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Bone & Joint 360
Vol. 1, Issue 2 | Pages 5 - 6
1 Apr 2012
Lavy C

Chris Lavy is an orthopaedic surgeon in Oxford (UK) who lived and worked in Malawi for ten years. There he helped build an orthopaedic hospital and research unit. He was also one of the founders of COSECSA, the regional college of surgeons for East and Central Africa in 1999.


The Journal of Bone & Joint Surgery British Volume
Vol. 50-B, Issue 1 | Pages 243 - 243
1 Feb 1968
Brooks D


The Bone & Joint Journal
Vol. 96-B, Issue 2 | Pages 177 - 180
1 Feb 2014
Dossche L Noyez JF Ouedraogo W Kalmogho E

Total hip replacement (THR) still is a rare intervention in many African countries. In Burkina Faso it is not performed on a regular basis. A visiting programme for THR was started in a district hospital with no previous relevant experience. In this paper we present an analysis of the surgical technical problems and peri-operative complications of 152 THRs in 136 patients and three bipolar hemiarthroplasties in three patients undertaken in this new programme with limited orthopaedic equipment. There were 86 male and 53 female patients with a mean age of 49 years (21 to 78). We identified 77 intra-operative technical problems in 51 operations. There were 24 peri-operative complications in 21 patients, 17 of which were bony in nature. So far, ten revision THRs have been performed in nine patients.

Regular analysis of the technical problems and complications was used to improve quality, and we identified patient selection adapted to the local circumstances as important to avoid complications. Our reflections on the problems encountered in initiating such a programme may be of help to other teams planning similar projects.

Cite this article: Bone Joint J 2014;96-B:177–80.


The Journal of Bone & Joint Surgery British Volume
Vol. 32-B, Issue 4 | Pages 615 - 617
1 Nov 1950
Edelstein JM


The Journal of Bone & Joint Surgery British Volume
Vol. 64-B, Issue 3 | Pages 286 - 288
1 Jun 1982
Purry N

Perthes' disease is thought to be rare in black children but no figures of incidence have previously been available. A search was therefore made for cases of the disease occurring in the Eastern Cape during the five-year period 1975 to 1979. Of 55 cases found, 38 were in white children, 11 in children of mixed ancestry ("coloured" children) and six in black children. The annual incidence in white children aged 14 years and under was 10.8 per 100 000, in coloured children 1.7 per 100 000, and in black children 0.45 per 100 000. In all races the incidence in the metropolitan area of Port Elizabeth was roughly twice that in the rural part of the region. The reason for the low incidence in coloured and black children is not known but various factors are suggested.



Bone & Joint Open
Vol. 5, Issue 3 | Pages 210 - 217
13 Mar 2024
Mthethwa PG Marais LC Aldous CM

Aims. The aim of this study is to determine the predictors of overall survival (OS) and predictive factors of poor prognosis of conventional high-grade osteosarcoma of the limbs in a single-centre in South Africa. Methods. We performed a retrospective cross-sectional analysis to identify the prognostic factors that predict the OS of patients with histologically confirmed high-grade conventional osteosarcoma of the limbs over ten years. We employed the Cox proportional regression model and the Kaplan-Meier method for statistical analysis. Results. This study comprised 77 patients at a three-year minimum follow-up. The predictors of poor OS were: the median age of ≤ 19 years (hazard ratio (HR) 0.96; 95% confidence interval (CI) 0.92 to 0.99; p = 0.021); median duration of symptoms ≥ five months (HR 0.91; 95% CI 0.83 to 0.99; p < 0.037); metastasis at diagnosis (i.e. Enneking stage III) (HR 3.33; 95% CI 1.81 to 6.00; p < 0.001); increased alkaline phosphatase (HR 3.28; 95% CI 1.33 to 8.11; p < 0.010); palliative treatment (HR 7.27; 95% CI 2.69 to 19.70); p < 0.001); and amputation (HR 3.71; 95% CI 1.12 to 12.25; p < 0.032). In contrast, definitive surgery (HR 0.11; 95% CI 0.03 to 0.38; p < 0.001) and curative treatment (HR 0.18; 95% CI 0.10 to 0.33; p < 0.001) were a protective factor. The Kaplan-Meier median survival time was 24 months, with OS of 57.1% at the three years. The projected five-year event-free survival was 10.3% and OS of 29.8% (HR 0.76; 95% CI 0.52 to 1.12; p = 0.128). Conclusion. In this series of high-grade conventional osteosarcoma of the appendicular skeleton from South Africa, 58.4% (n = 45) had detectable metastases at presentation; hence, an impoverished OS of five years was 29.8%. Large-scale future research is needed to validate our results. Cite this article: Bone Jt Open 2024;5(3):210–217


Bone & Joint Open
Vol. 3, Issue 7 | Pages 582 - 588
1 Jul 2022
Hodel S Selman F Mania S Maurer SM Laux CJ Farshad M

Aims. Preprint servers allow authors to publish full-text manuscripts or interim findings prior to undergoing peer review. Several preprint servers have extended their services to biological sciences, clinical research, and medicine. The purpose of this study was to systematically identify and analyze all articles related to Trauma & Orthopaedic (T&O) surgery published in five medical preprint servers, and to investigate the factors that influence the subsequent rate of publication in a peer-reviewed journal. Methods. All preprints covering T&O surgery were systematically searched in five medical preprint servers (medRxiv, OSF Preprints, Preprints.org, PeerJ, and Research Square) and subsequently identified after a minimum of 12 months by searching for the title, keywords, and corresponding author in Google Scholar, PubMed, Scopus, Embase, Cochrane, and the Web of Science. Subsequent publication of a work was defined as publication in a peer-reviewed indexed journal. The rate of publication and time to peer-reviewed publication were assessed. Differences in definitive publication rates of preprints according to geographical origin and level of evidence were analyzed. Results. The number of preprints increased from 2014 to 2020 (p < 0.001). A total of 38.6% of the identified preprints (n = 331) were published in a peer-reviewed indexed journal after a mean time of 8.7 months (SD 5.4 (1 to 27)). The highest proportion of missing subsequent publications was in the preprints originating from Africa, Asia/Middle East, and South America, or in those that covered clinical research with a lower level of evidence (p < 0.001). Conclusion. Preprints are being published in increasing numbers in T&O surgery. Depending on the geographical origin and level of evidence, almost two-thirds of preprints are not subsequently published in a peer-reviewed indexed journal after one year. This raises major concerns regarding the dissemination and persistence of potentially wrong scientific work that bypasses peer review, and the orthopaedic community should discuss appropriate preventive measures. Cite this article: Bone Jt Open 2022;3(7):582–588



The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 5 | Pages 678 - 683
1 May 2011
Aird J Noor S Lavy C Rollinson P

There are 33 million people worldwide currently infected with human immunodeficiency virus (HIV). This complex disease affects many of the processes involved in wound and fracture healing, and there is little evidence available to guide the management of open fractures in these patients. Fears of acute and delayed infection often inhibit the use of fixation, which may be the most effective way of achieving union. This study compared fixation of open fractures in HIV-positive and -negative patients in South Africa, a country with very high rates of both HIV and high-energy trauma. A total of 133 patients (33 HIV-positive) with 135 open fractures fulfilled the inclusion criteria. This cohort is three times larger than in any similar previously published study. The results suggest that HIV is not a contraindication to internal or external fixation of open fractures in this population, as HIV is not a significant risk factor for acute wound/implant infection. However, subgroup analysis of grade I open fractures in patients with advanced HIV and a low CD4 count (< 350) showed an increased risk of infection; we suggest that grade I open fractures in patients with advanced HIV should be treated by early debridement followed by fixation at an appropriate time


The Journal of Bone & Joint Surgery British Volume
Vol. 91-B, Issue 3 | Pages 341 - 343
1 Mar 2009
Lubega N Mkandawire NC Sibande GC Norrish AR Harrison WJ

In Africa the amount of joint replacement surgery is increasing, but the indications for operation and the age of the patients are considerably different from those in the developed world. New centres with variable standards of care and training of the surgeons are performing these procedures and it is important that a proper audit of this work is undertaken. In Malawi, we have pioneered a Registry which includes all joint replacements that have been carried out in the country. The data gathered include the age, gender, indication for operation, the prosthesis used, the surgical approach, the use of bone graft, the type of cement, pressurising systems and the thromboprophylaxis used. All patients have their clinical scores recorded pre-operatively and then after three and six months and at one year. Before operation all patients are counselled and on consent their HIV status is established allowing analysis of the effect of HIV on successful joint replacement. To date, 73 total hip replacements (THRs) have been carried out in 58 patients by four surgeons in four different hospitals. The most common indications for THR were avascular necrosis (35 hips) and osteoarthritis (22 hips). The information concerning 20 total knee replacements has also been added to the Registry


The Journal of Bone & Joint Surgery British Volume
Vol. 58-B, Issue 2 | Pages 155 - 158
1 May 1976
Roper A

Dysplasia of the hip is almost unknown in the Bantu peoples of Africa, except in cases of arthrogryposis and in those with partly European ancestry. Evidence is produced to show that the importance of intrinsic genetic factors in hip dysplasia far outweighs that of the extrinsic factors. These are of great importance only if allowed to act on a hip in which genetic factors have already determined dysplasia. Evidence is also produced to contradict the theory that the "piggyback" carrying method used by Bantu mothers is the reason for the immunity from dysplasia of the hip. The absence of "primary" osteoarthritis of the hip is noted, and the range of hip disorders leading to "secondary" osteoarthritis in the adult African is compared with that in the adult European. Three patients are described, one in each of the groups mentioned above, the third having an isolated "typical" congenital dislocation of one hip. The methods of study used were enquiry into obstetric history and into carrying methods, and arthrography to confirm clinical findings. The experience of other surgeons working in Africa is recorded


The Bone & Joint Journal
Vol. 105-B, Issue 7 | Pages 719 - 722
1 Jul 2023
Costa ML Brealey SD Perry DC

Musculoskeletal diseases are having a growing impact worldwide. It is therefore crucial to have an evidence base to most effectively and efficiently implement future health services across different healthcare systems. International trials are an opportunity to address these challenges and have many potential benefits. They are, however, complex to set up and deliver, which may impact on the efficient and timely delivery of a project. There are a number of models of how international trials are currently being delivered across a range of orthopaedic patient populations, which are discussed here. The examples given highlight that the key to overcoming these challenges is the development of trusted and equal partnerships with collaborators in each country. International trials have the potential to address a global burden of disease, and in turn optimize the benefit to patients in the collaborating countries and those with similar health services and care systems.

Cite this article: Bone Joint J 2023;105-B(7):719–722.


Bone & Joint 360
Vol. 11, Issue 5 | Pages 48 - 48
1 Oct 2022


The Journal of Bone & Joint Surgery British Volume
Vol. 47-B, Issue 3 | Pages 526 - 532
1 Aug 1965
Harris NH Kirkaldy-Willis WH

1. A primary subacute type of staphylococcal osteomyelitis has been described. It is the commonest form of osteomyelitis seen in East Africa, and the incidence appears to be increasing in Great Britain. 2. A review of the literature indicates that this is not a new disease but that in the past there has been some confusion in terminology. 3. The causative organism is a coagulase positive staphylococcus, but in a few instances a coagulase negative one has been isolated. The staphylococcus is thought to be of reduced virulence and in East Africa it is likely that the population has acquired an increased resistance to the staphylococcus. 4. Two radiologically distinct groups are recognised, depending on whether a bone abscess is present or not. In the first group there are two types of localised abscesses: the familiar Brodie's lesion and the less well recognised large bone abscess that occurs in the metaphysis of a long bone. While the pathology of the two types is similar, the radiological features are quite distinct. The lesions in the second group are characterised by extensive diaphysial changes, with or without metaphysial involvement, and an obvious abscess cannot usually be demonstrated. 5. The main clinical features are the long history, often weeks or months, before diagnosis; insignificant or absent general reaction to the infection and minimum physical signs. 6. Vertebral body osteomyelitis in adults is included because it generally presents as a subacute infection; the difficulties in distinguishing it from a tuberculous infection are outlined. 7. The most useful diagnostic aids are the staphylococcal antibody titres (especially in vertebral infections) and the erythrocyte sedimentation rate. A limited surgical exposure is usually required if the causative organism is to be isolated and empirical antibiotic therapy is to be avoided. The total and differential white blood count are so often normal in these patients that they are considered to be of no diagnostic value. 8. Curettage and local antibiotics together will cure the localised bone abscess. Other lesions may be effectively treated by systemic antibiotics alone, but in the later stages removal of sequestra and infected granulation tissue may be necessary. In this instance it is essential to make a planned incision and to cut a window in the bone large enough to expose the whole of the lesion; primary suture of the wound is advocated


Bone & Joint 360
Vol. 11, Issue 4 | Pages 48 - 48
1 Aug 2022


Bone & Joint Research
Vol. 11, Issue 8 | Pages 585 - 593
1 Aug 2022
Graham SM Jalal MMK Lalloo DG Hamish R. W. Simpson A

Aims

A number of anti-retroviral therapies (ART) have been implicated in potentially contributing to HIV-associated bone disease. The aim of this study was to evaluate the effect of combination ART on the fracture healing process.

Methods

A total of 16 adult male Wistar rats were randomly divided into two groups (n = eight each): Group 1 was given a combination of Tenfovir 30 mg, Lamivudine 30 mg, and Efavirenz 60 mg per day orally, whereas Group 2 was used as a control. After one week of medication preload, all rats underwent a standardized surgical procedure of mid-shaft tibial osteotomy fixed by intramedullary nail with no gap at the fracture site. Progress in fracture healing was monitored regularly for eight weeks. Further evaluations were carried out after euthanasia by micro-CT, mechanically and histologically. Two blinded orthopaedic surgeons used the Radiological Union Scoring system for the Tibia (RUST) to determine fracture healing.


Bone & Joint 360
Vol. 12, Issue 3 | Pages 44 - 44
1 Jun 2023


Bone & Joint 360
Vol. 12, Issue 4 | Pages 48 - 48
1 Aug 2023


Bone & Joint 360
Vol. 12, Issue 1 | Pages 45 - 47
1 Feb 2023

The February 2023 Research Roundup360 looks at: Clinical and epidemiological features of scaphoid fracture nonunion; Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh); Characterization of genetic risk of end-stage knee osteoarthritis treated with total knee arthroplasty; Platelet-rich plasma or autologous blood injection for plantar fasciitis; Volume and outcomes of joint arthroplasty; The hazards of absolute belief in the p-value laid bare.


Bone & Joint 360
Vol. 12, Issue 2 | Pages 6 - 9
1 Apr 2023
O’Callaghan J Afolayan J Ochieng D Rocos B


The Bone & Joint Journal
Vol. 105-B, Issue 3 | Pages 247 - 253
1 Mar 2023
Pakarinen O Ponkilainen V Uimonen M Haapanen M Helenius I Kuitunen I

Aims

To analyze whether the addition of risk-based criteria to clinical examination-based selective ultrasound screening would increase the rates of early detected cases of developmental dysplasia of the hip (DDH) and decrease the rate of late detected cases.

Methods

A systematic review with meta-analysis was performed. The initial search was performed in the PubMed, Scopus, and Web of Science databases in November 2021. The following search terms were used: (hip) AND (ultrasound) AND (luxation or dysplasia) AND (newborn or neonate or congenital).


Bone & Joint Open
Vol. 4, Issue 3 | Pages 120 - 128
1 Mar 2023
Franco H Saxby N Corlew DS Perry DC Pigeolet M

Aims

Within healthcare, several measures are used to quantify and compare the severity of health conditions. Two common measures are disability weight (DW), a context-independent value representing severity of a health state, and utility weight (UW), a context-dependent measure of health-related quality of life. Neither of these measures have previously been determined for developmental dysplasia of the hip (DDH). The aim of this study is to determine the DW and country-specific UWs for DDH.

Methods

A survey was created using three different methods to estimate the DW: a preference ranking exercise, time trade-off exercise, and visual analogue scale (VAS). Participants were fully licensed orthopaedic surgeons who were contacted through national and international orthopaedic organizations. A global DW was calculated using a random effects model through an inverse-variance approach. A UW was calculated for each country as one minus the country-specific DW composed of the time trade-off exercise and VAS.


Bone & Joint Open
Vol. 4, Issue 2 | Pages 87 - 95
10 Feb 2023
Deshmukh SR Kirkham JJ Karantana A

Aims

The aim of this study was to develop a core outcome set of what to measure in all future clinical research on hand fractures and joint injuries in adults.

Methods

Phase 1 consisted of steps to identify potential outcome domains through systematic review of published studies, and exploration of the patient perspective through qualitative research, consisting of 25 semi-structured interviews and five focus groups. Phase 2 involved key stakeholder groups (patients, hand surgeons, and hand therapists) prioritizing the outcome domains via a three-round international Delphi survey, with a final consensus meeting to agree the final core outcome set.


The Bone & Joint Journal
Vol. 106-B, Issue 7 | Pages 662 - 668
1 Jul 2024
Ahmed I Metcalfe A

Aims

This study aims to identify the top unanswered research priorities in the field of knee surgery using consensus-based methodology.

Methods

Initial research questions were generated using an online survey sent to all 680 members of the British Association for Surgery of the Knee (BASK). Duplicates were removed and a longlist was generated from this scoping exercise by a panel of 13 experts from across the UK who provided oversight of the process. A modified Delphi process was used to refine the questions and determine a final list. To rank the final list of questions, each question was scored between one (low importance) and ten (high importance) in order to produce the final list.


The Bone & Joint Journal
Vol. 106-B, Issue 3 | Pages 277 - 285
1 Mar 2024
Pinto D Hussain S Leo DG Bridgens A Eastwood D Gelfer Y

Aims

Children with spinal dysraphism can develop various musculoskeletal deformities, necessitating a range of orthopaedic interventions, causing significant morbidity, and making considerable demands on resources. This systematic review aimed to identify what outcome measures have been reported in the literature for children with spinal dysraphism who undergo orthopaedic interventions involving the lower limbs.

Methods

A PROSPERO-registered systematic literature review was performed following PRISMA guidelines. All relevant studies published until January 2023 were identified. Individual outcomes and outcome measurement tools were extracted verbatim. The measurement tools were assessed for reliability and validity, and all outcomes were grouped according to the Outcome Measures Recommended for use in Randomized Clinical Trials (OMERACT) filters.


Bone & Joint Open
Vol. 5, Issue 9 | Pages 776 - 784
19 Sep 2024
Gao J Chai N Wang T Han Z Chen J Lin G Wu Y Bi L

Aims

In order to release the contracture band completely without damaging normal tissues (such as the sciatic nerve) in the surgical treatment of gluteal muscle contracture (GMC), we tried to display the relationship between normal tissue and contracture bands by magnetic resonance neurography (MRN) images, and to predesign a minimally invasive surgery based on the MRN images in advance.

Methods

A total of 30 patients (60 hips) were included in this study. MRN scans of the pelvis were performed before surgery. The contracture band shape and external rotation angle (ERA) of the proximal femur were also analyzed. Then, the minimally invasive GMC releasing surgery was performed based on the images and measurements, and during the operation, incision lengths, surgery duration, intraoperative bleeding, and complications were recorded; the time of the first postoperative off-bed activity was also recorded. Furthermore, the patients’ clinical functions were evaluated by means of Hip Outcome Score (HOS) and Ye et al’s objective assessments, respectively.


Bone & Joint Open
Vol. 4, Issue 5 | Pages 370 - 377
19 May 2023
Comeau-Gauthier M Bzovsky S Axelrod D Poolman RW Frihagen F Bhandari M Schemitsch E Sprague S

Aims

Using data from the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial, we sought to determine if a difference in functional outcomes exists between monopolar and bipolar hemiarthroplasty (HA).

Methods

This study is a secondary analysis of patients aged 50 years or older with a displaced femoral neck fracture who were enrolled in the HEALTH trial and underwent monopolar and bipolar HA. Scores from the Western Ontario and McMaster University Arthritis Index (WOMAC) and 12-Item Short Form Health Survey (SF-12) Physical Component Summary (PCS) and (MCS) were compared between the two HA groups using a propensity score-weighted analysis.


Bone & Joint Open
Vol. 3, Issue 10 | Pages 832 - 840
24 Oct 2022
Pearson NA Tutton E Joeris A Gwilym SE Grant R Keene DJ Haywood KL

Aims

To describe outcome reporting variation and trends in non-pharmacological randomized clinical trials (RCTs) of distal tibia and/or ankle fractures.

Methods

Five electronic databases and three clinical trial registries were searched (January 2000 to February 2022). Trials including patients with distal tibia and/or ankle fractures without concomitant injuries were included. One reviewer conducted all searches, screened titles and abstracts, assessed eligibility, and completed data extraction; a random 10% subset were independently assessed and extracted by a second reviewer at each stage. All extracted outcomes were mapped to a modified version of the International Classification of Functioning, Disability and Health framework. The quality of outcome reporting (reproducibility) was assessed.


Bone & Joint Research
Vol. 12, Issue 3 | Pages 179 - 188
7 Mar 2023
Itoh M Itou J Imai S Okazaki K Iwasaki K

Aims

Orthopaedic surgery requires grafts with sufficient mechanical strength. For this purpose, decellularized tissue is an available option that lacks the complications of autologous tissue. However, it is not widely used in orthopaedic surgeries. This study investigated clinical trials of the use of decellularized tissue grafts in orthopaedic surgery.

Methods

Using the ClinicalTrials.gov (CTG) and the International Clinical Trials Registry Platform (ICTRP) databases, we comprehensively surveyed clinical trials of decellularized tissue use in orthopaedic surgeries registered before 1 September 2022. We evaluated the clinical results, tissue processing methods, and commercial availability of the identified products using academic literature databases and manufacturers’ websites.


Bone & Joint Open
Vol. 4, Issue 3 | Pages 146 - 157
7 Mar 2023
Camilleri-Brennan J James S McDaid C Adamson J Jones K O'Carroll G Akhter Z Eltayeb M Sharma H

Aims

Chronic osteomyelitis (COM) of the lower limb in adults can be surgically managed by either limb reconstruction or amputation. This scoping review aims to map the outcomes used in studies surgically managing COM in order to aid future development of a core outcome set.

Methods

A total of 11 databases were searched. A subset of studies published between 1 October 2020 and 1 January 2011 from a larger review mapping research on limb reconstruction and limb amputation for the management of lower limb COM were eligible. All outcomes were extracted and recorded verbatim. Outcomes were grouped and categorized as per the revised Williamson and Clarke taxonomy.


Bone & Joint Research
Vol. 11, Issue 11 | Pages 814 - 825
14 Nov 2022
Ponkilainen V Kuitunen I Liukkonen R Vaajala M Reito A Uimonen M

Aims

The aim of this systematic review and meta-analysis was to gather epidemiological information on selected musculoskeletal injuries and to provide pooled injury-specific incidence rates.

Methods

PubMed (National Library of Medicine) and Scopus (Elsevier) databases were searched. Articles were eligible for inclusion if they reported incidence rate (or count with population at risk), contained data on adult population, and were written in English language. The number of cases and population at risk were collected, and the pooled incidence rates (per 100,000 person-years) with 95% confidence intervals (CIs) were calculated by using either a fixed or random effects model.


Bone & Joint Open
Vol. 3, Issue 5 | Pages 432 - 440
1 May 2022
Craig AD Asmar S Whitaker P Shaw DL Saralaya D

Aims

Tuberculosis (TB) is one of the biggest communicable causes of mortality worldwide. While incidence in the UK has continued to fall since 2011, Bradford retains one of the highest TB rates in the UK. This study aims to examine the local disease burden of musculoskeletal (MSK) TB, by analyzing common presenting factors within the famously diverse population of Bradford.

Methods

An observational study was conducted, using data from the Bradford Teaching Hospitals TB database of patients with a formal diagnosis of MSK TB between January 2005 and July 2017. Patient data included demographic data (including nationality/date of entry to the UK), disease focus, microbiology, and management strategies. Disease incidence was calculated using population data from the Office for National Statistics. Poisson confidence intervals were calculated to demonstrate the extent of statistical error. Disease incidence and nationality were also analyzed, and correlation sought, using the chi-squared test.


The Bone & Joint Journal
Vol. 105-B, Issue 4 | Pages 400 - 411
15 Mar 2023
Hosman AJF Barbagallo G van Middendorp JJ

Aims

The aim of this study was to determine whether early surgical treatment results in better neurological recovery 12 months after injury than late surgical treatment in patients with acute traumatic spinal cord injury (tSCI).

Methods

Patients with tSCI requiring surgical spinal decompression presenting to 17 centres in Europe were recruited. Depending on the timing of decompression, patients were divided into early (≤ 12 hours after injury) and late (> 12 hours and < 14 days after injury) groups. The American Spinal Injury Association neurological (ASIA) examination was performed at baseline (after injury but before decompression) and at 12 months. The primary endpoint was the change in Lower Extremity Motor Score (LEMS) from baseline to 12 months.


Bone & Joint 360
Vol. 10, Issue 5 | Pages 4 - 5
1 Oct 2021
Graham SM Harrison WJ Laubscher M Maqungo S


Bone & Joint 360
Vol. 1, Issue 2 | Pages 3 - 4
1 Apr 2012
Carey Smith R Wood D

Richard Carey Smith is an orthopaedic oncology surgeon with fellowship training in the UK, USA, Australia and Canada, and has worked in Zambia, Zimbabwe and Papa New Guinea. David Wood is head of the University Department of Orthopaedics in Perth, Western Australia. He did his masters in Africa, and first experienced Papa New Guinea on his medical elective, starting a lifelong commitment to medical aid work there.


Bone & Joint Open
Vol. 3, Issue 8 | Pages 628 - 640
1 Aug 2022
Phoon KM Afzal I Sochart DH Asopa V Gikas P Kader D

Aims

In the UK, the NHS generates an estimated 25 megatonnes of carbon dioxide equivalents (4% to 5% of the nation’s total carbon emissions) and produces over 500,000 tonnes of waste annually. There is limited evidence demonstrating the principles of sustainability and its benefits within orthopaedic surgery. The primary aim of this study was to analyze the environmental impact of orthopaedic surgery and the environmentally sustainable initiatives undertaken to address this. The secondary aim of this study was to describe the barriers to making sustainable changes within orthopaedic surgery.

Methods

A literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines through EMBASE, Medline, and PubMed libraries using two domains of terms: “orthopaedic surgery” and “environmental sustainability”.


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 11 | Pages 1414 - 1421
1 Nov 2008
Arya AP Klenerman L

The Jaipur foot was developed for barefoot amputees by Professor P. K. Sethi. He used local artisans and readily available materials. The prosthesis was cheap and could be made in one hour. It enabled amputees to work in rural conditions, muddy and wet fields and to climb trees. It has been widely used in India, South East Asia and Africa, where local variations to the design have now been made


The Journal of Bone & Joint Surgery British Volume
Vol. 47-B, Issue 1 | Pages 52 - 55
1 Feb 1965
Browne SG

The distinctive clinical characteristics of ainhum conforming to classical descriptions, as seen in 100 patients in Central and West Africa, are briefly reviewed, special emphasis being laid on those features that serve to differentiate ainhum from other conditions that may in some respects resemble it


The Journal of Bone & Joint Surgery British Volume
Vol. 54-B, Issue 3 | Pages 509 - 515
1 Aug 1972
Sallis JG Beighton P

1. A large Caucasian kindred in South Africa are affected by a previously undescribed inherited deformity of the hands and feet called digito-talar dysmorphism. 2. The principal features of digito-talar dysmorphism are flexion deformities, narrowing and ulnar deviation of the fingers. The thumb may be held in an abnormal position by a soft-tissue web. Rocker-bottom foot may develop, due to vertical talus. The facies is normal and the mentality is unimpaired. 3. The general health is good but orthopaedic measures may be needed for function and cosmesis. 4. The condition is transmitted as an autosomal dominant trait, with varying clinical expression of the abnormal gene


The Journal of Bone & Joint Surgery British Volume
Vol. 76-B, Issue 3 | Pages 477 - 479
1 May 1994
Cohen B Piscioneri F Candido F Rankin K

The prevalence of HIV infection in East Africa has increased rapidly in recent years. We made a prospective study of the incidence of HIV-seropositivity in patients undergoing orthopaedic procedures in a large district hospital in Bulawayo, Zimbabwe. One of our aims was to determine whether a clinically-based screening programme, derived from the Centre for Disease Control classification of HIV infection, could identify high-risk individuals before surgery. During a 3-month period, 76 patients were tested, and 12 were HIV-positive (16%). Only two of these patients (17%) had clinical features associated with HIV infection; ten (83%) were entirely asymptomatic. Our results indicate that preoperative clinical screening is unlikely to be successful in identifying seropositive patients before routine surgery


Bone & Joint 360
Vol. 10, Issue 5 | Pages 47 - 47
1 Oct 2021


The Journal of Bone & Joint Surgery British Volume
Vol. 58-B, Issue 4 | Pages 492 - 495
1 Nov 1976
Davidson J Beighton P

During the course of a nation-wide survey of patients with bone and joint deformities, twenty-six individuals with arthrogryposis multiplex congenita, in the narrow and precise sense of the term, were investigated. No patient was more than twenty-four years of age. However, on a basis of the figures of population, it can be estimated that 21-0 +/- 6-5 older affected individuals should have been encountered. Furthermore, there was a relative excess of younger children. The series was reasonably unbiased, and as arthrogryposis is non-lethal the deficiency of affected adults is an anomalous finding. It is tentatively suggested that arthrogryposis might result from the intra-uterine influence of an unknown environmental agent which has been present in South Africa for only a limited period of time. Detection of this factor could be an important step in the prevention of the disease


The Journal of Bone & Joint Surgery British Volume
Vol. 72-B, Issue 4 | Pages 658 - 663
1 Jul 1990
Sedel L Kerboull L Christel P Meunier A Witvoet J

Total hip replacement using an alumina head and socket and a titanium alloy stem is evaluated in a series of patients under 50 years of age. Between April 1977 and December 1986, 86 such replacements were performed in 75 patients, but mainly because patients had difficulty travelling from Africa, only 71 hips were followed up adequately; of these, 56 were primary procedures and 15 revisions. Survivorship analysis showed that 98% of the prostheses were retained for 10 years. On clinical and radiological examination 51 of the 71 hips were stable and acceptable, 15 had radiological changes on the acetabular side, and one on the femoral side; four other cases had clinical and radiological changes suggesting impending failure, possibly because fixation of the socket was inadequate. There were no differences between the results of the primary procedures and those of revisions. In these young patients, the results seem better with alumina-on-alumina hips than with other varieties, possibly because of their remarkably low wear


Bone & Joint 360
Vol. 10, Issue 4 | Pages 52 - 52
1 Aug 2021


The Journal of Bone & Joint Surgery British Volume
Vol. 47-B, Issue 1 | Pages 61 - 71
1 Feb 1965
Davis PR Rowland HAK

1. Radiography of the spines of thirty-three West African patients recently recovered or dead from tetanus revealed vertebral fractures in nineteen. These fractures occurred most frequently in the fourth to eighth thoracic vertebrae. 2. The spines of 111 Nigerians from the same area of West Africa were examined, measurement of the areas and shape of the vertebral bodies carried out, and the proportional incidence of articular shelves and laminar spicules was calculated. 3. The upper mid-thoracic vertebral bodies are relatively long and narrow and have but little greater cross-sectional area than those immediately above them; possessing no neural arch supports to sustain longitudinal compressive forces in flexion, they are at greatest hazard during tetanic spasms. 4. Analyses of these factors and of the clinical features, together with experimental observations drawn from the literature, are used to explain the prevalence of upper mid-thoracic vertebral fractures as a complication of tetanus in West Africans, and in particular the greater degree of compression and higher incidence found in children. 5. Vertebral fracture is not usually an important complication of tetanus; it causes little pain, does not prolong the illness, gives rise to no permanent disability and has no effect on the mortality


The Journal of Bone & Joint Surgery British Volume
Vol. 84-B, Issue 5 | Pages 732 - 734
1 Jul 2002
Lewis CP Lavy CBD Harrison WJ

The atlas of Greulich and Pyle for skeletal maturity and epiphyseal closure is widely used in many countries to assess skeletal age and to plan orthopaedic surgery. The data used to compile the atlas were collected from institutionalised American children in the 1950s. In order to determine whether the atlas was relevant to subSaharan Africa, we compared skeletal age, according to the atlas, with chronological age in 139 skeletally immature Malawian children and young adults with an age range from 1 year 11 months to 28 years 5 months. The height and weight of each patient were also measured in order to calculate the body mass index. The skeletal age of 119 patients (85.6%) was lower than the chronological age. The mean difference was 20.0 ± 24.1 months (t-test, p = 0.0049), and the greatest difference 100 months. The atlas is thus inaccurate for this group of children. The body mass index in 131 patients was below the normal range of 20 to 25 kg/m. 2. . The reasons for the low skeletal age in this group of children are discussed. Poor nutrition and chronic diseases such as malaria and diarrhoea which are endemic in Malawi are likely to be contributing factors. We did not find any correlation between the reduction in body mass index in our patients and the degree of retardation of skeletal age


The Bone & Joint Journal
Vol. 103-B, Issue 7 | Pages 1309 - 1316
1 Jul 2021
Garg B Bansal T Mehta N

Aims

To describe the clinical, radiological, and functional outcomes in patients with isolated congenital thoracolumbar kyphosis who were treated with three-column osteotomy by posterior-only approach.

Methods

Hospital records of 27 patients with isolated congenital thoracolumbar kyphosis undergoing surgery at a single centre were retrospectively analyzed. All patients underwent deformity correction which involved a three-column osteotomy by single-stage posterior-only approach. Radiological parameters (local kyphosis angle (KA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), C7 sagittal vertical axis (C7 SVA), T1 slope, and pelvic incidence minus lumbar lordosis (PI-LL)), functional scores, and clinical details of complications were recorded.


The Bone & Joint Journal
Vol. 103-B, Issue 3 | Pages 547 - 552
1 Mar 2021
Magampa RS Dunn R

Aims

Spinal deformity surgery carries the risk of neurological injury. Neurophysiological monitoring allows early identification of intraoperative cord injury which enables early intervention resulting in a better prognosis. Although multimodal monitoring is the ideal, resource constraints make surgeon-directed intraoperative transcranial motor evoked potential (TcMEP) monitoring a useful compromise. Our experience using surgeon-directed TcMEP is presented in terms of viability, safety, and efficacy.

Methods

We carried out a retrospective review of a single surgeon’s prospectively maintained database of cases in which TcMEP monitoring had been used between 2010 and 2017. The upper limbs were used as the control. A true alert was recorded when there was a 50% or more loss of amplitude from the lower limbs with maintained upper limb signals. Patients with true alerts were identified and their case history analyzed.


Bone & Joint Open
Vol. 1, Issue 6 | Pages 198 - 202
6 Jun 2020
Lewis PM Waddell JP

It is unusual, if not unique, for three major research papers concerned with the management of the fractured neck of femur (FNOF) to be published in a short period of time, each describing large prospective randomized clinical trials. These studies were conducted in up to 17 countries worldwide, involving up to 80 surgical centers and include large numbers of patients (up to 2,900) with FNOF. Each article investigated common clinical dilemmas; the first paper comparing total hip arthroplasty versus hemiarthroplasty for FNOF, the second as to whether ‘fast track’ care offers improved clinical outcomes and the third, compares sliding hip with multiple cancellous hip screws. Each paper has been deemed of sufficient quality and importance to warrant publication in The Lancet or the New England Journal of Medicine. Although ‘premier’ journals, they only occationally contain orthopaedic studies and thus may not be routinely read by the busy orthopaedic/surgical clinician of any grade. It is therefore our intention with this present article to accurately summarize and combine the results of all three papers, presenting, in our opinion, the most important clinically relevant facts.

Cite this article: Bone Joint Open 2020;1-6:198–202.