Scielo RSS <![CDATA[SA Orthopaedic Journal]]> http://www.scielo.org.za/rss.php?pid=1681-150X20150002&lang=en vol. 14 num. 2 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>The responsibility of clinical practice</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000200001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Multilevel lumbosacral fusions: Complications and patient-reported outcome</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000200002&lng=en&nrm=iso&tlng=en The ageing population presents with debilitating back pain and leg pain with a background of adult spinal deformity, after a protracted period of conservative care. Sagittal balance is required to achieve a good clinical outcome; however, the surgery is associated with a high incidence of complications. AIM: To review the outcome of multilevel (>4) instrumented lumbar fusion to sacrum/pelvis performed for degenerative conditions. METHODS: A retrospective descriptive study of 47 consecutive patients from 2002 to 2012. Inclusion criterion was fusion from at least L2 to Sl/pelvis, i.e. minimum of four levels. Imaging was assessed as to the restoration of normal sagittal profile as well as subsequent fusion. EQ5D, ODI and VAS scores pre-op and at 6 months post-op were analysed. Average age at surgery was 64 years (50-78). Thirteen cases were primary and 34 revisions. Indications were axial back pain either associated with sagittal imbalance (40%) or leg pain (36%) and leg pain alone in 10%. RESULTS: The intra-operative blood loss averaged 2 222 (250-7 000) ml with 40% re-infusion from cell-saver. The average surgical duration was 268 minutes. Proximal extent of instrumentation was T2 (1), T3 (1), T4 (2), T8 (1), T9 (1), T10 (17), Tll (2), T12 (5), Ll (4) and L2 (13). TLIFs were done in 20 cases mostly at the base of the construct. Pedicle subtraction osteotomies were performed in 14 revision cases. Dural tears occurred in 14 cases, all revision cases except one. Wound infection occurred in three cases. With the exception of transient quadriceps weakness related to osteotomy, no neurological complications occurred. One patient died peri-operatively. Subsequent revision was required in 13 cases for instrumentation failure. The OSD score improved by 15.3 points on average, which is clinically and statistically significant. CONCLUSION: Long lumbar fusions remain technically demanding with a high incidence of adverse events. This is due to the nature of revision surgery and high biomechanical demands on constructs. Surgical intervention can however be justified by the desperation of the cohort in terms of pain and poor function which can be modestly improved with this intervention. <![CDATA[<b>Primary bone tumours of the spine: Presentation, surgical treatment and outcome</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000200003&lng=en&nrm=iso&tlng=en BACKGROUND: Primary bone tumours of the spine are a group of rare tumours that include both benign and malignant lesions. Resection is associated with a high morbidity rate. METHODS: We retrospectively reviewed all the primary bone tumours of the spine that were surgically treated at our unit between 2005 and 2012 (haematological malignancies were excluded. RESULTS: Fifteen cases were included that presented at a median age of 36 years (range 8 to 65 years). Pain was the most common presenting symptom. Three patients had significant neurological deficits at time of presentation and in two cases there was an improvement after surgery. The median delay in diagnosis was 7 months (range 1 to 36 months). A variety of surgical strategies was employed with the use of adjuvant radio- or chemotherapy in six cases. Twelve benign and three malignant tumours were resected. Complications (sepsis, failure of fixation and recurrence) were encountered in five cases (33%. CONCLUSIONS: Primary bone tumours of the spine are often associated with a significant delay in diagnosis. Surgical strategy should be individualised for each case. Acceptable results can be achieved with this approach. <![CDATA[<b>Instructional course lecture: Spondylolysis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000200004&lng=en&nrm=iso&tlng=en Spondylolysis is a defect of the pars interarticularis of the vertebral arch. Its cause is often multifactorial but mostly thought to be as a result of a stress fracture. Most fractures occur at L5 (71%-95%) and L4 (5%-23%).¹ <![CDATA[<b>Sonographic assessment of the shoulders in asymptomatic elderly diabetics in a Nigerian population</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000200005&lng=en&nrm=iso&tlng=en BACKGROUND: There is an increased risk of developing shoulder lesions in diabetics especially with increasing age. Ultrasonography provides a low risk and cost effective method of evaluating shoulder disorders in the general population. METHODS: This is a study of 60 diabetic subjects and 60 controls that were asymptomatic of shoulder joint disease. An ultrasound examination of both shoulders was performed according to standard protocol. Data were analysed using the SPSS data analysis software. RESULTS: Of the 60 diabetic subjects, 32 were male and 28 were female, while there were 35 males and 25 females in the subject group. Supraspinatus (SST) tendon thickness was greater in diabetics than in controls, (6.44 ± 1.00 mm vs 5.25 ± 0.87 mm, P = 0.000) and (6.02 ± 0.90 mm vs 5.06 ± 0.81 mm, P = 0.000) in the dominant and non-dominant shoulders respectively. Biceps tendon (BT) thickness was also significantly greater in diabetics (4.16 ± 0.57 mm vs 3.20 ± 0.49 mm, P = 0.000), and (3.99 ± 0.48 mm vs 3.99 ± 0.48 mm, P = 0.000) in the dominant and non-dominant shoulders respectively. CONCLUSION: There was an increase in asymptomatic shoulder pathology in diabetic patients that was associated with ageing. <![CDATA[<b>Subpubic cartilaginous cyst: A rare cause of a pelvic soft tissue mass</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000200006&lng=en&nrm=iso&tlng=en We present a rare case of subpubic cartilaginous cyst in a multiparous female patient as a cause of a pelvic soft tissue (vulvar) mass. We discuss the relevant imaging and differential diagnosis as well as specific considerations in making the diagnosis of a subpubic cartilaginous cyst. <![CDATA[<b>Dysplasia epiphysealis hemimelica: An interesting case report involving the talus and literature review</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000200007&lng=en&nrm=iso&tlng=en Dysplasia epiphysealis hemimelica (DEH) is a rare osteochondromatous condition arising unilaterally from an epiphysis in the developing skeleton. Unhindered, this osseocartilaginous lesion continues to grow until skeletal maturity. Characteristic radiographic features are usually sufficient to make the diagnosis. One common site of occurrence is the talus, which has the potential to cause pain, joint deformity or limit range of motion. We report a case of DEH of the talus causing fixed hindfoot valgus deformity, successfully treated with surgery, and review the literature on DEH and its current treatment strategies. <![CDATA[<b>Corticosteroid usage in hand and wrist surgery</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000200008&lng=en&nrm=iso&tlng=en Hand and wrist surgery probably leads the other orthopaedic disciplines in corticosteroid usage. Despite widespread usage there still remains some scepticism among patients and surgeons about the 'poison 'of steroid injections. For various (often fiscal!) reasons patients are not offered cortisone injections as a simple, quick and effective conservative option to many common hand/wrist maladies. <![CDATA[<b><i>Mycobacterium fortuitum </i></b><b>as infectious agent in a septic total knee replacement: Case study and literature review</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000200009&lng=en&nrm=iso&tlng=en Infection of prosthetic joints with non-tuberculous mycobacteria (NTM) is rare. The rapidly growing mycobacteria (RGM) are a subgroup of NTM. They are not very virulent organisms, found ubiquitously in the environment, and most infections in humans are due to direct inoculation of the organism into a joint or soft tissue. We describe a 70-year-old patient, who developed an infection with Mycobacterium fortuitum after primary knee arthroplasty, one of only a handful described in the literature. Peri-prosthetic infections with RGM are a challenge because there is a lack of data guiding management, and because the diagnosis is often delayed. Routine cultures of joint effusions or tissue are often discarded before the non-tuberculous mycobacteria have a chance to culture (in our case, 14 days). Principles of treatment include: making a diagnosis from tissue culture, staged revision surgery with aggressive surgical debridement of the joint and high dosages antibiotics (for at least six weeks, treating empirically initially until a sensitivity profile for the organism is available). The second stage of the revision should be delayed by 3-6 months. In our case the removed implant was autoclaved and re-implanted loosely with antibiotic-loaded cement as part of the first-stage revision. <![CDATA[<b>Expert Opinion on Published Articles</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000200010&lng=en&nrm=iso&tlng=en Infection of prosthetic joints with non-tuberculous mycobacteria (NTM) is rare. The rapidly growing mycobacteria (RGM) are a subgroup of NTM. They are not very virulent organisms, found ubiquitously in the environment, and most infections in humans are due to direct inoculation of the organism into a joint or soft tissue. We describe a 70-year-old patient, who developed an infection with Mycobacterium fortuitum after primary knee arthroplasty, one of only a handful described in the literature. Peri-prosthetic infections with RGM are a challenge because there is a lack of data guiding management, and because the diagnosis is often delayed. Routine cultures of joint effusions or tissue are often discarded before the non-tuberculous mycobacteria have a chance to culture (in our case, 14 days). Principles of treatment include: making a diagnosis from tissue culture, staged revision surgery with aggressive surgical debridement of the joint and high dosages antibiotics (for at least six weeks, treating empirically initially until a sensitivity profile for the organism is available). The second stage of the revision should be delayed by 3-6 months. In our case the removed implant was autoclaved and re-implanted loosely with antibiotic-loaded cement as part of the first-stage revision.