Scielo RSS <![CDATA[SA Orthopaedic Journal]]> http://www.scielo.org.za/rss.php?pid=1681-150X20120002&lang=pt vol. 11 num. 2 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>OUTREACH</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000200001&lng=pt&nrm=iso&tlng=pt http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000200002&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Musculoskeletal burden of disease</b>: <b>do we have any idea?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000200003&lng=pt&nrm=iso&tlng=pt Planning an orthopaedic surgical service is extremely difficult as we are faced with competing demands. Our teaching hospitals are expected to provide a comprehensive training yet the service is dominated by trauma-related patient care. In the past, elective orthopaedic surgery was often ring-fenced in separate hospitals but due to many reasons this has changed. All sub-specialities are competing for resources. <![CDATA[<b>Tuberculosis of the foot and ankle in children</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000200004&lng=pt&nrm=iso&tlng=pt We reviewed 28 patients in order to assess the outcome of tuberculosis of the foot and ankle in children and to describe a classification that would relate to prognosis. The median age was 3 years (1 to 12.5 years). The ankle was involved in 13 (46.4%) patients, the midfoot in nine (32.1%), the subtalar joint in five (17.9%) and the calcaneus in one (3.6%). Radiographs of ankle joint involvement showed osteopaenia with or without lytic lesions of the distal tibial epiphysis, sclerosis or lytic lesions of the dome of the talus, or joint space narrowing. Midfoot involvement showed osteopaenia with or without 'absence' of bone (cuneiforms, cuboid and navicular). Subtalar involvement showed lytic lesions of the calcaneus and/or inferior talus that were not always visible on plain radiographs but were confirmed with CT scan in three patients. Open biopsy was done in all patients. Histology and/or culture were positive in 26 of 28 patients. Treatment was with isoniazid, rifampicin and pyrazinamide for 9 months. Two patients had multiple-drug-resistant tuberculosis and their drugs were modified accordingly. At a mean follow-up of 5.9 years (3 to 18 years) no patients had residual symptoms and all except one had a plantigrade foot. Ten patients (35.7%) had an excellent result, 14 patients (50%) a good and four patients (14.3%) had a poor result. Joint space narrowing was a reliable predictor of a poor outcome in the ankle joint (3/9). All patients with midfoot involvement had a good functional outcome, although the joint space was not always definable. One of the five patients with subtalar involvement had a poor result. <![CDATA[<b>Late-onset Blount's disease</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000200005&lng=pt&nrm=iso&tlng=pt BACKGROUND: Late-onset Blount's disease is subdivided by age at onset into juvenile (4-10 years) and adolescent (≥ llyears). Recent literature recommends the use of external fixation with gradual correction of tibial varus and simultaneous correction of associated femoral varus. METHODS: We retrospectively reviewed 36 patients (43 knees) treated from 1990-2005. Of the 36 patients, 22 were female and 61.1% were obese. Seventeen knees were in juvenile and 26 in adolescent patients. Pre-operatively and at follow-up patients were assessed clinically and radiographically. Pre-operative mechanical axis ranged from 8-55° varus. Seventeen of the 43 knees (39.5%) had femoral varus (lateral distal femoral angle >90°, range 94°-102°). Surgery involved a tibial barrel-vault osteotomy, acutely correcting the overall mechanical axis, internal tibial torsion and procurvatum. Fixation was with Steinmann pins and plaster. RESULTS: At a mean follow-up of 4 years (38 knees to maturity), 33 knees (76.7%) had a good result. In three juvenile knees the varus recurred after initial correction to 0-4° valgus. Joint line obliquity ranged from 4°-12°. CONCLUSION: Tibial osteotomy alone with limited internal fixation can achieve good results in late-onset Blount's. In juvenile knees overcorrection to 5-10° mechanical valgus accommodates recurrence secondary to persistent growth inhibition. <![CDATA[<b>Ultrasound diagnosis of femoral nerve neurostenalgia</b>: <b>a cause of hip pain in a young adult</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000200006&lng=pt&nrm=iso&tlng=pt Femoral neurostenalgia is a compressive neuropathy which is an uncommon cause of hip pain in active young adults. Compression of the nerve can cause debilitating pain and an inability to walk. Correct clinical diagnosis and correct treatment can result in complete relief of symptoms. We present a case of a young female with a spontaneous acute onset of severe hip pain for ten months. After seeing several specialists and having undergone numerous special investigations, femoral nerve compression by the iliopsoas was demonstrated on ultrasound, but only confirmed during surgery for a suspected femoral hernia. After decompression of the nerve the patient was completely pain free. <![CDATA[<b>Neonatal compartment syndrome of the forearm</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000200007&lng=pt&nrm=iso&tlng=pt We present a clinical case of a neonate with a cellulitic appearance of the forearm. We discuss the differential diagnosis and the clinical features that led us to the diagnosis of forearm compartment syndrome. Early surgical decompression in this case resulted in a favourable outcome. To the best of our knowledge, this is the first case reported in the African literature. <![CDATA[<b>Biting off more than you can chew</b>: <b>Microbiological flora isolated from human and animal bite wounds</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000200008&lng=pt&nrm=iso&tlng=pt BACKGROUND: Bite wounds, from human and animal origin, can lead to significant complications if appropriate therapy is not undertaken timeously. A basic knowledge of the microbiological flora is essential for each clinical setting in order to be able to facilitate appropriate empiric antibiotic therapy. MATERIAL AND METHODS: All patients admitted to the Steve Biko Academic Hospital over a 27-month period with histories of bite wound and taken to theatre for debridement were included in this study. All culture data was collected together with sensitivity profiles for all organisms isolated. RESULTS: In total, 38 patients were included in this study, with 25 sustaining human bite wounds, 11 sustaining dog bites, and only two with snake bites. The most striking finding is the predominance of Streptococcus spp isolated from human bite wounds. Although a relatively rare finding, Salmonella spp was isolated from one of the patients who sustained a snake bite. A surprising fraction of isolates were resistant to Amox-Clav, with only marginally improved sensitivity rates to second generation cephalosporins and fluoroquinolones. CONCLUSIONS: This study emphasises the importance of obtaining microbiological cultures on all patients admitted with bite wounds. This will not only assist in surveillance practices, but also provides the clinician with targeted therapy if the empiric antimicrobial should fail. <![CDATA[<b>No loosening of an uncemented acetabular component at a minimum of 15 years</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000200009&lng=pt&nrm=iso&tlng=pt One hundred consecutive total hip replacements using a cementless Duraloc 300 cup were reviewed at a minimum of 15 years. All acetabular metal components were found to be stable with no evidence of loosening. <![CDATA[<b>Proximal humerus chondroblastoma with a secondary aneurysmal bone cyst</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000200010&lng=pt&nrm=iso&tlng=pt One hundred consecutive total hip replacements using a cementless Duraloc 300 cup were reviewed at a minimum of 15 years. All acetabular metal components were found to be stable with no evidence of loosening. <![CDATA[<b>MRI findings of cyclops lesions of the knee</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000200011&lng=pt&nrm=iso&tlng=pt Cyclops lesions develop in the anterior aspect of the intercondylar notch typically after anterior cruciate ligament (ACL) reconstruction or injury. It is a lesion consisting of fibrous tissue with or without cartilage and bony components. A cyclops lesion is one of the causes for reduced extension and, in the cases reported here, also knee pain or discomfort after ACL reconstruction. We present the MRI features, particularly the features on proton density weighted turbo spin echo (PDW TSE) and proton density weighted turbo spin echo fat saturation (PDW TSE FS) sequences of four cases of cyclops lesions, and distinguish between the MRI findings of large and small lesions. We also describe a cyclops lesion after a posterior cruciate ligament reconstruction, not described in literature before. <![CDATA[<b>Chronic knee dislocation treated with a Taylor Spatial Frame</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000200012&lng=pt&nrm=iso&tlng=pt Chronic knee dislocations are fortunately not seen commonly, but when these injuries do present, they are typically a source of severe functional impairment to the patient. Surgical management may harbour further complications due to the extensive soft tissue release that is required, and the fact that significant deformities are corrected acutely. We report on a 32-year-old, HIV-1 infected, female patient 20 months after a dislocation of the left knee. Due to the extent of her flexion contracture, she was unable to walk unaided. A Taylor Spatial Frame was applied across the knee, and gradual reduction of the dislocation, with correction of the knee flexion deformity, was performed over a period of 26 days. The final result produced a stable, ankylosed knee that allowed weight bearing without the need for any walking aids. No complications attributed to the reduction or the fixator was experienced, and no additional surgeries were required. We conclude that gradual reduction of chronic knee dislocations, using the Taylor Spatial Frame, provides a safe and effective method of treating these complex injuries without subjecting patients to extensive surgical soft tissue release procedures. <![CDATA[<b>The lift-off sign</b>: <b>further observations on the Lachman test for diagnosis of anterior cruciate ligament rupture</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000200013&lng=pt&nrm=iso&tlng=pt The Lachman test is a commonly used clinical test for evaluating anterior cruciate ligament (ACL) integrity. When performing the Lachman test we have noted an additional, previously unreported finding, which helps to discriminate between the intact and ruptured ACL. This observation, which we have named the lift-off sign, can be explained using the different classes of lever system operating in each case. <![CDATA[<b>The evaluation of a new general trauma course with an orthopaedic focus for newly qualified doctors</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000200014&lng=pt&nrm=iso&tlng=pt Management of trauma patients by junior doctors is common in South Africa. Recent literature published in South Africa and observations of various senior doctors have raised the concern that the newly qualified doctor lacks both knowledge and skill in the management of trauma patients, and especially those with orthopaedic injuries. A general trauma course with an orthopaedic focus was developed for newly qualified doctors to address these concerns. The course was assessed by using a questionnaire before and after the course. The post-course questionnaire showed significant improvement in newly qualified doctors' knowledge of trauma management. <![CDATA[<b>Irreducible or missed lateral patellar dislocation</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000200015&lng=pt&nrm=iso&tlng=pt The most common direction of patellar dislocation is lateral. The dislocation is usually recognised early and easily reduced. This case report highlights a young girl in which the dislocation was not recognised and subsequently became irreducible requiring an open reduction. CASE PRESENTATION: A 17-year-old girl sustained a lateral patellar dislocation during a twisting motion of the right knee while doing karate. On clinical examination the patient had a lateral patellar dislocation but the initial radiographs appeared fairly normal. Pre-operative CT examination confirmed the diagnosis. Closed reduction failed necessitating an open reduction. The lateral retinacular defect after reduction of the patella was filled using the anterior half of the iliotibial band. Eighteen months following surgery the patella was stable and the patient regained a good range of motion. CONCLUSION: Lateral patellar dislocation may be subtle and misdiagnosed. Not obtaining the necessary radiographs may contribute to not diagnosing the condition. Doubtful cases should have a CT scan to confirm the diagnosis. Mobilising part of the ITB is a viable option to obtain healthy living tissue to cover a lateral retinacular defect. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000200016&lng=pt&nrm=iso&tlng=pt The most common direction of patellar dislocation is lateral. The dislocation is usually recognised early and easily reduced. This case report highlights a young girl in which the dislocation was not recognised and subsequently became irreducible requiring an open reduction. CASE PRESENTATION: A 17-year-old girl sustained a lateral patellar dislocation during a twisting motion of the right knee while doing karate. On clinical examination the patient had a lateral patellar dislocation but the initial radiographs appeared fairly normal. Pre-operative CT examination confirmed the diagnosis. Closed reduction failed necessitating an open reduction. The lateral retinacular defect after reduction of the patella was filled using the anterior half of the iliotibial band. Eighteen months following surgery the patella was stable and the patient regained a good range of motion. CONCLUSION: Lateral patellar dislocation may be subtle and misdiagnosed. Not obtaining the necessary radiographs may contribute to not diagnosing the condition. Doubtful cases should have a CT scan to confirm the diagnosis. Mobilising part of the ITB is a viable option to obtain healthy living tissue to cover a lateral retinacular defect. <![CDATA[<b>Genetic ownership and sharing</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000200017&lng=pt&nrm=iso&tlng=pt The most common direction of patellar dislocation is lateral. The dislocation is usually recognised early and easily reduced. This case report highlights a young girl in which the dislocation was not recognised and subsequently became irreducible requiring an open reduction. CASE PRESENTATION: A 17-year-old girl sustained a lateral patellar dislocation during a twisting motion of the right knee while doing karate. On clinical examination the patient had a lateral patellar dislocation but the initial radiographs appeared fairly normal. Pre-operative CT examination confirmed the diagnosis. Closed reduction failed necessitating an open reduction. The lateral retinacular defect after reduction of the patella was filled using the anterior half of the iliotibial band. Eighteen months following surgery the patella was stable and the patient regained a good range of motion. CONCLUSION: Lateral patellar dislocation may be subtle and misdiagnosed. Not obtaining the necessary radiographs may contribute to not diagnosing the condition. Doubtful cases should have a CT scan to confirm the diagnosis. Mobilising part of the ITB is a viable option to obtain healthy living tissue to cover a lateral retinacular defect.