surgery must not be regarded as a failure. <![CDATA[<b>Expert Opinion on Published Articles</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000200011&lng=en&nrm=iso&tlng=en Degenerative spondylolisthesis is a condition that occurs in the middle decades of a person's life and mainly affects the L4 and L5 level, especially in women. A good history, a clinical examination, well-planned special investigations and a definite diagnosis are mandatory. Various risk factors have been identified. A thorough investigation, a definite diagnosis and adequate conservative management remain the gold standard for treatment. The majority of patients can be managed conservatively. Only about 10 to 15 per cent need surgery. Indications for surgery include severe mechanical backache with an unstable segment and radicular pain as well as progressive neurological deficit. Various forms of surgery and types of instrumentation are available, but the gold standard remains a posterior decompression, intertransverse fusion and pedicular instrumentation resulting in a solid intertransverse fusion. Other surgical modalities do exist, but they are associated with higher cost and morbidity. For some of these no long-term results are available. Conservative treatment and decompressive surgery, where correctly indicated, and a solid fusion can increase a patient's quality of life considerably. Informed consent must be obtained and the patient must be informed that degeneration is an ongoing process. The same condition may recur at a higher level, in which case the surgery must not be regarded as a failure. <![CDATA[<b>Personal Opinion or Clinical Tips</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000200012&lng=en&nrm=iso&tlng=en Degenerative spondylolisthesis is a condition that occurs in the middle decades of a person's life and mainly affects the L4 and L5 level, especially in women. A good history, a clinical examination, well-planned special investigations and a definite diagnosis are mandatory. Various risk factors have been identified. A thorough investigation, a definite diagnosis and adequate conservative management remain the gold standard for treatment. The majority of patients can be managed conservatively. Only about 10 to 15 per cent need surgery. Indications for surgery include severe mechanical backache with an unstable segment and radicular pain as well as progressive neurological deficit. Various forms of surgery and types of instrumentation are available, but the gold standard remains a posterior decompression, intertransverse fusion and pedicular instrumentation resulting in a solid intertransverse fusion. Other surgical modalities do exist, but they are associated with higher cost and morbidity. For some of these no long-term results are available. Conservative treatment and decompressive surgery, where correctly indicated, and a solid fusion can increase a patient's quality of life considerably. Informed consent must be obtained and the patient must be informed that degeneration is an ongoing process. The same condition may recur at a higher level, in which case the surgery must not be regarded as a failure.