Scielo RSS <![CDATA[SA Orthopaedic Journal]]> http://www.scielo.org.za/rss.php?pid=1681-150X20100003&lang=en vol. 9 num. 3 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300001&lng=en&nrm=iso&tlng=en <![CDATA[<b>National Health Insurance in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300002&lng=en&nrm=iso&tlng=en <![CDATA[<b>National Health Insurance in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300003&lng=en&nrm=iso&tlng=en http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300004&lng=en&nrm=iso&tlng=en <![CDATA[<b>Tuberculosis of the sternum in patients with infective spondylitis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300005&lng=en&nrm=iso&tlng=en OBJECTIVE: Tuberculous osteomyelitis of the sternum is rare. With the increased incidence of HIV seropositivity, atypical musculoskeletal manifestations of tuberculosis (TB) are becoming more common. The aim of this study was to review the clinical presentation, diagnosis, treatment and outcome of patients presenting with tuberculous involvement of the sternum. METHODS: A retrospective chart review was performed on all patients with tuberculous involvement of the sternum, with specific reference to: age, gender, clinical presentation, HIV status, CD4 count, antiretroviral treatment, co-morbidities, diagnosis, management and outcomes. RESULTS: Fourteen patients with sternal TB were reviewed at King George V Hospital from May 2006 to June 2008. The average age was 17.5 years. All 14 cases had infective spondylitis with associated sternal involvement. There were no cases of primary sternal TB. There were three cases of delayed diagnosis that presented with severe spinal and anterior chest wall deformities. The diagnosis was suspected clinically in seven patients and an incidental finding in the remaining seven. Sternal lesions on lateral radiographs were only picked up in two patients. MRI was diagnostic in all 14 patients. The disease was multifocal in all cases. Seven patients had multiple level, non-contiguous infective spondylitis. It was noted that all patients had a lesion in the dorsal spine. Six patients were HIV-positive, with average CD4 counts of 277 (110-696). None of the patients were on antiretroviral therapy prior to the diagnosis of sternal TB. The sternal component of the disease was managed non-operatively with antituberculous chemotherapy. Average follow-up was 14 months (3-22). All patients responded well to therapy. CONCLUSION: Atypical manifestations of TB are becoming increasingly prevalent. Due to increased awareness among clinicians and improved imaging techniques, the diagnosis of sternal TB is easier to make and treatment with antituberculous chemotherapy appears to be an effective management strategy. <![CDATA[<b>Spinal deformity in neurofibromatosis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300006&lng=en&nrm=iso&tlng=en Scoliosis is a common orthopaedic condition associated with neurofibromatosis (NF). The associated scoliosis can be severe and tortuous providing management challenges with frequently poor outcome. An awareness and earlier intervention may well improve this. We present 14 patients with NF seen in our spinal service from mid 2001 until 2008. Clinical presentation, curves and surgical management are reported. <![CDATA[<b>Known primary with secondary disease</b>: <b>is tissue diagnosis necessary?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300007&lng=en&nrm=iso&tlng=en Spinal metastasis as the presenting problem is frequently encountered in oncological practice. This scenario is often complicated by an unknown primary or a previously diagnosed primary some years before. Once identified, the primary is often more accessible than the spine metastasis in terms of biopsy. This raises the issue of whether the metastatic lesion's histology can be inferred from the previously known primary or in fact the current primary's histology. A case is reported which highlights the inherent risks of these assumptions. It identifies the need for adequate specimen when performing a biopsy. The limits of fine needle biopsy must be recognised. Involvement of the cervico-thoracic junction should be recognised as an unstable area with early aggressive surgical intervention necessary to stabilise and prevent deformity and associated neural compression. Finally, local metastatic tissue should always be sent for histological assessment. <![CDATA[<b>It is not always tuberculosis of the spine</b>: <b>ganglioneuroblastoma</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300008&lng=en&nrm=iso&tlng=en Tuberculosis has been said to be the great mimicker of our times because of the spectrum of clinical and radiological presentation. We report the case of a 15-year-old girl who was referred as tuberculosis of the spine, but which was in fact a ganglioneuroblastoma of the spine. This case report highlights the radiologic features of spinal tuberculosis and the importance of obtaining a tissue diagnosis prior to treatment. <![CDATA[<b>Management of open tibia fracture following fresh water contamination</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300009&lng=en&nrm=iso&tlng=en Tuberculosis has been said to be the great mimicker of our times because of the spectrum of clinical and radiological presentation. We report the case of a 15-year-old girl who was referred as tuberculosis of the spine, but which was in fact a ganglioneuroblastoma of the spine. This case report highlights the radiologic features of spinal tuberculosis and the importance of obtaining a tissue diagnosis prior to treatment. <![CDATA[<b>A morphometric study of the clavicle</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300010&lng=en&nrm=iso&tlng=en Recognition of unfavourable outcomes in displaced fractures of the clavicle in its middle third has stimulated global interest in the fixation of these fractures. The design of fixation devices is dependent on in-depth knowledge of the dimensions and morphology of the clavicle in order to optimise the configuration and fixation points of such a device. In this study 100 dry clavicles were obtained from the Anatomy Department for assessment of the dimensions, angular deviations and gross morphology. The clavicle could be divided into distinct regions according to its muscle and ligament attachments and the cross-sectional morphology was typified for each region. The physical data presented can be utilised to inform fracture or osteotomy fixation-device design. <![CDATA[<b>Anterior shoulder instability with bony deficiencies and the author's preferred method of treatment</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300011&lng=en&nrm=iso&tlng=en Anterior shoulder instability in the athlete is a common problem. It is imperative that in order to prevent unnecessary time away from sport that the correct decisions and interventions are taken at the appropriate times. The last decade has seen a change in our perceptions of the surgical options for this type of patient. We now have a better understanding of the pathology, the surgical options and their outcomes and the natural history both of the condition and surgery. <![CDATA[<b>Histomorphometry and the management of metabolic bone disease</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300012&lng=en&nrm=iso&tlng=en Static and dynamic histomorphometry provides reproducible data on bone morphology and metabolism. The series of selected abbreviated case reports presented in this manuscript illustrates the role of histomorphometry in the diagnosis and management of metabolic bone disease states. <![CDATA[<b>Road traffic accidents and orthopaedic injuries in children</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300013&lng=en&nrm=iso&tlng=en An audit on the epidemiology of road traffic accident-related fractures was performed in a state hospital in Gauteng, South Africa. The aim of the study was to evaluate the demographics and mechanism of injuries sustained in road traffic accidents. The study was a retrospective review of all admissions to the Chris Hani Baragwanath Hospital over a three-year period. Boys were injured twice as commonly as girls, the mean age at injury was 5 years and 86% of the injuries were sustained during pedestrian vehicle accidents. We conclude that road awareness and road safety programmes should be increased in an effort to reduce these preventable injuries. <![CDATA[<b>Is tetanus toxoid still necessary today?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300014&lng=en&nrm=iso&tlng=en An audit on the epidemiology of road traffic accident-related fractures was performed in a state hospital in Gauteng, South Africa. The aim of the study was to evaluate the demographics and mechanism of injuries sustained in road traffic accidents. The study was a retrospective review of all admissions to the Chris Hani Baragwanath Hospital over a three-year period. Boys were injured twice as commonly as girls, the mean age at injury was 5 years and 86% of the injuries were sustained during pedestrian vehicle accidents. We conclude that road awareness and road safety programmes should be increased in an effort to reduce these preventable injuries. <![CDATA[<b>Controversies in the management of tibial plateau fractures</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300015&lng=en&nrm=iso&tlng=en Over the past decades, a greater understanding of the mechanism of long-bone injury has led to a proliferation of treatments of these fractures. Various surgical techniques have been developed and enhanced, offering the modern-day surgeon a wide choice of fixation options and devices, all with their own indications, contraindications and potential problems. The treatment of the soft-tissue injuries that so often accompany tibial plateau fractures (TPFs) and the type of material that is best for the filling of subchondral defects after the reduction of depressed fractures are among a range of subjects that are also matters of controversy. Based on a wealth of literature, this paper takes a critical look at the controversies that have developed regarding aspects of the classification, treatment modalities and prognosis of TPF with reference to related matters. After discussing each of these aspects of TPF separately, the author makes recommendations. <![CDATA[<b>Contiguous bifacet cervical fracture dislocations</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300016&lng=en&nrm=iso&tlng=en Bifacet dislocations of the cervical spine are severe debilitating injuries often associated with complete cord injury. Contiguous bilateral facet dislocations are extremely rare and, to the best of our knowledge, have only been described once before. We present a patient who was involved in a road traffic accident. Pre-operative radiographs suggested contiguous bifacet injury and this was confirmed intra-operatively. This should alert physicians to the possibility of contiguous injuries to the cervical spine. <![CDATA[<b>Avulsion fracture of the calcaneal tuberosity</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300017&lng=en&nrm=iso&tlng=en Bifacet dislocations of the cervical spine are severe debilitating injuries often associated with complete cord injury. Contiguous bilateral facet dislocations are extremely rare and, to the best of our knowledge, have only been described once before. We present a patient who was involved in a road traffic accident. Pre-operative radiographs suggested contiguous bifacet injury and this was confirmed intra-operatively. This should alert physicians to the possibility of contiguous injuries to the cervical spine. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300018&lng=en&nrm=iso&tlng=en Bifacet dislocations of the cervical spine are severe debilitating injuries often associated with complete cord injury. Contiguous bilateral facet dislocations are extremely rare and, to the best of our knowledge, have only been described once before. We present a patient who was involved in a road traffic accident. Pre-operative radiographs suggested contiguous bifacet injury and this was confirmed intra-operatively. This should alert physicians to the possibility of contiguous injuries to the cervical spine. <![CDATA[<b>Erratum</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000300019&lng=en&nrm=iso&tlng=en Bifacet dislocations of the cervical spine are severe debilitating injuries often associated with complete cord injury. Contiguous bilateral facet dislocations are extremely rare and, to the best of our knowledge, have only been described once before. We present a patient who was involved in a road traffic accident. Pre-operative radiographs suggested contiguous bifacet injury and this was confirmed intra-operatively. This should alert physicians to the possibility of contiguous injuries to the cervical spine.