SA Orthopaedic Journal

Editorial

An assessment of the three-point index in predicting the redisplacement of distal radial fractures in children

BACKGROUND: Distal metaphyseal radial fractures are common in the paediatric population and their management is predominantly conservative. The incidence of redisplacement of these fractures is high and various methods have been described with the view to predict fracture redisplacement. One of these indices is the three-point index (TPI). METHODS: A retrospective review of 43 patients with distal radius fractures revealed that 19 patients suffered significant redis-placement at 2 weeks after closed manipulation in a plaster cast. RESULTS: The TPI index in the study was found to have a sensitivity of 84%, a specificity of 37%, a negative predictive value of 75% and a positive predictive value of 51%.: CONCLUSIONS: It was concluded that the TPI was a sensitive but not specific measure of fracture redisplacement and not practically applicable to influence management of these fractures and therefore not a useful tool in our clinical setting.

The Torg-Winchester form of hereditary osteolysis: Orthopaedic manifestations and management

The genetic osteolyses are an uncommon group of skeletal disorders in which severe orthopaedic complications can occur. In this article we present the clinical and radiological features of a boy with the Torg-Winchester form of osteolysis and discuss the orthopaedic management of his upper and lower limb deformities. Heritable osteolysis warrants consideration as a possible diagnosis in children presenting with clinical deformity following minimal trauma and radiological evidence of progressive dissolution of bone.

The spectrum of orthopaedics at Chris Hani Baragwanath Academic Hospital

Chris Hani Baragwanath Academic Hospital (CHBAH) is the third largest hospital in the world and is the largest in the Southern hemisphere, serving a population of more than 3.5 million people.¹ The purpose of this review is to identify the orthopaedic-related health events that occur within the population being serviced by the hospital, and in doing so provide a tool to be used for improving orthopaedic-related patient care and outcomes in public health services.² We also took special interest in the data collected during the 2010 FIFA Soccer World Cup. METHOD: A retrospective review for the period from 1 January 2010 to 31 December 2010 was conducted. This included all orthopaedic admissions, theatre cases performed and outpatient assessments.3,4 RESULTS: For the period of the review there were 4 102 orthopaedic admissions from the emergency unit. Theatre records show that 5 832 orthopaedic theatre cases were performed. This comprised more than 75 different types of operative procedures. An average of 780 patients were assessed at the orthopaedic outpatient clinic every week, with a total of 40 516 patients seen in 2010. An evaluation of the statistics over the time period shows no significant differences between 2010 FIFA Soccer World Cup and other months of the year regarding the orthopaedic spectrum.

SLAP lesions: Clinical experience of 63 cases

BACKGROUND: Superior Labrum Anterior and Posterior injuries or SLAP injuries have a frequency of 3.9% to 12%, and up to 35% in contact sportsmen. Our purpose is to check this pathology in our centre and to value clinical and working final results after its treatment. MATERIAL AND METHODS: An observational, descriptive and retrospective study of 63 patients. Medium age, sex, laterality, profession, type of SLAP, associated injuries, surgical techniques, complications, and Rowe, Constant and UCLA tests among other data, are analysed. RESULTS: 89% men, 11% women. Median age 45.3 ± 9.8 years. Right shoulders: 68%; left 32%. Intra-operative data: predominant SLAP type was type II (59.5%). We achieved subacromial decompression in 43.5% of cases. Rowe's test: 84.5 ± 18.3 points; Constant's test 72 ± 20.4 points; UCLA test: 29.5 ± 9.1 points. CONCLUSION: SLAP injuries constitute an important reason for shoulder pain in the labour world, although it is probably unsuspected. Treatment by means of shoulder arthroscopy with bioabsorbable bioknotless anchors is successful in many cases in allowing patients to show clinical improvement and return to work. Other concomitant injuries to SLAP must be investigated to optimise the results of surgical treatment.

Relationship of radiographic criteria to clinical findings in patients with femoroacetabular impingement

BACKGROUND: Femoroacetabular impingement (FAI) leads to pain, limited joint motion and eventually osteoarthritis. The aim was to determine the usefulness of different radiographic criteria to diagnose FAI. METHODS: A total of 250 healthy-appearing participants were selected randomly for screening of hip pain and specific impingement tests. They were categorised in three groups: Group 0 included asymptomatic participants without positive impingement tests; Group 1 participants were either asymptomatic with positive impingement tests or symptomatic with negative tests; participants with painful hip and positive impingement tests formed Group 2. Radiographic criteria including cross-over sign, posterior wall sign, coxa profunda, acetabular protrusion, pistol grip deformity, centre-edge angle, extrusion index, offset ratio, alpha angle, herniation pits and osteoarthritic changes were utilised in anteroposterior and cross-table lateral radiograph assessment of all cases. Radiographic criteria were compared in different groups. RESULTS: Only centre-edge angle (mean 35.3 ± 5.9, p=0.05), herniation pits (p=0.04) and osteoarthritic changes (p=0.05) showed a statistically significant difference in patients with FAI in comparison to other groups. CONCLUSION: As herniation pits and osteoarthritis signs are secondary findings of femoroacetabular impingement and the centre-edge angle value is not very sensitive, radiographic criteria are not diagnostic of FAI.

Bilateral ankylosis of the hip: A case report

Bilateral ankylosis of the hip is a surgical challenge even to the experienced surgeon. We present a case of bilateral ankylosis of the hips and review of literature in order to see if there are any tips and tricks to be kept in mind before attempting this type of surgery.

Traumatic spondylolisthesis of the axis: Surgical indication and outcomes

STUDY DESIGN: : A retrospective review of patient records, images and demographic data. OBJECTIVE: The purpose of this study is to review the indications for surgery in traumatic spondylolisthesis of the axis (TSA). SUMMARY OF BACKGROUND DATA: The majority of authors agree that non-operative management with traction reduction, followed by rigid immobilisation, will result in bony union in 95% of all cases. Asymptomatic pseudo-arthrosis or local kyphosis is usually tolerated well. There are very few true indications for surgery in TSA. METHODS: A retrospective review of all patients admitted to a level one spinal cord injury centre between 2003 and 2012 with a TSA who underwent surgical intervention. Seven cases were identified. Mechanism of injury, associated injuries, fracture type, indication for surgery, surgical procedure employed, clinical and radiological outcomes were reviewed. RESULTS: In 80 patients managed as in-patients with TSA over a 10-year period, only 7 (<10%) required surgery. The fracture configuration had no bearing on whether surgery was utilised, but 'patient factors' had the biggest impact on the decision to operate. These factors included poly-traumatised patients, ICU admission, need for ventilation, skull fractures, scalp lacerations and acute psychosis. CONCLUSION: Indications for surgery are based largely on patient factors and ease of nursing rather than a specific fracture displacement or configuration.

SA Orthopaedic Journal peer reviewers (past and present)

Neuromuscular scoliosis - surgical management and outcomes

Neuromuscular scoliosis affects a heterogeneous group of patients with myopathic, upper and lower motor neuron diseases. Spinal surgery is often required to optimise respiratory, sitting and ambulatory function. OBJECTIVES: Review of management and outcomes of surgically treated neuromuscular scoliosis. STUDY DESIGN: Retrospective review of prospectively maintained data, including demographics, intra-operative variables, pre- and post-operative imaging, complications, outcomes and a telephonic follow-up questionnaire. RESULTS: Ninety-eight patients (45 male and 53 female) were included in the study. The average operating time was 230 (100-525 ± 60.9) minutes and an average of 15.4 (8-19 ± 2.9) levels were fused. Pedicle screw only constructs corrected the primary curve by 63% initially and 56% correction at last follow-up. Hybrid constructs had an immediate correction of 69% and 47% at last follow-up. Although pedicle screw constructs lost less correction when compared to hybrid constructs, this was not a statistically significant difference. Pelvic obliquity was corrected from 14.02 (0-80 ± 15.54) to 4.06 (0-35 ± 7.69) degrees. The majority of the telephonic responses were positive. CONCLUSION: : Corrective spinal surgery in the neuromuscular patient is demanding with a high rate of complications but outcomes are good, with radiographic correction maintained in the long term and high level of patient and parent satisfaction. LEVEL OF EVIDENCE: III

Upper cervical deformities secondary to hydrocephalus - a case report

BACKGROUND: Hydrocephalus may complicate upper cervical pathology but is seldom the cause of cervical spine pathology. METHODS: This case report describes a child with hydrocephalus secondary to an intraventricular haemorrhage, who required atlantoaxial fusion for recurrent C1/C2 rotatory subluxation, and who has subsequently developed progressive subaxial deformity. CONCLUSION: This case highlights some of the important fundamentals of the paediatric cervical spine, its biomechanics, susceptibility to injury, and the progressive nature of deformities where the inciting aetiology cannot be addressed.

Total knee replacement infected with Mycobacterium tuberculosis: A case study and review of the literature

Prosthetic joint infection is an infrequent complication occurring in approximately 1% of primary joint arthroplasty.1,2 It often is a devastating complication necessitating prolonged treatment and multiple surgeries.³ The majority are due to staphylococcal infections followed by Gram-negative bacilli and Streptococcus species, but atypical and zoonotic infections do occur.4,5 Mycobacterium tuberculosis infections of prosthetic joints have been described in sporadic reports. Osteoarticular tuberculosis (TB) historically accounts for between 1% and 4% of all TB infections, making it one of the more common extra-pulmonary sites.6 During the past decade reported TB infections in South Africa have doubled and the estimated incidence over the last 15 years has risen three-fold. This staggering rise is exclusively due to the Human Immunodeficiency Virus (HIV) pandemic with more than half being HIV positive.7 However, only 20% of osteoarticular TB is associated with pulmonary disease.6,8 Despite significant efforts TB remains one of the most challenging global health problems affecting not only developing countries. Its relevance has been promoted by recent reports from, among others, the United Kingdom and the Netherlands, indicating that there has been a reversal of its decline in these developed countries which directly relates to immigration.9,10,11 The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis has further complicated its treatment, with the largest number of reported XDR tuberculosis cases coming from South Africa.12