Scielo RSS <![CDATA[SA Orthopaedic Journal]]> http://www.scielo.org.za/rss.php?pid=1681-150X20080003&lang=es vol. 7 num. 3 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Message from the President</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000300001&lng=es&nrm=iso&tlng=es <![CDATA[<b>Editorial</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000300002&lng=es&nrm=iso&tlng=es <![CDATA[<b>Open reduction and internal fixation of scapula fractures</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000300003&lng=es&nrm=iso&tlng=es Scapular fractures requiring surgery are relatively rare injuries. This retrospective review looks at the outcome of open reduction and internal fixation of these fractures and the surgical exposures necessary for their fixation. All surgically treated scapular fractures from January 2000 to December 2006, with the exception of Ideberg type Ia (anterior rim) fractures of less than 25% with an associated dislocation, had their clinical notes and radiology reviewed. The surgical approach was analysed with regard to the fracture classification and exposure. Reduction, union and failure of fixation were assessed. Outcomes were determined with respect to pain and range of movement. At an average follow-up of 9 months (range 6 to 72 months), all of the fractures had united. Twenty out of the 25 patients were pain-free (80%) and the rest only had mild pain. Twenty-two patients (88%) had a good or functional range of movement. Adequate reduction was obtained in all but one fracture. A good outcome can be expected in over 80% of scapular fractures requiring surgical fixation. Union is predictable and the complication rate is low. Most of the fractures can be addressed by employing teres minor/infra-spinatus intermuscular planes or subscapularis muscle splits without rotator cuff tenotomies. <![CDATA[<b>Surgery for displaced three- and four-part proximal humeral fractures: The rationale for our approach</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000300004&lng=es&nrm=iso&tlng=es There are a multitude of different surgical techniques described, practised and reported to have similar outcomes for displaced proximal humeral fractures. This paper reviews the outcomes of these techniques and the reason for using the different options; it also reviews the factors which affect outcomes. It will outline our decision-making process to justify the management of these fractures at the University of Cape Town. <![CDATA[<b>Clinical outcomes after arthroscopic rotator cuff repair</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000300005&lng=es&nrm=iso&tlng=es BACKGROUND: Despite the fact that a few studies have reported good results following arthroscopic rotator cuff repair, other studies have raised concern regarding the biomechanical strength and integrity of arthroscopic rotator cuff repair. The purpose of this study was to independently evaluate the clinical results after arthroscopic rotator cuff repair. METHODS: We performed an independent retrospective review of 42 consecutive patients who underwent arthroscopic decompression and rotator cuff repair between 01 October 2002 and 30 November 2006. Indications for surgery were pain and decreased shoulder function that did not respond to conservative treatment. Complete data were available for a minimum of 12 months postoperatively. The patients were evaluated both pre-operatively and at follow-up using a Visual Analogue Pain Score (VAS), the American Shoulder and Elbow Surgeon's (ASES) Outcome Score and clinical examination. Their ranges of motion as well as muscle strength were evaluated. RESULTS: The ASES and VAS scores, range of motion and muscle strength were significantly improved after arthroscopic rotator cuff repair. CONCLUSION: Arthroscopic rotator cuff repair can reliably improve both shoulder pain and function, regardless of tear size. Future arthroscopic results may be improved with a double row suture technique and improved instrumentation and anchors. We are engaged in a follow-up study to ultrasonically evaluate the structural integrity of the arthroscopic rotator cuff repairs at a minimum of one year post-surgery. <![CDATA[<b>Treatment of lunate and perilunate dislocations with a combined approach and anchor repair of the dorsal scapholunate interosseous ligament</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000300006&lng=es&nrm=iso&tlng=es AIM: To determine the outcome of patients with isolated lunate and perilunate dislocations treated with a combined approach and anchor repair of the dorsal scapholunate interosseous ligament. METHODS: A combined volar and dorsal approach with anchor repair of the dorsal scapholunate interosseous ligament was used to treat six patients with isolated lunate or perilunate dislocations. Patients were assessed using the Disabilities of the Arm, Shoulder and Hand Score (DASH) and Mayo Wrist Score; and radiolog- ically using the scapholunate angle, radiolunate angle and the scapholunate gap at final follow-up. RESULTS: The mean time to surgery was 13.5 days. The mean time to final follow-up was 28.5 months. At final follow-up, the mean Mayo wrist score was 78.3. The mean DASH score was 13.7. The mean range of motion was 51° extension, 58° flexion, 11° radial deviation, 24° ulna deviation, 75° pronation and 78° supination. The mean grip strength was 31.9 kg which represented 73.9% of the contralateral grip strength. The mean scapholunate angle was 48°, the mean radiolunate angle was 9° and the mean scapholunate gap was 2 mm. CONCLUSIONS: Vigilance with early diagnosis and appropriate treatment using this surgical technique results in good functional and radiological results for ligamentous lunate dislocations. <![CDATA[<b>The incidence of asymptomatic Kienböck's disease</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000300007&lng=es&nrm=iso&tlng=es The aim of the study was to determine the incidence of asymptomatic Kienböck's disease in patients who attended the Dr George Mukhari Hospital (formerly: Ga-Rankuwa Hospital), and to determine the relevance of ulnar variance on the disease. This was a retrospective study. In a 12-month period we reviewed postero-anterior X-rays of 1 287 patients seen at our radiology department, with complaints unrelated to the upper limb including the wrist and hand. We identified 23 cases (1.87%) of asymptomatic Kienböck's disease. The majority (63%) were male with an average age of 49 years, and 37% were female with an average age of 46.5 years. All were unilateral and all were in the dominant hand. Thirteen cases (57%) had an ulna neutral wrist and the remaining ten (43%) had an ulnar negative variance. The vast majority (83%) were unemployed. From the results of our study we could deduct with reasonable confidence that at least a 1.87% incidence of asymptomatic stage II, III and IV Kienböck's disease is present in the black African population. Analysis of the data shed no further light on the aetiology. The relevance of ulnar variance as an aetiological factor is seriously questioned. <![CDATA[<b>An approach to the assessment of cavus deformity</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000300008&lng=es&nrm=iso&tlng=es The aim of the study was to determine the incidence of asymptomatic Kienböck's disease in patients who attended the Dr George Mukhari Hospital (formerly: Ga-Rankuwa Hospital), and to determine the relevance of ulnar variance on the disease. This was a retrospective study. In a 12-month period we reviewed postero-anterior X-rays of 1 287 patients seen at our radiology department, with complaints unrelated to the upper limb including the wrist and hand. We identified 23 cases (1.87%) of asymptomatic Kienböck's disease. The majority (63%) were male with an average age of 49 years, and 37% were female with an average age of 46.5 years. All were unilateral and all were in the dominant hand. Thirteen cases (57%) had an ulna neutral wrist and the remaining ten (43%) had an ulnar negative variance. The vast majority (83%) were unemployed. From the results of our study we could deduct with reasonable confidence that at least a 1.87% incidence of asymptomatic stage II, III and IV Kienböck's disease is present in the black African population. Analysis of the data shed no further light on the aetiology. The relevance of ulnar variance as an aetiological factor is seriously questioned. <![CDATA[<b>The MIRA prosthesis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000300009&lng=es&nrm=iso&tlng=es Osteoarthritis of digital joints, e.g. proximal interphalangeal joints and metacarpophalangeal joints, may need surgical intervention if conservative management has failed to control function loss and/or pain. The ideal arthroplasty prosthesis should cause minimal loss of bony tissue, should have a high level of congruency, a low degree of constraint and not be technically demanding. The MIRA prosthesis replaces only the damaged osteoarthritic tissue, is biomechanically sound and respects the all important investing and stabilising capsule-ligamentous and musculo-tendinous structures. <![CDATA[<b><i>The Hand Book - A practical approach to common hand problems.</i></b><b> Third Edition Editors: U Mennen and C van Velze</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000300010&lng=es&nrm=iso&tlng=es Osteoarthritis of digital joints, e.g. proximal interphalangeal joints and metacarpophalangeal joints, may need surgical intervention if conservative management has failed to control function loss and/or pain. The ideal arthroplasty prosthesis should cause minimal loss of bony tissue, should have a high level of congruency, a low degree of constraint and not be technically demanding. The MIRA prosthesis replaces only the damaged osteoarthritic tissue, is biomechanically sound and respects the all important investing and stabilising capsule-ligamentous and musculo-tendinous structures. <![CDATA[<b>Know the boundaries within your scope of practice</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000300011&lng=es&nrm=iso&tlng=es Osteoarthritis of digital joints, e.g. proximal interphalangeal joints and metacarpophalangeal joints, may need surgical intervention if conservative management has failed to control function loss and/or pain. The ideal arthroplasty prosthesis should cause minimal loss of bony tissue, should have a high level of congruency, a low degree of constraint and not be technically demanding. The MIRA prosthesis replaces only the damaged osteoarthritic tissue, is biomechanically sound and respects the all important investing and stabilising capsule-ligamentous and musculo-tendinous structures. <![CDATA[<b>Hydatid disease of bone</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000300012&lng=es&nrm=iso&tlng=es Osteoarthritis of digital joints, e.g. proximal interphalangeal joints and metacarpophalangeal joints, may need surgical intervention if conservative management has failed to control function loss and/or pain. The ideal arthroplasty prosthesis should cause minimal loss of bony tissue, should have a high level of congruency, a low degree of constraint and not be technically demanding. The MIRA prosthesis replaces only the damaged osteoarthritic tissue, is biomechanically sound and respects the all important investing and stabilising capsule-ligamentous and musculo-tendinous structures. <![CDATA[<b>A rare case of myositis ossificans and Guillain-Barré syndrome</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000300013&lng=es&nrm=iso&tlng=es Myositis ossificans is a common condition following trauma to muscles in and around bone and major joints. Myositis ossificans which occurs spontaneously, has also been well described where the aetiology is unknown or where it is hypothesised that repetitive trivial trauma is the cause. Although myositis ossificans has been associated with neurological complications following head injuries and spinal injuries, it has never been associated with patients diagnosed with Guillain-Barré syndrome. A case report is presented where a patient who had an acute onset of Guillain-Barré syndrome developed myositis ossificans in multiple areas around the major joints while still on a ventilator in the intensive care unit. <![CDATA[<b>Trapezoid dislocation</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000300014&lng=es&nrm=iso&tlng=es Myositis ossificans is a common condition following trauma to muscles in and around bone and major joints. Myositis ossificans which occurs spontaneously, has also been well described where the aetiology is unknown or where it is hypothesised that repetitive trivial trauma is the cause. Although myositis ossificans has been associated with neurological complications following head injuries and spinal injuries, it has never been associated with patients diagnosed with Guillain-Barré syndrome. A case report is presented where a patient who had an acute onset of Guillain-Barré syndrome developed myositis ossificans in multiple areas around the major joints while still on a ventilator in the intensive care unit. <![CDATA[<b>Expert Opinion on Published Articles</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000300015&lng=es&nrm=iso&tlng=es Myositis ossificans is a common condition following trauma to muscles in and around bone and major joints. Myositis ossificans which occurs spontaneously, has also been well described where the aetiology is unknown or where it is hypothesised that repetitive trivial trauma is the cause. Although myositis ossificans has been associated with neurological complications following head injuries and spinal injuries, it has never been associated with patients diagnosed with Guillain-Barré syndrome. A case report is presented where a patient who had an acute onset of Guillain-Barré syndrome developed myositis ossificans in multiple areas around the major joints while still on a ventilator in the intensive care unit. <![CDATA[<b>Clinical Tips</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2008000300016&lng=es&nrm=iso&tlng=es Myositis ossificans is a common condition following trauma to muscles in and around bone and major joints. Myositis ossificans which occurs spontaneously, has also been well described where the aetiology is unknown or where it is hypothesised that repetitive trivial trauma is the cause. Although myositis ossificans has been associated with neurological complications following head injuries and spinal injuries, it has never been associated with patients diagnosed with Guillain-Barré syndrome. A case report is presented where a patient who had an acute onset of Guillain-Barré syndrome developed myositis ossificans in multiple areas around the major joints while still on a ventilator in the intensive care unit.