Scielo RSS <![CDATA[SA Orthopaedic Journal]]> http://www.scielo.org.za/rss.php?pid=1681-150X20120004&lang=es vol. 11 num. 4 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Is everything presented in medical journals or presentations true?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000400001&lng=es&nrm=iso&tlng=es <![CDATA[<b>In defence of South African Orthopaedic Training</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000400002&lng=es&nrm=iso&tlng=es <![CDATA[<b>Posterior vertebral column resection for severe spinal deformities</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000400003&lng=es&nrm=iso&tlng=es STUDY DESIGN: A retrospective review of patient records and imaging. OBJECTIVES: The purpose of this study is to review the indications, surgical challenges and outcomes of patients undergoing posterior vertebral column resection (PVCR). SUMMARY OF BACKGROUND DATA: PVCR is indicated in the management of severe rigid spine deformities. It is a complex surgical procedure and is only performed in a few spine centres due to the technical expertise required and associated risk. METHODS: Twelve patients with severe spinal deformities who underwent PVCR were retrospectively reviewed after a follow-up of 2 years. Surgery was performed with the aid of motor-evoked spinal cord monitoring and cell saver when available. The average surgical duration was 307 minutes (100-490 ± 126.3). The average blood loss was 1350 ml (4OO-3OOO ± 897.9). The indication for PVCR was gross deformity and myelopathy which was due to congenital spinal deformities and old tuberculosis (TB). Clinical records and the radiographic parameters were reviewed. RESULTS: Kyphosis of an average of 73° was corrected to 29° and coronal Cobb was corrected from an average of 48° to 22°. Ten patients improved neurologically to ASIA D and E. One patient deteriorated immediately post-operatively, required revision with no initial improvement but reached ASIA E by 6 months post-op. Four patients had associated syringomyelia. All were re-scanned at 1 year. The three with small syrinxes demonstrated no progression on MRI and a large syrinx resolved completely. In addition to the neurological deterioration, complications included one right lower-lobe pneumonia. CONCLUSION: PVCR is an effective option to correct complex rigid kyphoscoliosis. In addition it allows excellent circumferential decompression of the cord and neurological recovery. When the congenital scoliosis is associated with syringomyelia with no other cause evident, it may allow resolution of the syrinx. <![CDATA[<b>Massive bone loss around the knee - the orthopaedic oncological perspective</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000400004&lng=es&nrm=iso&tlng=es Massive bone loss, as a consequence of tumour resection, has been dealt with historically by a variety of techniques. This article describes the techniques commonly used in the management of intercalary, intra-articular and extra-articular resections with uncontained bone defects. <![CDATA[<b>A randomised controlled trial of steroid injection in the management of plantar fasciitis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000400005&lng=es&nrm=iso&tlng=es ABSTRACT BACKGROUND: The management of plantar fasciitis varies among clinicians because no single treatment has strong scientific evidence to support its use to improve outcome. Steroid injections are more commonly used in our practice with varied and unpredictable response. This study set out to compare the effects of steroid injections with conservative regimen (analgesics, stretch exercises and insoles) versus conservative management alone for the treatment of plantar fasciitis. METHODS: A double blind randomised controlled trial. Eighty-eight patients with plantar fasciitis were randomised to two treatment arms, 47 to the steroid injection arm and 41 to the control arm. Both arms received standard conservative management. Visual analogue scale (VAS) and Foot Function Index (FFI) scores of the patients were recorded at study entry, at one month and at two months. RESULTS: The mean age of the overall study cohort was 42.9 years (SD 9.1). Forty-eight per cent were male. There was a significant reduction in mean pain scores, after one month and after two months in both the steroid and the control arms (p<0.005). The mean FFI at study entry was 50.5 (SD 18.2). At one month and two months follow-up, the mean FFI scores were 43.4 (SD 16.2) and 41.4 (SD 15.3), respectively (P<0.001). There was no statistically significant difference in pain scores between patients who received steroid injections 7.36 (SD 1.6) and those in the control arm 7.22 (SD 1.7) at one month (P = 0.73) (CI-0.64 to 0.9). There was also no statistically significant difference in pain scores between the two groups of patients: steroid injections 6.77 (SD 1.8) and the controls 6.54 (SD 1.7) at two months (P = 0.59) (CI-0.61 to 1.06). FFI scores at one month were 43.25 (SD 17.63) for the steroid group and 43.79 (SD 14.73) for the control group (P = 0.88) (CI-7.78 to 6.6). At two months, the scores were 42.26 (SD 17.19) for the steroid arm and 40.48 (SD 13.30) for the control arm (P = 0.615) (CI-5.21 to 8.75). CONCLUSIONS: Patients with plantar fasciitis improve significantly with conservative management. At one and two months, compared to a control group of conservative management alone, injection of steroids does not make a difference in improving pain and functionality. <![CDATA[<b>Circular external fixator application for midshaft tibial fractures</b>: <b>Surgical technique</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000400006&lng=es&nrm=iso&tlng=es The use of fine wire circular external fixation has recently undergone a resurgence in popularity among orthopaedic trauma and reconstructive surgeons. Their modularity, biomechanical characteristics and minimally invasive application make these fixators indispensable for complex trauma and post-traumatic limb reconstruction. The application of these fixators is technically demanding and a steep learning curve exists. This article aims to provide a simplified, stepwise approach to the application of a circular external fixator to the tibia. <![CDATA[<b>Bell's cruciate paralysis</b>: <b>a rare neurological diagnosis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000400007&lng=es&nrm=iso&tlng=es Bell's cruciate paralysis is a rare incomplete spinal cord syndrome characterised by brachial diplegia. It is caused by an insult to the cervicomedullary junction of the spinal cord. We report three cases of cruciate paralysis following traumatic injury to the cervical spine. In all three cases the clinical diagnosis of cruciate paralysis was confirmed with magnetic resonance imaging (MRI). The prognosis varies according to the underlying cause, but is generally good. The clinical diagnosis of cruciate paralysis helps localise the injury to the cervicomedullary junction. <![CDATA[<b>Outcomes of the treatment of gunshot fractures of lower extremities with interlocking nails</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000400008&lng=es&nrm=iso&tlng=es Gunshot injuries are gradually on the increase in civilian populations in developing countries due to the increase in violence in our society. The treatment of fractures from such injuries is changing with the use of locked intramedullary nailing becoming an acceptable and effective method of fixation. The Surgical Implant Generation Network (SIGN) interlocking nail is gaining universal acceptance in developing countries due to its ease of use without the need for an image intensifier. The purpose of this study is to evaluate the outcome of the use of SIGN interlocking nailing in gunshot fractures of the lower limbs. This is a prospective study of all patients in three tertiary centres in developing countries who had gunshot fractures of the lower limbs fixed with SIGN nails from 1 June 2007 to 31 May 2009 and followed up for a period of two years. There were 28 patients with 31 fractures with an average age of 32.5 years ± 12.6 SD. All the patients were males except for one female. Fractures occurred in the femur in 20 (71.4%) and tibia in 11 (29.6%). The SIGN nail was used to fix all fractures, and union was achieved in all the patients. The most common complication was wound infection in five patients (15.2%). The intramedullary locked nail provided an effective method of fixation for gunshot fractures of the lower extremity with minimum complications. <![CDATA[<b>Clinical assessment of the flexor digitorum superficialis muscle to the fifth finger -accuracy of common tests</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000400009&lng=es&nrm=iso&tlng=es INTRODUCTION: There are several tests described to determine the presence of the flexor digitorum superficialis (FDS) muscle in the fifth digit, though it is unclear which of them is most accurate. We conducted a study to determine the accuracy of three common tests. METHODS: A prospective study was conducted comparing three common clinical tests among patients and students in a large teaching hospital in East Africa to determine their accuracy in ascertaining the presence of the FDS in the fifth digit. RESULTS The modified test was the most accurate in detecting the FDS, followed by the new test. The most inaccurate test was the standard test. DISCUSSION The modified test was the most accurate test and is recommended in clinical studies trying to demonstrate the FDS function to the fifth digit. <![CDATA[<b>Pelvic fractures in children</b>: <b>experience at a Johannesburg academic hospital</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000400010&lng=es&nrm=iso&tlng=es BACKGROUND: Pelvic fractures in the paediatric population are rare. The skeletally immature pelvis is flexible and therefore a pelvic fracture suggests significant force with a high association of concomitant injuries. Despite these being potentially devastating injuries there are no clear outlines with respect to the investigation, classification and management of these fractures. MATERIALS AND METHODS: We retrospectively reviewed 20 children with pelvic fractures. We utilised the Injury Severity Score (ISS) and Revised Trauma Score (RTS) to assess the physiological instability of the patient. The Torode and Zieg classification was used to describe pelvic fractures. At follow-up the functional independence for self-care, mobility and cognition was assessed. RESULTS: Pelvic fractures represented only 0.03% of paediatric orthopaedic admissions. Concomitant injuries were present in 55% of patients. Four of the 20 pelvic fractures were unstable (type 4), of which three required ICU admission and external pelvic fixation for haemodynamic instability. At a mean follow-up of 4 months all patients were functionally independent. CONCLUSIONS: Although rare, pelvic fractures in children have a high rate (55%) of concomitant injuries. The ISS and RTS scoring systems are useful to predict the severity of the injury. Conservative management and external pelvic fixation (in haemodynamically unstable type 4 fractures) resulted in favourable outcomes <![CDATA[<b>An unusual case of a transabdominal, transdiscal stab wound to the spine</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000400011&lng=es&nrm=iso&tlng=es BACKGROUND: Anterior stab wounds to the spine are extremely rare. Depending on the weapon, trajectory and anatomical level, patients are likely to present with associated damage to large vessels, the lungs, heart, and the gastrointestinal, as well as genitourinary system. METHODS: In this case report, we describe the management of a 21-year-old male patient who presented with an injury to the cauda equina after an abdominal stab with a glass bottle. The patient escaped a thorough secondary survey and neurological examination due to massive intra-abdominal injuries, which required initial damage control surgery. Weak left-sided dorsiflexion of the ankle with paraesthesia in the left L4 and L5 nerve root distribution was initially overlooked. RESULTS: During a follow-up appointment, one month after discharge, chronic pain and cauda equina symptoms were noted. Further imaging revealed a large glass fragment, which had been driven, transabdominally, through the L4/L5 disc into the spinal canal. The fragment was removed through a posterior approach, which alleviated the chronic pain, although the neurological deficit remained unchanged. CONCLUSION: Neurological damage through anterior stab wounds to the spine has not yet been described. The best approach to these patients is a staged management initially directed at treating life-threatening injuries in the form of damage control surgery. Once stable, a thorough neurological reassessment must follow to rule out spinal cord injuries http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000400012&lng=es&nrm=iso&tlng=es <![CDATA[<b>Ethical musing about the allocation of scarce resources, renal transplants and commercialisation</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000400013&lng=es&nrm=iso&tlng=es BACKGROUND: Anterior stab wounds to the spine are extremely rare. Depending on the weapon, trajectory and anatomical level, patients are likely to present with associated damage to large vessels, the lungs, heart, and the gastrointestinal, as well as genitourinary system. METHODS: In this case report, we describe the management of a 21-year-old male patient who presented with an injury to the cauda equina after an abdominal stab with a glass bottle. The patient escaped a thorough secondary survey and neurological examination due to massive intra-abdominal injuries, which required initial damage control surgery. Weak left-sided dorsiflexion of the ankle with paraesthesia in the left L4 and L5 nerve root distribution was initially overlooked. RESULTS: During a follow-up appointment, one month after discharge, chronic pain and cauda equina symptoms were noted. Further imaging revealed a large glass fragment, which had been driven, transabdominally, through the L4/L5 disc into the spinal canal. The fragment was removed through a posterior approach, which alleviated the chronic pain, although the neurological deficit remained unchanged. CONCLUSION: Neurological damage through anterior stab wounds to the spine has not yet been described. The best approach to these patients is a staged management initially directed at treating life-threatening injuries in the form of damage control surgery. Once stable, a thorough neurological reassessment must follow to rule out spinal cord injuries <![CDATA[<b>Simplifying venous thromboembolism management</b>: <b>a new and safer era</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000400014&lng=es&nrm=iso&tlng=es BACKGROUND: Anterior stab wounds to the spine are extremely rare. Depending on the weapon, trajectory and anatomical level, patients are likely to present with associated damage to large vessels, the lungs, heart, and the gastrointestinal, as well as genitourinary system. METHODS: In this case report, we describe the management of a 21-year-old male patient who presented with an injury to the cauda equina after an abdominal stab with a glass bottle. The patient escaped a thorough secondary survey and neurological examination due to massive intra-abdominal injuries, which required initial damage control surgery. Weak left-sided dorsiflexion of the ankle with paraesthesia in the left L4 and L5 nerve root distribution was initially overlooked. RESULTS: During a follow-up appointment, one month after discharge, chronic pain and cauda equina symptoms were noted. Further imaging revealed a large glass fragment, which had been driven, transabdominally, through the L4/L5 disc into the spinal canal. The fragment was removed through a posterior approach, which alleviated the chronic pain, although the neurological deficit remained unchanged. CONCLUSION: Neurological damage through anterior stab wounds to the spine has not yet been described. The best approach to these patients is a staged management initially directed at treating life-threatening injuries in the form of damage control surgery. Once stable, a thorough neurological reassessment must follow to rule out spinal cord injuries