Scielo RSS <![CDATA[SA Orthopaedic Journal]]> http://www.scielo.org.za/rss.php?pid=1681-150X20090001&lang=en vol. 8 num. 1 lang. en <![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=S1681-150X2009000100001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Editorial</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000100002&lng=en&nrm=iso&tlng=en <![CDATA[<b>Spinal hydatidosis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000100003&lng=en&nrm=iso&tlng=en <![CDATA[<b>Tuberculosis - the masquerader of bone lesions in children</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000100004&lng=en&nrm=iso&tlng=en Fifty-three children with histologically confirmed tuberculous osteomyelitis were treated between 1989 and 2007. The age ranged from 1-12 years. There were 65 osseous lesions (excluding spinal and synovial). Seven had multifocal bone involvement. Four basic types of lesions were seen: cystic (n=46), infiltrative (n=7), focal erosions (n=6) and spina ventosa (n=7). The majority of lesions were in the metaphyses (n=36); the remainder were in the diaphysis, epiphysis, short tubular bones, flat bones and small round bones. Bone lesions resembled chronic infections, simple and aneurysmal bone cysts, cartilaginous tumours, osteoid osteoma, haematological bone lesions and certain osteochondroses seen during the same period of study. Histological confirmation is mandatory to confirm the diagnosis of tuberculosis as several bone lesions can mimic tuberculous osteomyelitis. <![CDATA[<b>Transforaminal lumbar interbody fusion (TLIF): Assessment of clinical and radiological outcome</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000100005&lng=en&nrm=iso&tlng=en AIM: To assess the complications and outcome of patients who underwent transforaminal lumbar interbody fusion (TLIF) with an interbody cage. METHODS: Fifty-two consecutive patients were reviewed retrospectively. Clinical and radiological data were collected and analysed. Thirty-three female and 19 male patients underwent the procedure with a mean age of 45.7 years (12-76 years). Eight cases were revision surgery. The primary pathology was a lytic listhesis in 20 patients, degenerative disc disease in 17, adjacent segment disease following a previous fusion in eight, degenerative listhesis in four, a congenital abnormality (L5 hemivertebrae and segmentation failure L2-4) in two, and a neuromuscular scoliosis in one patient. The mean blood loss was 610 ml and mean operative time 170 minutes. Mean stay in ICU or high care was 1 day, and mean hospital stay was 7.8 days. All patients operated since 2005 were evaluated pre- and post-op using the following scoring systems: EQ 5D, Visual Analogue Scale (VAS), Roland Morris scale and Oswestry Disability Index (ODI). RESULTS: There were no intra-operative complications. One patient developed a cauda equina syndrome 48 hours postoperatively when he was mobilised. This resolved completely following evacuation of the haematoma. In one case there was instrumentation failure with a rod screw disarticulation which led to failure of the posterior construct. There were statistically significant improvements in all clinical scores except the EQ 5D. Fusion could be assessed in 47 patients. Anterior interbody fusion was achieved in 95.3% of cases and posterior lateral fusion was achieved in 83.7%. CONCLUSION: Transforaminal lumbar interbody fusion is a safe and effective option to achieve circumferential fusion. It is technically challenging and the surgeon needs to be proficient in the technique to avoid catastrophic complications. Clinical scoring confirmed that our patients did benefit significantly in terms of pain and overall health status. <![CDATA[<b>Treatment of syndesmoses disruptions: A prospective, randomized study comparing conventional screw fixation vs TightRope<sup>®</sup> fiber wire fixation - medium term results</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000100006&lng=en&nrm=iso&tlng=en BACKGROUND: Open reduction and screw fixation is the current standard treatment for displaced injuries of the ankle syndesmosis. Despite reduction and stable internal fixation, however, these injuries do not uniformly have excellent outcomes. In addition, screw fixation has potential disadvantages. MATERIALS AND METHODS: An ongoing prospective, randomized clinical trial comparing conventional screw fixation with TightRope® fiber wire fixation for syndesmosis injuries. The objective of this paper is also to provide an overview of the important anatomical and biomechanical issues relating to syndesmosis injuries. RESULTS: At medium term follow-up the TightRope® fiber wire fixation group had a statistically significant better range of motion compared to conventional screw fixation. The AOFAS ankle and hindfoot score did not show a significant difference between the two groups. <![CDATA[<b>Cubital tunnel syndrome: Simple decompression versus decompression and anterior subcutaneous transposition</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000100007&lng=en&nrm=iso&tlng=en BACKGROUND: The procedure of choice in the surgical treatment of cubital tunnel syndrome remains controversial. The aim of this study is to report the results of simple decompression and decompression with anterior subcutaneous transposition. METHODS: A retrospective review (July 2002-January 2007) using the Bishop Score to assess outcome. A total of 102 procedures (91 patients, 11 bilateral) were performed with a minimum of 9 months' post-operative follow-up. The procedure was selected intra-operatively. All cases were operated by the senior author (MC). RESULTS: In the simple decompression group (n=47, average age 45.9 years), the average Bishop Score was 11.3 (5-13) with an average time to recovery of 3.7 months (1-6). Good to excellent results were obtained in 94% and fair results in 6%. In the anterior transposition group (n=55, average age 43.3 years) the average Bishop Score was 10.6 (5-13) with average time to recovery of 4.2 months (1-6). Good to excellent results were obtained in 93% and fair results in 7%. Complications included subluxation of the ulnar nerve in two cases, one wound dehiscence and one post-operative haematoma. CONCLUSIONS: The outcome in both groups was the same. Recovery is often prolonged. It took 3-6 months for 69% of patients to recover. Younger patients recovered sooner and the transposition and elderly groups took longer to recover. Simple decompression is adequate unless the nerve is unstable or the bed unsuitable. <![CDATA[<b>Comparison between unilateral and bilateral hallux valgus corrective surgery with respect to pain/tolerance and cost effectiveness</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000100008&lng=en&nrm=iso&tlng=en BACKGROUND: Bilateral sequential (under one anaesthetic) hallux valgus surgery is considered by many to be too debilitating and uncomfortable to the patient in the short term post-operative period (up to 6 weeks), and should be staged. METHOD: This retrospective study evaluates tolerance to pain, comfort and activities of daily living during the first 6 weeks post-operatively, as well as cost effectiveness in patients who had unilateral compared to those who had bilateral sequential forefoot surgery (limited to hallux valgus corrective surgery with/without lesser toe surgery). A questionnaire on pain and function was used. The functional outcome was graded by the AOFAS clinical rating system and the correction assessed clinically and radiologically. RESULTS: The results for pain and patient tolerance/comfort profile over time, for the two groups did not differ significantly. Cost and time factors were shown to be more favourable ultimately, in the bilateral hallux valgus surgery group. Both the outcome score and clinical correction were comparable in the two groups. CONCLUSION: This study favours bilateral sequential hallux valgus correction (when indicated) without compromising the results, or patient comfort and function. <![CDATA[<b>Results of the McLaughlin procedure for chronic locked posterior dislocation of the shoulder</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000100009&lng=en&nrm=iso&tlng=en AIM: To determine the functional outcome of patients undergoing McLaughlin procedure for chronic locked posterior dislocation of the shoulder. METHODS: A retrospective review of six patients who underwent this procedure was carried out. There were four females and two males. Ages ranged from 27 years to 68 years (mean age of 46.5 years). The average time interval between injury and presentation was 26.5 weeks (range 3-65 weeks). These procedures were all performed by the senior author (AAA) between 2003 and 2007. Patients were followed up clinically and radiologically for an average of 10.1 months (range 6-24 months). Outcome was assessed in terms of function, pain and patient satisfaction with the help of the Constant and Murley score.¹ RESULTS: No complications were noted and no recurrences were seen. At the last follow up, the average Constant score achieved was 73.5 (range 60-93). The maximum is 100 points. DISCUSSION: A search of the literature resulted in a handful of articles dealing with chronic posterior dislocation of the shoulder. All of these were with very few patients and some of the articles presented results with more than one procedure. In our case series, the McLaughlin procedure proved to be useful in achieving a painless, stable shoulder with reasonable function. CONCLUSION: The McLaughlin procedure is a reliable operation and produces satisfactory results for chronic locked posterior dislocation of the shoulder. <![CDATA[<b>Post-exposure prophylaxis (PEP): A practical guide</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000100010&lng=en&nrm=iso&tlng=en AIM: To determine the functional outcome of patients undergoing McLaughlin procedure for chronic locked posterior dislocation of the shoulder. METHODS: A retrospective review of six patients who underwent this procedure was carried out. There were four females and two males. Ages ranged from 27 years to 68 years (mean age of 46.5 years). The average time interval between injury and presentation was 26.5 weeks (range 3-65 weeks). These procedures were all performed by the senior author (AAA) between 2003 and 2007. Patients were followed up clinically and radiologically for an average of 10.1 months (range 6-24 months). Outcome was assessed in terms of function, pain and patient satisfaction with the help of the Constant and Murley score.¹ RESULTS: No complications were noted and no recurrences were seen. At the last follow up, the average Constant score achieved was 73.5 (range 60-93). The maximum is 100 points. DISCUSSION: A search of the literature resulted in a handful of articles dealing with chronic posterior dislocation of the shoulder. All of these were with very few patients and some of the articles presented results with more than one procedure. In our case series, the McLaughlin procedure proved to be useful in achieving a painless, stable shoulder with reasonable function. CONCLUSION: The McLaughlin procedure is a reliable operation and produces satisfactory results for chronic locked posterior dislocation of the shoulder. <![CDATA[<b>An evaluation of the quality of orthopaedic trauma referrals to a regional hospital</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000100011&lng=en&nrm=iso&tlng=en BACKGROUND: The purpose of this prospective study was to assess patient referrals to a regional hospital with respect to communication, quality of referral letters, transfer times, investigations, diagnostic accuracy, initial management as well as associated and missed injuries. METHOD: All in all 88 patient referrals were assessed prospectively over four months by a single investigator utilising a questionnaire. RESULTS: The average age was 41 years. Eighteen of the injuries (20%) were compound fractures. The average transfer time of closed injuries was 10 hours and 8 minutes and for compound injuries it was 4 hours and 20 minutes. Twenty patients (23%) were not discussed prior to transfer. Referring doctor details were deficient regarding the name 10 (11%), contact details 58 (66%) and designation 82 (93%). No receiving physician was listed in 23 (26%) referrals. Deficiencies were noted in describing the mechanism of injury (58%), time of injury (47%), type of splinting (60%) and type of analgesia (12%). Referrals of compound fractures showed a description of wound care in 11 (61%) referrals, antibiotic therapy in 9 (50%) and tetanus prophylaxis in 3 (16%). A total of 53 (60%) referrals presented without haematological investigations and 84 (95%) presented with radiological investigations, of which 54 (64%) were inadequate. Diagnostic errors emerged in 16% of referrals with a missed injury rate of 10%. CONCLUSION: Supervision, training and regular assessment of junior doctors is essential to improve the quality of patient care by the referring hospitals. <![CDATA[<b>Part II: Metabolic bone disease: Recent developments in the pathogenesis of rickets, osteomalacia and age-related osteoporosis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000100012&lng=en&nrm=iso&tlng=en The term 'metabolic bone disease' encompasses an unrelated group of systemic conditions that impact on skeletal collagen and mineral metabolism. Their asymptomatic progression leads to advanced skeletal debilitation and late clinical manifestation. This article provides a brief overview of advances in the understanding of the pathogenesis of rickets, osteomalacia and age-related osteoporosis. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000100013&lng=en&nrm=iso&tlng=en The term 'metabolic bone disease' encompasses an unrelated group of systemic conditions that impact on skeletal collagen and mineral metabolism. Their asymptomatic progression leads to advanced skeletal debilitation and late clinical manifestation. This article provides a brief overview of advances in the understanding of the pathogenesis of rickets, osteomalacia and age-related osteoporosis.