Background. Proximal phalangeal fractures are caused by an injury to the dorsum of the hand. This usually causes volar angulation which is unstable when reduced. K-wiring or external fixation can damage the soft tissue envelope, can introduce infection and can loosen or displace.
Objectives. Femoral shaft fracture treatment often results in mal-alignment and the high dosage of radiation exposure. The objective of this study is to develop a Parallel Manipulator Robot (PMR) on
Objective. Femoral shaft fracture treatment often results in mal-alignment and the high dosage of radiation exposure. The objective of this study is to develop a Parallel Manipulator Robot (PMR) on
Aim:. To review the use of
A retrospective follow-up study was done, assessing regional practices in acute cervical reduction in hospitals in the Western Cape. The constitutional court ruled on the urgency in managing cervical dislocations, and our task is to ensure that medical treatment is optimized to comply with best medical practice and the apex court. A questionnaire was distributed and completed by emergency departments at each hospital, the results retrieved, analysed, and compared to a similar survey done in 2016. Protocols for managing cervical spine dislocations had improved from 80% having no protocols to only over half of facilities (52,6%) not having protocols in place. Inadequate equipment availability remained a problem with only 50% of facilities having adequate equipment available in 2016 to 43,6% in 2023. 10,3% of participants did not know if there was equipment available. In terms of knowledge, there remained poor formal training with a drop from 93% participants identifying that the main indication to attempt emergency cervical reduction was acute cervical dislocation with worsening neurology, to only 46,2%. However, there was an increase in the number of participants who thought reduction was safe. The same percentage of participants from 2016 to 2023 would attempt emergency cervical reduction if given adequate training. Previously we found that most Western Cape hospitals had inadequate protocols, training, and equipment for cervical reductions. In 2023, more hospitals in the Province have protocols in place for cervical reductions and the same percentage of doctors would attempt emergency cervical reduction with adequate training. However, equipment and training for management of acute cervical dislocations has not improved. We conclude that most Western Cape Hospitals are unprepared to adequately manage acute cervical dislocations.
Total Hip Arthroplasty (THA) using the Direct Anterior Approach (DAA) is a muscle sparing approach which promotes early mobilisation of patients. It is a technically challenging approach shown to have a high rate of complications, especially during the learning curve. Here we present the results of 157 cases of THA via a DAA on a standard theatre table, with a minimum of 6 months follow-up. The authors conducted a prospective study on a group of 149 consecutive patients undergoing 157 cementless primary THAs for coxarthrosis, 8 bilateral. The same surgical technique was used in all patients, performed by the senior author WLW at a single centre. The average age of the patients at time of surgery was 69 years, 78% were female and 57% were right sided. All implants were uncemented, with bearings being ceramic on ceramic or Ceramic on highly cross-linked polyethylene. Patients were assessed clinically and radiographically pre- and post-operatively at 6 weeks, 6 months, 1 and 2 years. Intra-operatively, navigation was used to guide cup position and assess offset and leg length.Background
Materials & Methods
Femoral shaft fractures are fairly common injuries in paediatric age group. The treatment protocols are clear in patients of age less than 4 years and greater than 6 years. The real dilemma lies in the age group of 4–6 years. The aim of this study is to find whether a conservative line should be followed, or a more aggressive surgical intervention can provide significantly better results in these injuries. This study was conducted in a tertiary care hospital in Bhubaneswar, India from January 2020 to March 2021. A total of 40 patients with femur shaft fractures were included and randomly divided in two treatment groups. Group A were treated with a TENS nail while group B were treated with skin
Aim. Pin site infection (PSI) is a common complication of external fixators. PSI usually presents as a superficial infection which is treated conservatively. This study investigated those rare cases of PSI requiring surgery due to persistent osteomyelitis (OM), after pin removal. Method. In this retrospective cohort study we identified patients who required surgery for an OM after PSI (Checketts-Otterburn Classification Grade 6) between 2011 and 2021. We investigated patient demographics, aetiology of the OM, pathogen and histology, treatment strategies and complications. Infection was confirmed using the 2018 FRI Consensus Definition. Successful outcome was defined as an infection-free interval of at least 24 months following surgery, which was defined as minimum follow-up. Results. Twenty-seven patients were treated due to a pin site infection with an osteomyelitis (22 tibias, 2 humeri, 2 calcanei, 1 radius). 85% identified as male and the median age was 53.9 years. Eighteen infections followed external fixation of fractures, with 4 cases after Ilizarov deformity correction, 2 cases followed ankle fusion and 3 after
Arthroscopic hip procedures have increased dramatically over the last decade as equipment and techniques have improved. Patients who require hip arthroscopy for femoroacetabular impingement on occasion require surgery on the contralateral hip. Previous studies have found that younger age of presentation and lower Charlson comorbidity index have higher risk for requiring surgery on the contralateral hip but have not found correlation to anatomic variables. The purpose of this study is to evaluate the factors that predispose a patient to requiring subsequent hip arthroscopy on the contralateral hip. This is an IRB-approved, single surgeon retrospective cohort study from an academic, tertiary referral centre. A chart review was conducted on 310 primary hip arthroscopy procedures from 2009-2020. We identified 62 cases that went on to have a hip arthroscopy on the contralateral side. The bilateral hip arthroscopy cohort was compared to unilateral cohort for sex, age, BMI, pre-op alpha angle and centre edge angle measured on AP pelvis XRay, femoral torsion,
Introduction. Despite all modern advances the indications and possibilities of treatment in Legg-Calvé-Perthes Disease (LCPD) are still controversial. In the past 15 years we started using arthrodiastasis of the hip creating negative pressure over the avascular femoral head in some selected cases of LCPD in the active phasis of the disease. Now we present our experience with distraction in LCPD using the original Ilizarov circular frame for the hip. Materials and Methods. From 2015 to 2021, eight patients with LCPD were submoitted to hip distraction; all male ranging from six to 12 years (avg 8.2 years). All patients with bad prognosis, in Catterall Groups III and IV. All patients in the active phasis of the disease. Our follow-up is ranging from two to six years, with an average of 3.4 years. Results. All the preliminary results are good with recovering of range of motion of the affected hip joint in allpatients. After the first month under distraction is possible to observe new bone formation specially in the lateral pillar of the femoral head. Complications were not observed in this group of patients. Conclusions. The main point of this prospective study is to find that is possible to achieve cartilaginous growth on the femoral head stimulated by the
The purpose of this project was to evaluate North American trauma surgeon preferences regarding patient positioning for antegrade fixation of mid shaft femoral shaft fractures. This project was a cross sectional survey taken of orthopaedic fellows and staff surgeons, belonging to three organizations across North America. An estimated sample size was calculated a priori, while various online techniques were utilized to reduce non responder and fatigue bias. The survey was distributed multiple times to optimize yield. Two hundred twelve (212) participants responded in full, 134 (56%) of whom practiced in Canada. The majority of surgeons worked in level one trauma centres (74%), while 72% treated more than one femoral shaft fracture per week. The most common patient position for mid shaft fixation amongst all surgeons was lateral positioning with manual
Introduction. The shuck test was widely used to assess the overall soft-tissue tension around the hip joint during surgery. There have been few attempts to standardize how one evaluates soft tissue tension in total hip arthroplasty. The aim of this study was to ask how reliable the shuck test was as a measure of soft tissue tension in total hip arthroplasty. Methods. First, we assessed the intra- and inter-examiner variability of the force generated in the shuck test. Next, we asked how the strength of
Introduction. The incidence of dislocation after total hip arthroplasty (THA) was reported to be 0.5 to 10% in primary THA and 10 to 25 % in revision THA. The main causes of instability after THA were reported to be implant malalignment and inappropriate soft tissue tension. However, there was no study about quantitative data of soft tissue tension of unstable THA. The purpose of this study is to clarify the features of soft tissue tension of unstable THA in comparison to stable THA. Methods. The subjects were 15 patients with 15 THAs who had developed recurrent dislocation after primary THA. Thirty four patients with 37 THAs who developed no dislocation for one year after surgery were recruited as a stable THA group. In both group, all THAs were performed through posterolateral approach. In order to assess the soft tissue tension of THA, we recorded antero-posterior radiographs of the hips while applying distal
Methods. A pericapsular approach was used with capsulotomy and then correction of the lesions both in the pelvic and in the femoral aspects. The
Certain acetabular fractures involve impaction of the weight-bearing dome and medialisation of the femoral head. Intra-operative fracture reduction is made easier by
INTRODUCTION:. A discrepancy exists between biomechanical and clinical outcome studies when comparing cruciate-retaining (CR) versus posterior stabilized (PS) component designs. The purpose of this study is to re-evaluate experimental model results using half-body specimens with intact extensor mechanisms and navigation to evaluate PS and CR component gaps though an entire range of motion. METHODS:. A custom-designed knee testing apparatus was used for secure anchoring of the lower half of cadaver pelvic, allowing full range of knee motion and the application of
Purpose. Instability following total hip arthroplasty (THA) is an unfortunately frequent and serious problem that requires through evaluation and preoperative planning before surgical intervention. Prevention through optimal index surgery is of great importance, as the management of an unstable THA is challenging even for an experienced joints surgeon. However, even after well-planned surgery, a significant incidence of recurrent instability still exists. As you know Sir John Charnley is one of the first orthopaedic surgeons to address the issue of soft-tissue tensioning (STT) in the THA. Moreover leg-length discrepancy (LLD) after THA can pose a substantial problem for the orthopaedic surgeon. Such discrepancy has been associated with complications including nerve palsy, low back pain, and abnormal gait. The objective of this study is to assess hip instability of three different FOs in same patient undergoing THA during an operation. Methods. We performed 70 patients who had undergone unilateral THA using CT based navigation system at a single institution for advanced osteoarthoritis from May 2013 to May 2014. We used postero-lateral approach in all patients. After cup and stem implantation, we assessed soft tissue tensioning in THA during operation. Trial necks were categorized into one of three groups: standard femoral offset (sFO), high femoral offset (hFO, +4mm compared to sFO) and extensive high femoral offset (ehFO, +8 mm compared to sFO). We measured distance of lift-off about each of three femoral necks using CT based navigation system and a force gauge with hip flexed at 0 degrees and 30 degrees under a
Paediatric femoral fractures are a common result of significant trauma, and always require intervention. Hip spica casting,
INTRODUCTION. Proponents of the THA anterior approach have advocated for the use of dedicated surgical tables similar to those used in lower extremity fracture care that allow for
The evidence base within trauma and orthopaedics has traditionally favoured quantitative research methodologies. Qualitative research can provide unique insights which illuminate patient experiences and perceptions of care. Qualitative methods reveal the subjective narratives of patients that are not captured by quantitative data, providing a more comprehensive understanding of patient-centred care. The aim of this study is to quantify the level of qualitative research within the orthopaedic literature. A bibliometric search of journals’ online archives and multiple databases was undertaken in March 2024, to identify articles using qualitative research methods in the top 12 trauma and orthopaedic journals based on the 2023 impact factor and SCImago rating. The bibliometric search was conducted and reported in accordance with the preliminary guideline for reporting bibliometric reviews of the biomedical literature (BIBLIO).Aims
Methods