Scielo RSS <![CDATA[SA Orthopaedic Journal]]> http://www.scielo.org.za/rss.php?pid=1681-150X20090002&lang=es vol. 8 num. 2 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=S1681-150X2009000200001&lng=es&nrm=iso&tlng=es <![CDATA[<b>Tribute to Gordon Mthuthuzeli Siboto </b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000200002&lng=es&nrm=iso&tlng=es <![CDATA[<b>Indomethacin and heterotopic ossification in acetabular fractures: A prospective cohort study of the effect indomethacin has on the incidence and severity of heterotopic ossification</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000200003&lng=es&nrm=iso&tlng=es Heterotopic ossification (HO) that complicates acetabular fractures is initiated at the time of injury.19 We hypothesised that indomethacin medication commenced prior to surgery and within the first week following injury would be more effective than post-operative use alone. Over a four-year period 184 consecutive patients with significantly displaced acetabular fractures scheduled for acetabular reconstructive surgery were included in the study. Fifty-seven patients received indomethacin post-operatively only (Group 1), 95 pre- and post-operatively (Group 2), and 19 received no treatment for various reasons including intolerance of NSAIDs(Group 3). Three patients died and ten were lost to follow-up. Standard AP radiographs were reviewed at 2 weeks, 6 weeks, 3 months, 6 months and 12 months post-op and were grading as per Brooker on the 3-month follow-up radiograph. The mean Brooker values for Group 1 = 0.70; Group 2 = 0.33; Group 3 = 1.57. A statistical analysis of the p-values for Group 1 compared to Group 2 = 0.04; Group 1 to Group 3 = 0.002; Group 2 to Group 3 = 0.000006. Associated injury was the only parameter that correlated with increasing heterotopic ossification, while age, sex, approach and fracture type had no influence. This study confirms that indomethacin reduces the incidence and severity of HO in acetabular fracture surgery and is more effective if started pre-operatively. <![CDATA[<b>Posterior fracture dislocation of the hip joint in motor vehicle occupants</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000200004&lng=es&nrm=iso&tlng=es Between July 1994 and January 2000 one hundred and ten posterior fracture dislocations in 109 patients presenting to Groote Schuur Hospital required open reduction and internal fixation. Motor vehicle accidents accounted for 88 (80%) of the injuries equally divided between drivers and passengers. Eighty-one per cent of comminuted grade III injuries occurred on the right side. Of these, 71.5% occurred in vehicle drivers. Only 48% of the simple fractures were right-sided and 64% occurred in passengers. We concluded that the driver of a motor vehicle is more likely to sustain a right-sided fracture dislocation which is of greater severity than other occupants. These findings should alert the motor industry to take steps to minimise this injury. <![CDATA[<b>Posterior acetabular wall fracture fixation with a one-third tubular plate</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000200005&lng=es&nrm=iso&tlng=es We reviewed the records of 222 patients treated for posterior wall acetabular fractures from 1994 to 2006 at our institution. In 71 of these patients a 3.5 mm one-third tubular, small fragment plate was used instead of a reconstruction plate. The patients were followed up for an average of 17 months clinically and with radiographs. All fractures united. There were only two cases of hardware failure; in one a screw broke with no loss of reduction, and in the other the plate broke in a case with an associated posterior column fracture. The one-third tubular plate is quick and easy to apply to the posterior wall. It can be secured, providing a strong tension buttress that maintains reduction. We recommend this plate as the implant of choice for internal fixation of isolated posterior wall acetabular fractures that do not involve the posterior column. If the posterior column is involved a reconstruction plate must be added. <![CDATA[<b>Diagnosis and treatment of osteochondral defects of the ankle</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000200006&lng=es&nrm=iso&tlng=es An osteochondral defect of the talus is a lesion involving talar articular cartilage and subchondral bone. It is frequently caused by a traumatic event. The lesions may either heal, stabilise or progress to subchondral bone cysts. The subchondral cysts may develop due to the forcing of cartilaginous or synovial fluid with every step. Malalignment of the hindfoot plays an important role in the development of further degeneration. Plain radiographs may disclose the lesion. Modern imaging technology has enhanced the ability to fully evaluate and accurately determine the size and extent of the lesion, which are fundamental for proper treatment. Asymptomatic or low-symptomatic lesions are treated nonoperatively. For surgical treatment the following types of surgery are in clinical use: debridement and bone marrow stimulation, retrograde drilling, internal fixation, cancellous bone grafting, osteochondral autograft transfer, autologous chondrocyte implantation, and allograft transplantation. Although these are often successful, malalignment may persist with these treatment options. Calcaneal correction osteotomy may be suitable for osteochondral defects in select cases. <![CDATA[<b>Ankle arthroscopy: Indications, techniques and complications</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000200007&lng=es&nrm=iso&tlng=es Ankle arthroscopy is increasingly used as a technique for dealing with a wide range of ankle pathologies. Technological advancement and a more thorough understanding of the anatomy have resulted in improved ability to perform ankle arthroscopy. Arthroscopic surgery offers the advantages related to any minimally invasive procedure, such as fewer wound infections, less blood loss, smaller incisions and less morbidity. This article defines the major indications of arthroscopy and presents current techniques. <![CDATA[<b>Surgical management of cervical tuberculosis: Review of 18 patients</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000200008&lng=es&nrm=iso&tlng=es AIM: To review our experience and results of surgically managed cervical TB spondylitis. MATERIAL AND METHODS: Eighteen consecutive cases of cervical TB spondylitis managed surgically by the senior author (RD) between 2001 and 2008 were identified. Of the 18, nine were males and nine females. The ages ranged from 2 to 59 years, with five patients younger than 10 years, and nine older than 10 and younger than 20 years of age. Case notes and imaging were retrospectively reviewed. Epidemiological data, surgical procedures and complications and neurological status were recorded both pre-operatively and at follow-up. The average follow-up was 12.5 months. X-rays and MRI were assessed in terms of degree of involvement of the disease and sagittal plane deformity, and both correction and maintenance thereof. RESULTS: The average length of history was 14 weeks and the most common presenting complaint was neck pain. Blood results showed a consistently raised ESR (average 72), with a normal average white cell count of 8.7. All patients with neurology recovered or improved, and the four non-walking patients became ambulant again. Histology provided the most sensitive results with 14 out of 15 biopsies clearly positive and one suggestive (chronic inflammation). The five children under age 10 all had positive Mantoux skin tests. All X-rays showed increased prevertebral soft tissue mass. Surgery was individualised to anterior, posterior, or both. CONCLUSION: Cervical tuberculosis can be safely and successfully managed surgically; however, these patients are a heterogeneous group and their treatments should be individualised. Anterior plating is effective in obtaining fusion but there is a risk of loss of correction especially for longer constructs. The use of low weight traction for deformity correction prior to surgery and Halo jackets post-operatively are useful management tools. <![CDATA[<b>Short-segment posterior instrumentation of thoracolumbar fractures as standalone treatment</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000200009&lng=es&nrm=iso&tlng=es This article reports on the radiographic outcome of unstable thoracolumbar fractures managed with short segment posterior instrumentation as standalone treatment. Short segment posterior instrumentation is the method of choice for unstable thoracolumbar injuries in our unit. It is considered to be adequate treatment in cases with an intact posterior longitudinal ligament, and Gaines score below 7; as well as fracture dislocations, and seatbelt-type injuries, without loss of bone column bearing integrity. Sixty-five consecutive patients undergoing this surgery were studied. Patients were divided into two main cohorts, namely the 'Fracture group' (n=40) consisting of unstable burst fractures and unstable compression fractures; and the 'Dislocation group' (n=25) consisting of fracture dislocations and seatbelt-type injuries. The groups reflect similar goals in surgical treatment for the grouped injuries, with reduction in loss of sagittal profile and maintenance thereof being the main aim in the fracture group, appropriately treated with Schantz pin constructs; and maintenance in position only in the dislocation group, treated with pedicle screw constructs. Data were reviewed in terms of complications, correction of deformity, and subsequent loss of correction with associated instrumentation failure. Secondly, factors influencing the aforementioned were sought, and stratified in terms of relevance. Average follow-up was 278 days for the fracture group and 177 days for the dislocation group. There was an average correction in kyphotic deformity of 10.25 degrees. Subsequent loss in sagittal profile averaged 2 degrees (injured level) and 5 degrees (thoracolumbar region) for the combined fracture and dislocation group. The only factor showing a superior trend in loss of reduction achieved was the absence of bone graft (when non-fusion technique was employed). Instrumentation complications occurred in two cases (bent connection rod, and 10 degrees loss in regional sagittal profile following 2 degrees of reduction respectively). These complications represent 3.07% hardware failure in total. CONCLUSION: Short segment posterior instrumentation is a safe and effective option in the treatment of unstable thoracolumbar fractures as a standalone measure. <![CDATA[<b>Management of septic non-unions</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000200010&lng=es&nrm=iso&tlng=es The treatment of septic non-unions is a complex problem with high morbidity and prolonged and costly treatment with significant psycho-social implications. Good communication with the patient and individualised treatment objectives are therefore essential. With appropriate treatment and complete elimination of infection a good to excellent outcome can be expected. This article outlines the current thoughts and recommendations for the management of septic non-union. <![CDATA[<b>Acute dislocations of the knee</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000200011&lng=es&nrm=iso&tlng=es Acute dislocation of the knee is an uncommon but devastating injury. A high level of suspicion is needed in diagnosing it. Repeated neurovascular examinations are extremely important and even though it is wiser in our setting to do a routine angiogram, this is not a substitute for and does not exempt the patient from receiving a full neurovascular assessment. Outcome is better when the knees are treated surgically - immediately if there is vascular compromise, with the remainder being treated before two weeks as soon as the soft tissues allow. Anatomical restitution of the injured structures is the surgical goal. Avoidance of chronic persistent posterior subluxation and a controlled rehabilitation programme will yield best results. <![CDATA[<b>Fracture fixation in HIV-positive patients: A literature review</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000200012&lng=es&nrm=iso&tlng=es Acute dislocation of the knee is an uncommon but devastating injury. A high level of suspicion is needed in diagnosing it. Repeated neurovascular examinations are extremely important and even though it is wiser in our setting to do a routine angiogram, this is not a substitute for and does not exempt the patient from receiving a full neurovascular assessment. Outcome is better when the knees are treated surgically - immediately if there is vascular compromise, with the remainder being treated before two weeks as soon as the soft tissues allow. Anatomical restitution of the injured structures is the surgical goal. Avoidance of chronic persistent posterior subluxation and a controlled rehabilitation programme will yield best results. <![CDATA[<b>Actinomycosis of the calcaneus - a case report</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000200013&lng=es&nrm=iso&tlng=es Acute dislocation of the knee is an uncommon but devastating injury. A high level of suspicion is needed in diagnosing it. Repeated neurovascular examinations are extremely important and even though it is wiser in our setting to do a routine angiogram, this is not a substitute for and does not exempt the patient from receiving a full neurovascular assessment. Outcome is better when the knees are treated surgically - immediately if there is vascular compromise, with the remainder being treated before two weeks as soon as the soft tissues allow. Anatomical restitution of the injured structures is the surgical goal. Avoidance of chronic persistent posterior subluxation and a controlled rehabilitation programme will yield best results. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000200014&lng=es&nrm=iso&tlng=es Acute dislocation of the knee is an uncommon but devastating injury. A high level of suspicion is needed in diagnosing it. Repeated neurovascular examinations are extremely important and even though it is wiser in our setting to do a routine angiogram, this is not a substitute for and does not exempt the patient from receiving a full neurovascular assessment. Outcome is better when the knees are treated surgically - immediately if there is vascular compromise, with the remainder being treated before two weeks as soon as the soft tissues allow. Anatomical restitution of the injured structures is the surgical goal. Avoidance of chronic persistent posterior subluxation and a controlled rehabilitation programme will yield best results.