Scielo RSS <![CDATA[SA Orthopaedic Journal]]> http://www.scielo.org.za/rss.php?pid=1681-150X20090003&lang=en vol. 8 num. 3 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Making a difference</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000300001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Editorial</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000300002&lng=en&nrm=iso&tlng=en <![CDATA[<b>Part III: Metabolic bone disease: Recent developments in the pathogenesis of endocrine-, drug-, genetic-, renal-, HIV-, and malignancy-induced bone disease</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000300003&lng=en&nrm=iso&tlng=en A thorough understanding of the pathogenesis of bone changes is a prerequisite for the prevention and effective management of skeletal debilitation resulting from metabolic derangements. This article deals with recent developments in the pathogenesis of bone disease as a result of endocrine abnormalities, drugs, genetic and renal diseases, HIV and malignancy. <![CDATA[<b>Frozen shoulder: A review</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000300004&lng=en&nrm=iso&tlng=en A 'frozen shoulder' has often frustrated both orthopaedic surgeons and patients. A review of the literature has shown clear clinical and pathological stages of the disorder. No clear cause has yet been found for the idiopathic type of frozen shoulder. Management options and recent clinical results are discussed. It is clear, however, that research in the treatment of this condition is difficult and can result in misleading outcomes. <![CDATA[<b>The importance of the sagittal position of the arm in the measurement of external rotation of the adducted shoulder</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000300005&lng=en&nrm=iso&tlng=en The measurement of external rotation of the shoulder is commonly performed in two ways: with the arm adducted or with the arm abducted to 90°. This measurement forms an important part of the assessment of shoulder function. It has been shown that the observer reliability of external rotation measurement is poor.1-4 Following the observation that the range of external rotation of the shoulder with the arm adducted altered depending on the exact position of the arm in the sagittal plane, we conducted a study to quantify the effect of a small increment of forward flexion (15°) on the range of external rotation. External rotation of the shoulder was measured in 40 asymptomatic shoulders and 20 'frozen' shoulders with the arm in a vertical position and in 15° of forward flexion. The range of external rotation decreased significantly in forward flexion in both groups. External rotation decreased by an average of 16.9° in the asymptomatic group and 13.5° in the frozen shoulder group. This study has shown that the sagittal position of the arm has an effect on the range of external rotation of the adducted shoulder. This may account for some of the observer variation in its measurement and affect the scores of certain outcome measures. <![CDATA[<b>Optimising safety in the spine theatre</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000300006&lng=en&nrm=iso&tlng=en With the proliferation of spinal surgery, both in numbers of cases annually and variety of surgery, there has been an increase in complications and associated litigation. Fager reports that up to 40% of cases were non-defensible. A review of the published literature was performed to highlight some of the more common aspects in an effort to highlight them to the spine surgeon in an attempt to reduce their incidence and optimise safety in theatre. The following issues are discussed: Wrong level surgery Patient positioning Infection risk and rituals Neurophysiological monitoring Neuronavigation. <![CDATA[<b>Alignment in computer-navigated versus conventional total knee arthroplasty for valgus deformity</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000300007&lng=en&nrm=iso&tlng=en INTRODUCTION: Significant improvement has been reported in limb alignment and component orientation with computer-navigated total knee arthroplasty (TKA) especially in varus deformities. Literature is lacking regarding the radiographic results of navigated TKA in valgus knees. This study aims to analyse the radiographic results of navigated TKAs in valgus knees and compare them with results of our conventional technique. MATERIALS AND METHODS: We retrospectively analysed 120 primary TKAs done for valgus arthritic knees. Fifty-three computer-navigated TKAs (group N) were compared with a control group of 53 conventional TKAs (group C) for coronal and sagittal alignment of the femoral and tibial components on X-ray imaging at the end of two years after surgery. RESULTS: We found no significant difference in the postoperative coronal alignment of components between the two groups. The mean postoperative anatomic valgus angle in the group N was 5.48°±2.33° compared to 5.42° ±2.15° in group C (p=0.06). The percentage of outliers, from the acceptable range of 4° to 10° of anatomic tibiofemoral valgus, in group N was 13% (seven TKAs) compared to 17% (nine TKAs) in group C (p=0.78). Posterior femoral offset was restored more accurately in group N (p=0.047) compared to group C (p=0.68). A greater number of femoral components in group N (43%) was placed in extension relative to the distal femoral anatomic axis compared to group C (17%). CONCLUSION: Sequential soft-tissue release and computer navigation for valgus TKA gives excellent overall alignment with few outliers. The component alignment between the two groups seems to be no different except for the sagittal femoral component orientation. <![CDATA[<b>Simultaneous joint fusion and limb lengthening for knee deformities in children: A one-stage procedure The Kampala experience</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000300008&lng=en&nrm=iso&tlng=en BACKGROUND: Delay in the treatment of septic or tuberculous arthritis of the knee often results in a painful and stiff joint, mainly in a position of flexion. Often limb shortening is also present. A clinical study was undertaken to see what the long-term results of a one-stage procedure is, whereby an external fixator is used to achieve fusion of the knee and limb equalisation simultaneously by means of distraction of the callus at the arthrodesis site. METHOD: Seven children, with a mean age of 13.5 years at presentation, were included in this study. Four children had septic arthritis and three had tuberculosis. All children had the same procedure. The deformity was corrected and an Orthofix device applied. After seven days, distraction of the arthrodesis site was started and continued until the desired length was obtained. Screw replacement was necessary in five cases due to pin-track infection. RESULTS: A stable, painless, well-aligned limb was obtained in all the patients and they were able to walk unsupported. Complete correction of limb length discrepancy was obtained in five patients and partial correction in the remaining two cases. CONCLUSION: Knee arthrodesis is a suitable option for managing severe deformities in children and young adults as it results in a stable and painless limb and eliminates the use of walking aids. In cases where leg length discrepancy is also present, the fusion can be achieved simultaneously with the equalisation process. Our experience has shown that this is a worthwhile clinical procedure which can result in a marked improvement in the quality of the life of these children. <![CDATA[<b>Adult septic arthritis in a tertiary setting: A retrospective analysis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000300009&lng=en&nrm=iso&tlng=en PURPOSE OF THE STUDY: Septic arthritis (SA) constitutes an orthopaedic emergency as it can rapidly lead to progressive and irreversible joint destruction with loss of function. We aim to identify our microbiological spectrum and sensitivity profiles, and compare it to our empirical antimicrobial choice in the management of septic arthritis in the adult population. DESCRIPTION OF METHODS: A retrospective analysis was performed on patients admitted from June 2005 to March 2009. The study population consisted of all patients over the age of 14 years admitted for either arthrotomies or joint aspirations, yielding positive cultures of either joint fluid or pus swabs taken intra-operatively. A data analysis was also done on serum CRP and WCC on all the patients. SUMMARY OF RESULTS: Gram-positive organisms were cultured in only 53% of isolates, and Staphylococcus aureus accounted for only 25% of all isolates. Of all the Gram-positive organisms, 38% were multi-drug resistant, only sensitive to vancomycin. Gram-negative organisms constituted 36% of isolates, showing resistance in 55%. The remainder of isolates consisted of anaerobic organisms. CONCLUSION: Gram-negative and resistant strains are becoming more important as an aetiological agent in adult septic arthritis. The current use of cloxacillin as empiric antibiotic therapy only covers 32% of all isolates in our setting. Based on these findings, use of co-amoxyclav as empiric antibiotic will increase the cover to 46%. The emergence of resistant strains remains a challenge, as evidenced by this study. Patients not responding to initial empiric therapy should be considered for early use of extended spectrum antimicrobials. <![CDATA[<b>Meniscus injuries: Where do we stand?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000300010&lng=en&nrm=iso&tlng=en The role of the meniscus in the knee has previously been grossly underestimated. The last 25 years have produced an enormous amount of research that highlights the importance of the meniscus to the function of the knee. The primary role of the meniscus is load bearing in order to decrease the forces on the articular surface of the femur and tibia. However, the meniscus also functions as a secondary stabiliser of the knee, providing joint lubrication and shock absorption. The meniscus is also well supplied with nerve endings which explains the pain associated with meniscal injury and the role of the meniscus in proprioception. The management of meniscal injuries has evolved from open total meniscectomy to arthroscopic partial meniscectomy, meniscal repair, meniscal transplant and attempts at meniscal culture. This review provides an update on the literature and the current management options for meniscal injuries. <![CDATA[<b>Osteosarcoma: Pathology, staging and management</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000300011&lng=en&nrm=iso&tlng=en The role of the meniscus in the knee has previously been grossly underestimated. The last 25 years have produced an enormous amount of research that highlights the importance of the meniscus to the function of the knee. The primary role of the meniscus is load bearing in order to decrease the forces on the articular surface of the femur and tibia. However, the meniscus also functions as a secondary stabiliser of the knee, providing joint lubrication and shock absorption. The meniscus is also well supplied with nerve endings which explains the pain associated with meniscal injury and the role of the meniscus in proprioception. The management of meniscal injuries has evolved from open total meniscectomy to arthroscopic partial meniscectomy, meniscal repair, meniscal transplant and attempts at meniscal culture. This review provides an update on the literature and the current management options for meniscal injuries. <![CDATA[<b>Intraneural bleeding of the ulnar nerve in a haemophilic patient: Case report and guide to orthopaedic management</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000300012&lng=en&nrm=iso&tlng=en More than 90% of bleeding episodes in patients with haemophilia occur in the musculoskeletal system, of which most episodes occur in the joints. Haematoma formation in muscles, with the development of pseudotumours, may compromise neurovascular structures. The incidence of chronic compressive peripheral neuropathies due to extrinsic causes is low. Acute nerve compression due to intraneural bleeding in patients with haemophilia is a rare entity. We report on acute ulnar nerve compression due to intraneural bleeding, accompanied by median nerve symptoms and present a practical guide to the orthopaedic management of these patients. <![CDATA[<b>Proximal humeral allograft in a trauma setting</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000300013&lng=en&nrm=iso&tlng=en Proximal humeral allografts are usually reserved for reconstruction of the shoulder in a neoplastic setting. To our knowledge it has never been described for use in a trauma setting. In this case report, we present a 30-year-old man involved in a motor vehicle accident (MVA) in 2007. He is right-hand dominant and employed as a driver. He presented initially to a peripheral hospital, and he sustained what seems to be a right floating shoulder injury with clavicle, scapula and proximal humeral fractures. He was operated there and underwent excision of the proximal humerus. Subsequently he presented to us and a staged procedure was performed. Initially, the clavicle was plated and, six weeks later, he underwent reconstruction with a proximal humeral allograft. All rotator cuff muscles were re-attached and the allograft was secured with cement and an intramedullary nail. We present his pre-op and post-op pictures as well as the function achieved. We also present a brief review of the literature. <![CDATA[<b>Migration of a Kirschner wire from the wrist to the cubital fossa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000300014&lng=en&nrm=iso&tlng=en A patient presented with a distal radius and ulna fracture which was treated with closed reduction and Kirschner wires. The patient presented after an extended time period with elbow pain and associated loss of function. Examination revealed that the Kirschner wires migrated to his cubital fossa. Removal of the Kirschner wire resulted in complete functional recovery. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2009000300015&lng=en&nrm=iso&tlng=en A patient presented with a distal radius and ulna fracture which was treated with closed reduction and Kirschner wires. The patient presented after an extended time period with elbow pain and associated loss of function. Examination revealed that the Kirschner wires migrated to his cubital fossa. Removal of the Kirschner wire resulted in complete functional recovery.