Low back pain is a common complaint and reason for patients to seek medical help. Studies have shown that 80% of people over 60 yrs of age will have suffered from it at one point in their lives. Low back pain, after the common cold, is the 2nd most common reason for patients to visit medical practitioners. Aim. The purpose of this survey was to establish a patient profile, risk factors, previous management and care strategies for patients presenting to the Orthopaedic Out Patient Department at an Academic Hospital with low back pain. Method. We reviewed 257 patients during a 6 month period from July 2010- December 2010.0. Patients were excluded if there were: XR deformities (eg. spondylolistheses, masses, cysts etc); associated neurology, incontinence or constitutional symptoms; previous vertebral column fracture or surgery or current malignancy. Patients referred for first visits were also excluded. Results. There were 206 females and 51 males. The average age of patients was 55 yrs. The average duration of symptoms was 6 months and the average duration of clinical follow-up at the institution was 8 months. The occupational setback due to this affliction was great: 23% were unemployed due to the pain and 21% receiving Disability Grants for it. The average BMI of these patients was 35. A smoking and alcohol history was not conspicuous and very few patients had a history of trauma. The investigative and treatment strategy and implementation in these patients was haphazard

Background. The relationship between obesity and cauda equina syndrome (CES) has not been previously evaluated or defined. Aim. Purpose of this study was to examine the presentation, timing of surgery, peri-operative complications and outcome of Cauda Equina Syndrome in relation to Body Mass Index. Methods. A single centre retrospective analysis was performed on 40 patients admitted with cauda equina syndrome. Data was collected regarding patient demographics, body mass index (BMI), co-morbidities, onset & mode of presentation and speed of functional recovery following surgery. Results. There were 18 males and 22 females with an overall average age of 38.9 years. The average height was 168.7 cm, and the average weight was 89.3 kg, giving an average BMI of 30.6 Kg/m2. 80% of patients were considered overweight (BMI 25–29.5) or obese (BMI >30). The average duration of back or leg pain prior to presentation was 4.2 years for the obese group and 1.3 years for the non-obese group. Bilateral sciatica, urinary incontinence and dense peri-anal numbness were the predominant presenting features in the obese group. Onset of symptoms was slow and gradually evolving in the obese group compared to the fast onset in the obese group. In the non-obese group, 71% underwent surgery within 24 hrs as opposed to 31% in the obese group. Average follow-up was 6months (6 weeks to 14 months). We observed that higher the BMI more slower the recovery with residual neurology and sphincter dysfunction. Patients in ideal group had prompt early symptomatic recovery with no residual neurology and full bladder recovery. There was correlation between increasing BMI and increased rate of surgical complications. Conclusion. This is the first study exploring the impact of body mass index on CES presentation and outcome. Specific care in establishing an early diagnosis in obese individuals is imperative for timely intervention

Background. Rapid mobilisation programs, or “fast track” protocols, are aimed at shorter hospital stays. We found a limited local experience with these programs in total hip arthroplasty in South Africa, and decided to introduce a pilot study at our institution. Purpose. This pilot study is aimed at the feasibility and safety of a RM program in the private sector setting, as well as a review of the pertinent literature. Methods. 40 patients who met inclusion criteria underwent THR and TKR according to a specific protocol. Key aspects of the protocol included: minimum use of opiates, high volume pericapsular local block at time of surgery, no urinary catheter, mobilisation within 6 hrs of surgery and no high care admission. Target Discharge was 3 days. Patients were followed up retrospectively and outcomes included; length of stay, intra- and post-operative complications, subjective patient experience, re-admissions and re-operations. Results. 36 patients, (90 %), were discharged by day 3, 4 patients were discharged at day 4. Mean stay 2,8 days, shortest 2 days, and longest 4 days. 3 elderly female patients required catheterization for urinary incontinence, on the first night post surgery. No complications were experienced. The problems that prevented discharge within 3 days were post operative pain and orthostatic hypotension. There were no re-admissions or re-operations. One TKR required manipulation at 6 weeks. 5 patients required changes of dressings at home within one week post surgery. All the patients in this study were extremely satisfied. Conclusion. A rapid mobilisation program is relatively easy to implement although extra paramedical staff input is required. The results of this pilot study show that the protocol was effective and safe, as well as showing a significant hospital cost reduction. The obvious saving of costs are encouraging us to implement the protocol on a wider scale. Appendix. Lorem ipsum dolor sit amet, ligula suspendisse nulla pretium, rhoncus tempor placerat fermentum, enim integer ad vestibulum volutpat. Nisl rhoncus turpis est, vel elit, congue wisi enim nunc ultricies sit, magna tincidunt. Maecenas aliquam maecenas ligula nostra, accumsan taciti. Sociis mauris in integer, a dolor netus non dui aliquet, sagittis felis sodales, dolor sociis mauris, vel eu libero cras. Interdum at. Eget habitasse elementum est, ipsum purus pede porttitor class, ut adipiscing, aliquet sed auctor, imperdiet arcu per diam dapibus libero duis. Enim eros in vel, volutpat nec pellentesque le. NO DISCLOSURES

The straddle fractures represent a distinct anatomical pattern of pelvic trauma. Their specific clinical characteristics, associated injuries and clinical outcome remain mostly underreported and ambiguous. Over a 3-year period all straddle fractures were identified from a prospective database of a tertiary referral hospital. For all cases, excluding children < 16 years and pathologic fractures, demographic characteristics, associated trauma, ISS-2005, transfusion requirements, surgical procedures, post-operative course, complications and clinical outcome were recorded over a median follow-up of 19 months (7-36). All fractures were classified by the two senior authors separately. Of 280 pelvic fractures, 31(11%) straddle fractures were identified. The median age was 38 years (17-88) and the male/female ratio was 1.38. Half of them were classified as lateral-compression (51.6%), 19.4% as anteroposterior-compression, and 29% combined mechanism of injury. 9 cases had an intra-articular extension to one or both acetabula. Median ISS was 21 (9-57), while 71% had a serious (AIS>2) associated thoracic injury, 48.4% head injury, 38.7% abdominal injury, 51.6%- lower extremity fracture, and 38.7% significant urogenital injuries. Six underwent acute embolisation, and the mean transfusion rates over the initial 72hrs were 7.5 units-cRBC, 2.3 units-FFP, 0.5 units-PLTs. All cases were treated operatively, either with ORIF (14 cases), closed reduction and percutaneous screw fixation (10 cases), while an external fixator was used in 21 cases. The median length of stay was 21 days (1-106). The mortality rate was 6.5% (one on the day of admission and another after 15 days at the ICU). Eight superficial infections, 2 deep sepsis of pfannestiel wounds, as well as 1 asymptomatic nonunion of an inferior pubic rami were recorded. 5 cases underwent further surgery for late urogenital repair and 4 cases have chronic incontinence and sexual dysfunction symptoms. Straddle fractures represent a severe type of pelvic trauma, associated with severe mostly thoracic, head and extremity trauma, severe urogenital complications, and suggest pelvic ring instability that requires surgical stabilisation in the acute setting. They are easily identifiable at the initial radiological investigations and should alert the clinician for multidisciplinary assessment and early referral