Aim

To assess if immediate post-operative weight bearing has a negative influence on the results of osteotomy plus distal soft tissue repair to correct hallux valgus.

Design

The results of a crescentic osteotomy plus distal soft tissue repair with Akin osteotomy added as indicated were assessed in 61 consecutive cases. Thirty five were bilateral. This gives a total of 96 feet. During this time other procedures were also performed for hallux valgus.

Purpose of Study

Lengthening of the gastrocsoleus for equinus deformity is commonly performed in orthopaedic surgery. The aim of this study was to describe the precise details of each surgical procedure and assess each biomechanically in cadaver models.

Description of Methods

The surgical anatomy of the gastrocsoleus was investigated and standardized approaches were developed for the procedures described by Baumann, Strayer, Vulpius, Baker, Hoke and White. The biomechanical characteristics of these six procedures were then compared, in three randomized trials, in formalin preserved, human cadaver legs. The lengthening procedures were performed and a measured dorsiflexion force was applied across the metatarsal heads using a torque dynamometer. Lengthening of the gastrocsoleus was measured directly, by measuring the gap between the ends of the fascia or tendon.

Purpose

The purpose of this study was to follow up a cohort of South African doctors who had previously failed a validated musculoskeletal assessment tool, to examine the effect of a two-month Orthopaedic internship rotation on musculoskeletal competency.

Methods

A validated competency examination in orthopaedic medicine was used as the assessment tool. Topics included fractures and dislocations, arthritis, basic anatomy and emergencies that require immediate referral to an orthopaedic surgeon. The questionnaire consists of twenty-five short-answer questions. A validated answer key and scoring system were used to mark the questionnaire. In a previous study, we found that 91 per cent of South African doctors in our study group, at the start of their internship, failed to demonstrate basic competency on the examination. We concluded that medical school preparation in orthopaedic medicine in South Africa is inadequate. We reapplied the examination at the end of 2011 to a study group of seventy-six first and second-year interns, to assess whether a two-month orthopaedic rotation during internship had a significant effect on musculoskeletal competency.

Purpose

Intramedullary fixation of clavicle fractures requires an adequate medullary canal to accommodate the fixation device used. This computer tomography anatomical study of the clavicle and its medullary canal describes its general anatomy and provides the incidence of anatomical variations of the medullary canal that complicates intramedullary fixation of midshaft fractures.

Methods

Four hundred and eighteen clavicles in 209 patients were examined using computer tomography imaging. The length and curvatures of the clavicles were measured as well as the height and width of the clavicle and its canal at various pre-determined points. The start and end of the medullary canal from the sternal and acromial ends of the clavicle were determined. The data was grouped according to age, gender and lateralization.

Background

This is a continued assessment of the effectiveness of a locked intramedullary device in the treatment of acute clavicle shaft fractures. Results of patients treated thus far were assessed, including patients reported on previously.

Description of methods

Patients admitted with midshaft clavicle fractures were assessed to determine whether operative fixation of the fracture was required. Indications for surgery were midshaft clavicle fractures with 100% displacement; more than 1.5 cm of shortening, presence of a displaced butterfly segment, bilateral clavicle fractures, ipsilateral displaced glenoid neck fractures, skin and neurovascular compromise. Patients that matched the criteria for surgery were treated operatively with an intramedullary locked device by the author. Post-operatively, patients were kept in a shoulder immobilizer for a period of 6 weeks. Patients were invited to attend a scheduled follow-up visit where the data was collected that comprised the review. All patients were assessed by the surgeon, a radiologist, a physiotherapist and an occupational therapist. Scar size and quality, Dash score, Constant Shoulder score, complications and the radiological picture were assessed.

Background

This is an epidemiological study of patients with middle third clavicle fractures presenting to a tertiary hospital. The data is used to formulate a classification system for middle third clavicle fractures based on fracture configuration and displacement.

Description of methods

Patients presenting primarily to a referral hospital with middle third clavicle fractures were identified using the PACS radiology system. The radiographs were reviewed to determine the fracture type, displacement, shortening and amount of comminution. The clinical notes of each patient were reviewed to determine the mechanism of injury, soft tissue status, neurovascular status and treatment rendered. A novel classification system was developed to describe the different fracture configurations seen in the group. The interobserver and intraobserver correlation of the classification system as well as the ability of the classification system to predict treatment were tested.

Purpose

Penetrating injuries of the hand and forearm may cause significant morbidity for a patient. Our aim was to evaluate the accuracy of initial examination of forearm lacerations and pre-operative examination and compare both to the actual findings on surgical exploration. We wanted to identify any factors which may influence the accuracy of the initial examination. Existing literature indicates that there are differences between initial and subsequent examination in terms of picking up injuries.

Methods

65 consecutive patients with penetrating injuries to the hand/forearm were studied. The admitting casualty doctor/s completed an admission form indicating their findings on examination. Factors which may have hampered history taking and examination were noted on the form. The same form was filled in prior to surgery by one of the hand registrars after re-examining the patient prior to surgery. A separate surgical form was filled in by the surgeon indicating the actual findings at surgery.

Aim

We aimed to assess the efficacy of conservative management of proximal phalanx fractures in a plaster slab.

Methods

23 consecutive patients with proximal phalanx fractures were included in this prospective study. The fractures were reduced and the position was held with a dorsal slab for three weeks. They were followed up an average of 7 weeks (range 2 to 45) after the injury. Radiographic confirmation of adequate reduction was carried out each week until union. After removal of the plaster, range of motion of the finger and radiological evidence of union, non-union or malunion was documented.

Aim

Distal interphalangeal joint (DIPJ) arthrodesis is a well-accepted treatment of disease in the DIPJ of the hand. The ideal technique should be technically simple, quick, cheap, have minimal complications and yield a rapid return to function. Recent large published series report major complications of 11.1% and minor complications of 26% for this procedure. The study objective is to determine patient satisfaction and complication rates of DIPJ fusion using the Autofix screw (Small Bone Innovations, France), a smaller diameter headless compression screw.

Methods

A standard questionnaire was devised to assess patients' overall satisfaction and complications related to the procedure. This data is compared to equivalent procedures published internationally. The patient's radiological records were reviewed to determine bone union at 7 weeks post-operation.

Background

This retrospective analysis was prompted by the authors' observation of the relatively high incidence of venous thromboembolism (VTE) in the surgical repair of acute Achilles tendon ruptures.

Method

88 patients were treated surgically for an acute Achilles tendon rupture. No prophylactic anticoagulation was given to any patients. The incidence of VTE was then reviewed retrospectively.

Introduction

Total Ankle replacement designs continue to evolve, and provide an alternative to ankle arthrodesis for patients with ankle arthritis. It has been our practice to offer total ankle replacement to selected patients with ankle arthritis. The purpose of this study was to analyse the short term results of our patients with the Mobility R Total Ankle Replacement (TAR) system.

Methods

All patients who received TAR in our practice from 2004 to 2011 were reviewed. American Orthopaedic Foot and Ankle Scores AOFAS were assessed and compared both preoperatively and at time of follow-up. All complications both intra-operative and post-operatively were noted. Weight bearing X-rays were taken at follow-up, and implant alignment and the presence of lucencies were noted.

Aim

Research projects are a compulsory part of the postgraduate curriculum in most Academic Departments. To not only fulfil study requirements, but to ensure noteworthy and accurate results meticulous and reliable data collection is necessary. Our aim was to better understand what preferences health care professionals have in undertaking data collection.

Methods

We did a choice based conjoint analysis with an online data collection survey. This study type allows the evaluation of the relative importance of component attributes. We used 4 major criteria to evaluate preferences when performing data collection. These were: 1. Time to complete the form, 2. Remuneration and recognition, 3. Study design and 4. Responsibilities at the time of collection. We sent electronic questionnaires to doctors in the Orthopaedic, Ophthalmology and Plastic Surgery Departments at a Johannesburg Academic Institution.

Purpose of the study

Fibromatosis is a benign, but locally aggressive tumour. We had a series of patients who had a high rate of recurrence though they had a wide surgical excision. The question raised was whether there are newer treatment modalities with a higher success rate. We did a retrospective study and review of the literature in order to see if there was anything new that can help us reduce recurrences.

Materials and Methods

A retrospective study of all patients who presented with histologically confirmed fibromatosis at an orthopaedic practice in the past 19 years was conducted. Age of the patient at first presentation; sex; tumour site; surgery performed; histological results; first line of treatment and recurrence rate were reviewed. Patients were also contacted telephonically in order to know if they had any recurrence that was managed by another orthopaedic surgeon.

Purpose

Adipose derived stem cells have been shown to enhance both wound and bone healing. The stem cells are harvested, purified, cultured and the viability assessed in order to provide adequate cellular yield. The isolation process requires trained laboratory staff, intensive procedures utilizing multiple purification solutions and expensive equipment for culturing and interpretation of viability of the isolated stem cells.

The aim of the study was to investigate the effect of simple lipo-aspirate on wound and bone healing.

Methodology

This is a prospective, interventional study to investigate the effect of adipocyte extract on wound and bone healing. 9 Young, healthy, large white female pigs were used in the study. Fat was harvested using standard liposuction technique and injected around the defects created. Skin defects were evaluated for secondary wound healing macroscopically and histologically. 3 pigs were used in a pilot study to evaluate the possibility of investigating the effects of lipo-aspirate in bone defects.

Purpose of study

To gather & interpret statistics surrounding orthopaedic trauma in order to improve on infrastructure & logistics within our department and to highlight the massive social burden of orthopaedic trauma

Description of methods

A retrospective review of all orthopaedic casualty, admissions and theatre cases in 2011 from casualty and theatre registries along with weekly Morbidity & Mortality presentations.

Aim

The purpose of this study was to establish the diagnostic utility and spectrum of fluoroscopy guided percutaneous transpedicular biopsies of the thoraco-lumbar spine performed at our institution and to review some aspects regarding the diagnosis of spinal tuberculosis (TB).

Methods

A retrospective study was performed on a consecutive series of 48 patients who underwent fluoroscopy guided percutaneous transpedicular biopsies of the spine performed at our institution. Biopsy specimens were sent for microscopy, culture and sensitivity (MC&S) as well as for TB microscopy, culture and polymerase chain reaction (PCR) and for histology.

Purpose of the study

Percutanous acetabular surgery is a new and developing technique in fixation of acetabulum fractures. The most common screw used is the anterior column screw that traverses anterograde or retrograde through the anterior column of the acetabulum. Standard height and width calculations derived from CT scans do not take the trajectory of the screw into consideration. They have been shown to exaggerate the available safe bone corridor for screw passage. Posterior column screws can be placed in a retrograde fashion via the ischial tuberosity to fixate posterior column. Limited international data is available and no studies to date have been conducted on the South African population. This study assesses the anterior and posterior acetabular columns of South African individuals and ascertains the safe bone corridor sizes.

Methods

Pelvic CT-scans of 100 randomly selected patients were reviewed. Specific computer software was used to virtually place anterior screws through the anterior acetabular column, in its clinical trajectory. Specific entry points inferior to the pubic tubercles significantly changed the relation of the screw trajectory to the mid- column isthmus and were incorporated in the measurement of the anterior column. All the available lengths and diameters were measured and averages were calculated for males and females.

Objective

To investigate the relationship between the pattern of pelvic or acetabular fracture, and bladder injuries.

Methods

A total of 173 patients admitted at our Academic Hospital from January 2006 to March 2012 with cystograms done for pelvic or acetabular fractures were studied retrospectively. Records of pelvic X-Rays, CT scans and cystograms were reviewed. Tile's classification and Young & Burgess classification were used for pelvic fractures and Judet & Letournel classification system for acetabular fractures.

Purpose of study

Unstable pelvic ring injuries usually occur in polytrauma patients and are associated with high mortality and morbidity. Percutaneous screw fixation of sacro-iliac joint dislocations, fracture-dislocations and sacral fractures is a well-recognised technique first described by Routt and is increasingly gaining popularity. This method is biomechanically comparable to open reduction and internal fixation with plates and screws but offers the advantages of minimally invasive surgical techniques. It is however a technically demanding procedure with reported complications including hardware failure, misplacement of screws, nerve injury and poor posterior reduction. The purpose of the study is to report clinical results of patients treated with closed reduction and percutaneous ilio-sacral screw fixation for unstable pelvic ring fractures by a single surgeon.

Methods

A review of prospectively collected data was performed on all patients who had percutaneous sacro-iliac fixation between 2009 and 2012. Thirty five percutaneus sacro-iliac screws were inserted in 30 patients with a mean age of 25.6 years (range 17–62). Fracture types included 10 AO type B, and 20 AO type C. The mean follow-up period was 11.6 months (range 3–38).

The complications assessed were screw misplacement, neurovascular complications, hardware breakage and loss of reduction.

Purpose of study

The addition of interlocking screws to intramedullary nails adds greatly to the stability of these constructs, yet the placement of distal screws accounts for a significant proportion of the total fluoroscopy and operative times. The Sureshot® (Smith and Nephew™) is a computerised system that allows placement of distal screws without fluoroscopy by using electromagnetic guided imagery. The purpose of this study is to compare traditional free-hand technique to the Sureshot® technique in terms of operating time, radiation dose and accuracy.

Methods

Between September 2011 and March 2012 we prospectively randomised 66 consecutive patients presenting to us with femur shaft fractures requiring intramedullary nails to either free-hand (n=33) or Sureshot® assisted (n=28) distal locking. Fractures warranting only one distal locking screw, or those requiring retrograde or cephalo-medullary nailing, were excluded. Five patients' data was not suitable for analysis. The two groups were assessed for distal locking time, distal locking radiation and accuracy of distal locking.

Background

In 2011 Aird et al published their results of the effects of HIV on early wound healing in open fractures treated with internal and external fixation. The study was conducted between May 2008 and March 2009 and performed in semi-rural area of KwaZulu-Natal, South Africa. These results suggested that HIV is not a contraindication to internal or external fixation of open fractures, as HIV is not a significant risk factor for acute wound implant infection. We present a longer term follow up of this same cohort of patients from the original study.

Methods

From March 2011 to January 2012 we attempted to contact all patients from Airds original study. A simple telephonic questionnaire was obtained from all the patients contacted, regarding possible late sepsis, non-union and implant removal. Patients were requested to visit the outpatient department for a clinical assessment, a repeat HIV test and new X-rays.

Purpose

Distal metaphyseal radial fractures are common in the paediatric population and the management of these fractures is controversial. The incidence of re-displacement in the closed management of these fractures is as much as 30% in some studies. Various methods have been described with the view to predict fracture displacement of distal radial fractures in children. One of these indices is the three point index (TPI). This index seeks to assess the adequacy of 3 point moulding and thus predict fracture displacement. It is a calculated ratio that if above 0.8 states that there is an increased risk of fracture re-displacement. The purpose of this study is to assess the accuracy of this index in predicting displacement of distal radial fractures in children.

Methods

This retrospective study included 65 patients of both sexes under the age of 13 for a period of one year from January 2011 to January 2012. All patients with a dorsally displaced fracture of the distal radius were included. 22 patients were excluded because of loss to follow-up or absence of a complete series of x-rays. All patients were taken to theatre for a general anaesthetic and manipulation of their fractures using an image intensifier to confirm reduction. X-rays of initial fracture displacement, post manipulation position and follow-up fracture position at 2 and 6 weeks were assessed. The sensitivity, specificity, negative and positive predictive values of the TPI in screening for fracture re-displacement were calculated.

Aims

To describe four South African patients (including a sibling pair) with pycnodysostosis and to highlight the importance of a comprehensive assessment of the patient, and not just the fracture. To emphasise the significance of the input of a multidisciplinary team which should include a medical geneticist, in order to provide optimal care for patients and their families.

Methods

A comprehensive evaluation of the clinical and radiological features of these four patients was undertaken and the orthopaedic complications documented, with the times from presentation to definitive diagnosis.

Objective

To determine the incidence, distribution and associated organ damage in patients that sustained multilevel spinal injuries presenting to a level 1 trauma unit. Is the standard trauma series adequate?

Methodology

A retrospective, chart review of all spinal injury patients that were admitted to the spinal unit from March 2007 to May 2011 was performed. Patients with multilevel spinal injuries were isolated from paediatric, single level, and gunshot injuries. All Trauma unit patients undergo a full body C.T scan with angiography. Using the radiologist's reports the incidence, mechanism of injury, distribution patterns and associated organ damage sustained by this subset of patients was tabulated and reported on.

Purpose

To determine whether MRI done prior to reduction altered the surgeon's choice of reduction method.

Method

One hundred and four patients were included in this retrospective review. The first component of this study identified the presence of uncontained, herniated discs in this patient group. The MRI scans were reviewed by two teams including a radiology team and orthopaedic team. These scans were assessed without clinical information and the teams did not have access to the patient notes. An Interrater agreement assessment was applied to the data and the most reliable inter-observer variables of disc injury were chosen to identify the presence of a herniated uncontained intervertebral disc. The second part of this study entailed a detailed clinical note review specifically looking at type of reduction, whether it was intended and the reason why a certain type of reduction was chosen. These naturally divided the 104 patients into 5 cohorts including; closed reduction, Intended open reduction due to the documented presence of a ‘dangerous disc’, open reduction following failed closed reduction, open reduction with no documented reason and open reduction due to delay in presentation. Since closed reduction would not be considered in delayed presentations this cohort was removed from data analysis. Additionally the pre and post reduction neurological status was noted.

Purpose

To perform an Interrater reliability study determining the agreement between an Orthopaedic team and a Radiology team on the MRI features of prolapsed uncontained cervical discs in Flexion-Distraction injuries of the cervical spine. This leads us to determine how many patients demonstrated evidence of a ‘dangerous’ disc: an uncontained disc herniating posteriorly that may be drawn into the spinal canal during closed reduction.

Methods

One hundred and ten patients who had pre-reduction MRI scans managed during the last 10 years were included. Variables were chosen and defined by the senior Author and explained to both teams prior to reviewing the scans. The review was performed by each team independently and without any access to clinical information. Data collection and interpretation was designed by a statistician to reduce risk of data entry errors. Interrater reliability/agreement was determined using the Cohen Kappa value.

Purpose of study

The vast majority of C2 ring fractures can be managed non-operatively but occasionally the situation precludes this and surgery is considered. Thus study reviews our indications and surgical options in this scenario.

Methods

A retrospective review of patient folders and x-rays was performed of all patients with C2 traumatic spondylolisthesis that were managed surgically between 2003 and 2012.

Demographic data, particularly indications for surgery, the options chosen and the clinical and radiological outcomes were analysed.

Purpose of study

Transarticular screw fixation offers acceptably high fusion rates but is not possible in 18% of patients due to a high riding vertebral artery. It also requires pre-operative anatomical reduction which is not always possible. The Harms' technique utilises a posterior C1 lateral mass and C2 pedicle screw. This allows easier access due to the angle of drilling and has become an increasingly popular surgical technique.

The aim of this study is to review and compare the above techniques with regard to surgery, complications and outcome.

Description of methods

This study is a retrospective chart and radiographic review of patients undergoing posterior C1-2 fusion in a single institution in the period 2003 to 2011. The most common aetiology was rheumatoid arthritis and post-traumatic instability. All atlanto-axial instability patients that came to surgery are included in this study, and only cases with less than six months follow-up were excluded. We report on surgical indications, surgical outcomes, complications and radiographic outcomes.

Purpose of the study

The aim of the study was to review the surgical management of Neuromuscular Scoliosis (NMS) and its outcome.

Method

NMS patients who underwent surgery between 2001 and 2012 were identified. Case notes, surgical data, complications and radiographic results were reviewed retrospectively. The families were contacted telephonically. Sitting posture status and whether the parents and patients would opt to have the surgery again if given the opportunity, was assessed.

Aim

To investigate anterior instrumented corrective fusion for thoracolumbar or lumbar scoliosis.

Methods

A retrospective review of medical records and radiographs of 38 consecutively managed patients who underwent anterior spine surgery for thoracolumbar curves by a single surgeon between 2001 and 2011. The cohort consisted of 28 female and 10 male patients with idiopathic scoliosis as the commonest aetiology. Data collated and analysed included patient demographics, surgical factors, post-operative management and complications. In addition, radiographic analysis was performed on pre-operative and follow-up x-rays.

Aim

To assess the process of using patient matched cutting blocks in Primary TKA with respect to: radiology, the proposed engineering plans, the process in theatre and cost effectiveness. Background: Patient matched cutting blocks (PMCB) are the subject of much interest in primary TKA. Our unit has experience of over 100 cases with a single system.

Method

We have analysed our initial experience with PMCB. We have compared the sizes of implants used in theatres versus the sizes predicted on the image-generated plans. We have assessed the potential time saving in theatre, during each case and in the turn-around time between cases. We have also looked at the number of trays of instruments used in PMCB versus non-PMCB cases.

Background

In our pursuit of surgical accuracy and precision we often neglect to evaluate our results objectively. With the use of Computerised Tomography (CT) in pre-operative planning we can use the same technology in order to evaluate surgical accuracy.

Hypothesis

The use of Patient Specific Instrumentation (CT based) produces an accurate intra operative guide for precision cutting in knee arthroplasty.

Aim

To assess the clinical outcome at 1 year of 30 cases of primary TKA performed with PMCB.

Method

Data was collected prospectively pre-operatively on over 100 primary TKA's performed with PMCB. Of these cases, 30 have reached a point of 1 year follow-up. Validated outcome measures including American Knee Society score, Oxford Knee Score and WOMAC were completed pre-operatively and at 1 year. Radiographic analysis of alignment was performed.

Aim

To assess the accuracy of predicted and actual cut alignment from PMCB versus intra-operative computer navigation.

Method

We performed 10 primary TKA cases in which both PMCB and computer navigation were used. Standard imaging was performed to generate the plan and the cutting blocks to perform the case with PMCB. At the start of the case, standard navigation procedure was followed using the Praxim navigation system to register the centre of the femoral head, femoral and tibial surfaces and alignment. The PMCB were applied to the femur and tibia and the navigation cut-registering shim was placed in the slot on the PMCB to record the position and alignment of the proposed cut in the coronal and sagittal planes. The following parameters were compared: overall limb alignment in the coronal plane, distal femoral coronal angle, depth of resection on medial and lateral distal femoral condyle and depth of resection on medial and lateral proximal tibia. Differences in the pre-operative PMCB plan, intra-operative navigation assessment and proposed cuts after application of the blocks intra-operatively were recorded.

Background

Patient satisfaction after TKR ranges from 75 to 95 percent with 5 to 20 percent of patients who are dissatisfied with their outcome. Noble has shown pain to be the most important factor in patient satisfaction after TKR with others showing patient expectation and increased age to be important. Stability of the flexion gap has been shown by Dennis to be important in wear in the long term, but to our knowledge no study has been done linking stability of the flexion gap to patient satisfaction.

Methods

65 patients underwent a computer navigated TKR with a posterior stabilized fixed bearing prosthesis by a single surgeon. Intraoperative measurements were captured of the flexion gap laxity on varus and valgus stress to evaluate stability of the flexion gap. Patients were divided into a stable group with lift off of 3 mm or less and a lax group with lift off of more than 3 mm on either side. No patient in either group had symptoms of clinical instability. This was correlated with patient satisfaction at one year postoperatively as assessed by telephonic interview.

Introduction

Maximizing efficiency in total knee replacement surgery is desirable and one of the key aspects is optimum utilization of available theatre time allocation. The level of complexity of the pathology is often one of the determinants of the length of operative time. Body mass index (BMI) has also been positively correlated with operative time. However, two patients with the same BMI but different body habitus (central obesity vs generalized obesity) may present different challenges during surgery. An index focusing on the anthropometry of the lower limb (supra-patella index SPI) has been proposed and we hypothesize that it correlates more closely with operative time than BMI.

Method

BMI and SPI were determined in all patients recruited into a prospective trial of a specific knee implant. All patients were operated on by one of two surgeons in a standardized manner. Data including operative time and tourniquet time were determined.

Purpose of study

The aim is to assess the use of non-fusion instrumentation “growth rods” in early onset scoliosis (EOS).

Methods

A retrospective review of 12 consecutive patients who had undergone a growth rod procedure for EOS was performed.

Six patients had neuromuscular scoliosis, 5 had juvenile idiopathic scoliosis while one had a congenital aetiology. Growth constructs were predominately constructed from modular commercially available sets using hooks, screws and connection blocks. One VEPTR was used in a severe kyphoscoliosis. Patients returned to theatre at 6 monthly intervals for a lengthening procedure.

Patients were assessed with regards to age at presentation, age at surgery, indications for surgery, initial Cobb angle, post- operative Cobb angle, number of lengthening's done, instrumentation used, amount of spine growth achieved and complications.

Objective

Posterior vertebral column resection (PVCR) is indicated in the management of severe rigid spine deformities. It is a complex surgical procedure and is only performed in a few spine centres due to the technical expertise required and associated risk. The purpose of this study is to review the indications, surgical challenges and outcomes of patients undergoing PVCR.

Methods

12 patients with severe spinal deformities who underwent PVCR were retrospectively reviewed after a follow-up of 2 years. Surgery was performed with the aid of motor evoked spinal cord monitoring and cellsaver when available. The average surgical duration was 310 minutes (100–490). The average blood loss was 1491 ml (0–3500). The indication for PVCR was gross deformity and myelopathy which was due to congenital spinal deformities and one case of old tuberculosis. Clinical records and the radiographic parameters were reviewed.

Background

Foraminal stenosis is often encountered in patients undergoing decompression for spinal stenosis. Given the increased resection of facets and the presence of the more sensitive dorsal root ganglion, it is hypothesized that patients with foraminal stenosis have poorer postoperative outcomes.

Methods

Thirty-one patients undergoing decompression without fusion for lumbar spinal stenosis were evaluated. The degree of foraminal stenosis was determined by 2 independent reviewers for absence of fat around the nerve roots. ImageJ digital imaging software was also used to evaluate the foraminal area. Patients with foraminal stenosis were compared with those without using the Oswestry Disability Index (ODI) and a numerical pain scale for back and leg pain at a minimum of 1 year follow-up.

Purpose of Study

Discecomy is a common operation peformed for back pain at our hospital. We analysed the theatre register looking at demographic and health data for our patients to shed more light on this cases

Description of Methods

Entries in the spinal unit theatre registers from 2000–2012 were reviewed, and all patients undergoing discectomy for disc herniation recorded analysed regarding demographics and epidemiology.

Aim

To analyse the available rotating hinge knee implants available on the market with a view to deriving a rational algorithm for implant selection.

Method

Information on available hinge designs was gathered from the literature and further questionnaires were sent to the relevant implant companies asking for more specific information regarding the minimum bone resection necessary to accommodate the implant, the maximum bone loss that can be compensated with augments, method of transmission of forces, type and size of stems, availability of metaphyseal-filling cones and cost.

Aim

To assess the outcome and complication rate of rotating hinge knee prostheses in our unit.

Method

From our knee database we have identified 137 consecutive rotating hinged TKRs (implanted 2004–2010) for severe instability, arthrofibrosis and severe bone loss in either primary or revision arthroplasty. Prospective pre-operative scores and post-operative scores were obtained. 23 had died or were lost to follow-up. This left 114 cases with complete outcome and complication data.

Objectives

The aim of this study was to study the short to medium term outcome of a contemporary modular revision knee system used in our centre for managing knee revision arthroplasty.

Methods

Between July 2006 and October 2011, 153 revision cases were done using the Legion revision system. Seventy eight cases completed a 2 years follow up. Preoperative, one and two years follow up scores and radiographic analysis were recorded. Outcome measures included the American Knee Society (AKSS), Oxford (OKS) and WOMAC scores. The American knee society radiographic analysis system was employed to assess assessment standing AP, lateral and skyline views. Figgie's method was used to measure the joint line reproduction. A difference of 5 mm (pre=op/post-op) was deemed satisfactory.

Aim

To assess the survivorship of unicompartmental replacements (UKR) revised to UKR. Background: Partial revision of UKR, or revision to a further UKR is a rarely performed procedure with some data from the Australian registry suggesting that results are not good, with early revision being required.

Method

All revision procedures from initial UKR are prospectively followed and scored as part of our department's knee database. We analysed the 37 cases in our database that showed revision of UKR to UKR. These included cases in the following categories: a) Mobile bearing revised to mobile bearing (n=8) b) Mobile bearing revised to fixed bearing (n=20) c) Fixed bearing revised to fixed bearing (n=9)

Introduction

Periprosthetic medial tibial plateau fractures (TPF) are rare but represent a serious complication in unicompartmental knee arthroplasty (UKA). Most common treatment of these fractures is osteosynthesis with canulated screws or plates.

Aim

The aim of this study was to evaluate these two different treatment options of periprosthetic fractures. The hypothesis was that osteosynthetic treatment with plates show significantly higher maximum fracture loads than fixation with cannulated screws.

Aim

To assess if there is a reproducible relationship between the width and thickness of the normal patella.

Method

43 MRI scans of young adults, average age 27 (range 17–38) were studied. Exclusion criteria included a diagnosis of degenerative joint disease, patella-femoral pathology or age under 16/over 40 (102 patients). The bony thickness of the patella, the chondral thickness and patella width were measured, as was the location of maximal patella thickness. Inter/intra observer variability was calculated and correlation analysis performed.

Background

Using digital X-rays to plan a hip replacement can cause problems with sizing and templating the prosthesis. Using an AP view of both hips is desirable as this allows the use of the sometimes unaffected contralateral hip for templating.

Method

We devised a method of using a 20mm ball bearing as a marker positioned at the same depth as the greater trochanter, but between the patient's legs. Placing the marker between the patient's legs avoids the problem of the marker disappearing off the side of the X-ray, as is seen when placing the marker at the side of the obese patient. The marker is then used to calibrate the size of the digital X-ray. We used a hundred consecutive post-operative X-rays, comparing the size of the head of the femoral prosthesis used at surgery with the size measured pre-operatively using the marker.

Purpose

To assess whether anterior cruciate ligament (ACL) reconstruction performed at an Academic Hospital improves knee function and allows patients to return to their pre-injury level of normal and sporting activity.

Methods

We included patients with an isolated ACL injury who had an ACL reconstruction performed by the arthroscopy unit at an academic hospital.

A single follow-up visit at a minimum of 1 year after surgery was performed, testing the following:

Purpose

South African arthroplasty surgeons commonly make use of new bearing surface technology. This new technology only has short term, industry funded clinical trials or simulator studies available to prove its performance and motivate its use. These products are being used despite the availability of conventional components with proven long term in vivo efficacy.

In the light of the recent Du Puy ASR recall, which also showed initial good clinical results, we reviewed the available data on some of the new available bearing surface technology.

Methods

We performed a literature search to identify the best available clinical data regarding duration of follow up and number of patients for a selection of new bearing surfaces and compared it to well known long term clinical follow up studies and joint registry data of conventional products.

Introduction

Digital x-rays on computer screens are difficult to template due to the lack of standardized magnification. This can be overcome by the use of markers placed onto or next to the patient but have certain shortcomings. Trochanteric marker placements are operator dependant and very difficult to use in the obese patient. Inter- thigh markers are also operator dependent and often embarrassing for radiographer and patient. Anterior combined with posterior markers are very accurate (King et al) but can only be used with a digital template system which is costly and time consuming. We would like to describe a new method of posterior bar markers that are easy to use with standard hip templates.

Methods

Over a period of 30 months this method of templating was used on 296 primary total hip replacements. Fifty eight patients had a previous hip replacement with known head diameter which was used as a control to assess the accuracy of enlargement with this method. X-rays were taken of each patient as a standard supine AP of both hips with the patient lying on a marker ruler with 30mm metal bar markers. The X- rays are then loaded onto a PACS digital x-ray system for use in theatre. In theatre the X-rays are enlarged until the 30mm bar markers are enlarged to 31mm on a standard ruler which represents a 20% (as seen in patients with contralateral hip replacements) enlargement of the hip and standard 20% enlarged plastic templates can then be used to measure the neck resection level and assess implant size and offset. The patients with previous contralateral hip replacements were used as controls to evaluate the accuracy of this method by correlating the head size on the enlarged x-ray with the 20% enlarged ruler on the template.

Purpose

Diagnosis of acetabular retroversion is essential in femoroacetabular impingement (FAI), but its assessment from radiographs is complicated by pelvic tilt and the two-dimensional nature of plain films. We performed a study to validate the diagnostic accuracy of the crossover sign (COS) and the posterior wall sign (PWS) in identifying acetabular retroversion.

Method

COS and PWS were evaluated from radiographs and computed tomography (CT) scans as the standard of reference in 50 hips of subjects with symptoms of FAI. A CT-based method using 3-D models was developed to measure the COS, PWS, true acetabular version and pelvic tilt relative to the anterior pelvic plane. The new CT-based method aimed to eliminate errors resulting from variations in the position and orientation of the pelvis during imaging.

Background

Leg length discrepancy real or perceived remains an important source of patient dissatisfaction after a total hip replacement. Pre-operative templating and intra-operative measurement has to be used to ensure an accurate restoration of the normal centre of rotation of the hip as well as equal leg lengths. Theoretically more bone has to be resected from the femur to maintain the centre of the femoral head in the same location. This is due to a smaller size of the prosthetic femoral head compared to the native femoral head. It was postulated that this was an accurate predictor of leg length after a total hip replacement.

Methods

56 consecutive patients who underwent a total hip replacement (cemented, uncemented or hybrid) had intra-operative measurements documented of their femoral head-neck resection distance. This was compared with the measurement of the femoral prosthesis that was inserted. A telephonic survey of the patients perceived leg equality as well as a radiological measurement of their actual leg lengths on a standing AP X-ray at 6 weeks post-operatively was done.

Introduction

The deltamotion bearing system provides a large bearing even with small acetabular components. With optimally placed components the risk of dislocation is extremely low. However the acetabular component is a monobloc system and has significant technical considerations. This is an early series of patients to determine whether a monobloc system can be reliable placed in an acceptable position

Method

66 consecutive deltamotion cases were performed between 1/09/2010 and 31/12/2011. 52 cases were in primary operations and 14 were in revisions. In each case the surgical technique was modified and a trial reduction was performed using the pinnacle trial shell and liner. This enabled the surgeon to determine the optimum combined anteversion before insertion of the definitive component. In no case was a component sacrificed due to failure to achieve adequate press fit fixation. In each case the acetabular component was assessed to determine the angle of inclination and version. 32 cases had follow up of greater than 1 year and these patients were contacted telephonically and interviewed concerning adventitious noises.

Purpose

The outcome of idiopathic chondrolysis in South Africa has been reported as a progressive downhill course resulting in a painful, stiff hip (Jones 1971, Sparks&Dall 1982). The cause of the disease remains unknown. Theories suggested are mechanical (decreased movement with loss of synovial nutrition; increased joint pressure) and an auto-immune response in genetically predisposed individuals. Our experience with continuous passive motion (CPM) and anti-inflammatory treatment has been disappointing.

Method

In order to improve our understanding of the disease and our results, we prospectively studied 5 consecutive patients. All the patients had a subtotal capsulectomy (Roy&Crawford 1988) to relieve intra-articular pressure and correction of the flexion and abduction deformities. Post-operative treatment was with anti-inflammatories and CPM

Purpose

Following closed or open reduction for developmental dysplasia of the hip (DDH), assessment of reduction is essential. With potentially poor accuracy in confirming reduction, the risk of abnormal hip development and ultimately poor outcome exists if reduction is not achieved. Computed tomography (CT) has been used in recent years to assess reduction. The aim of this study was to compare the accuracy in confirming hip reduction following closed or open reduction in children with DDH, using CT and plain radiographs and to decide whether CT scans improved the assessment of reduction.

Methods

We retrospectively reviewed 6 patients treated for DDH at an Academic Hospital. The patients were treated with either closed or open reduction. Post operatively radiographs and CT scans were obtained to assess reduction. Reduction was assessed using Shenton's line, medial joint space, a femoral mid-cervical line through the tri-radiate cartilage and a tri-radiate intersectional line on axial CT. The CT scans were analyzed using Osirix on an Apple Macintosh computer.

Purpose of Study

Multiple measurements have been described for the assessment of developmental dysplasia of the hip (DDH). In particular, the centre edge angle (CEA) has been described by Wiberg to assess the position of the femoral head in relation to the acetabular edge in patients over the age of five years. The purpose of this study is twofold. Firstly to assess the reliability of all measurements available in the literature and secondly to evaluate whether or not the CEA can be reliably measured below five years of age.

Methods

Eighty seven patients were included for assessment. Radiographs were measured within six months of spica cast/Batchelor cast removal, depending on whether closed or open reduction was performed. A web based computer programme was used to store the radiographs electronically and with the help of an electronic template the following measurements were recorded: CEA, AI, centre head distance discrepancy ratio (CHDDR), Smith's c/b and h/b ratios. Three readers recorded measurements at two intervals, to determine intra and inter reader reliability.

Purpose of the study

This study aims to evaluate the use of closed reduction of hips with developmental dysplasia of the hip (DDH) and medial open reduction of these hips as a subsection of closed reduced hips.

Methods

The study was a retrospective analysis of treatment of 30 children with developmental dysplasia of the hip (DDH). These children were taken from a consecutive series of children treated over a period from June 2000 to 2011 with closed reduction by a single surgeon. The ages at the time of diagnosis were between 1 day and 13 months (mean 5.25 weeks). Included in this series are 7 patients treated with medial open reduction, all done with the Ludloff approach. Follow up of these patients was from 8 months to 12 years (mean 5 years). All patients needing secondary procedures were noted. The X- rays were evaluated for percentage acetabulum cover in patients over the age of 8 and improvement of the acetabular index in all these patients.

Purpose

The authors have used the Edinburgh Visual Gait Score (VGS) in the management of diplegic cerebral palsy patients treated with Botulinum toxoid injections into their hamstrings muscles. Video-filmed gait episodes were recorded before and after Botox injections over a treatment period of 6 years from 2007 to 2012.

Method

The video-recordings of 32 patients were available for VGS analysis. Ages ranged from 5 to 22 years, with 17 patients under the age of 12 years, and 15 over 12 years. Gross Motor Function Classification System (GMFSC) levels were accorded to: 8 patients level 1, 10 patients level 2, and 14 patients level 3; 15 were boys and 17 girls. The indication for hamstring injections were a GMFCS level of 1 to 3, age five years or older, no previous hamstring surgery, and a patient keen to have the Botox treatment. Video-recordings were taken with a Sony and a Canon Digital camera in a back-front-back view and a lateral left-right view; walking distance ap was 10 metres, lateral camera distance 5 metres. All injections of Botox were done by the senior author without anaesthetic or sedation. All assessments were done by the junior authors; they did not know the patients, the status before or after injections or repeat injections, or the dates of injections and filming of the episodes.

Purpose of Study

In children with spastic diplegia, surgery for equinus has a high incidence of both over and under correction. We wished to determine if conservative (mainly Zone 1) surgery for equinus gait, in the context of multilevel surgery, could result in the avoidance of calcaneus and crouch gait as well as an acceptable rate of recurrent equinus, at medium term follow-up.

Description of Methods

This was a retrospective, consecutive cohort study of children with spastic diplegia, between 1996 and 2006. All children had distal gastrocnemius recession or differential gastrocsoleus lengthening, on one or both sides, as part of Single Event Multilevel Surgery. The primary outcome measures were the Gait Variable Scores (GVS) and Gait Profile Score (GPS) at two time points after surgery.

Purpose

The treatment of children with contractures involving the lower limbs is challenging. Many are confined to wheelchairs for several years till their potential to ambulate is discovered. The aim is to review the treatment and outcome of eight children treated for contractures and deformities of the lower limbs following confinement to wheelchairs.

Methods

Eight children aged 4–14 years were treated for contractures of the hips, knees and feet between 2005 and 2011. The initial diagnosis was not made in 5 children. All children had never walked previously. Four patients were labelled “cerebral palsy”.

All children were seen with a physiotherapist to assess their walking potential. Genetic and paediatric medical assessment was also made. Final diagnosis revealed arthrogryposis (n = 3) pterygium syndrome (n = 1) calcinosis cutis (n = 1) viral neuropathy (n = 1) and cerebral palsy (n = 2)

Clinically all children were assessed to have good upper limb function for use of crutches. Surgical correction of the feet was required in 6 patients. Extension osteotomies of the knees were done in 8 patients following serial plaster cast treatment and hamstring release. Hip releases were done in 4 patients.

Objectives

To demonstrate that instrumented fusion of the paediatric cervical spine is possible and can be performed safely.

Study Design

A retrospective review of paediatric patients who had instrumented fusion of the cervical spine.

Purpose

182 AMIS Total Hip Replacements were analysed for implant placement using the IMATRI system to evaluate the accuracy of the minimal invasive technique. These hips were done in two different periods to assess if the measurement and analyses of the implant placement improved over time.

Methods

182 Consecutive AMIS Total Hip Replacements were performed during two different periods. Postoperative X-rays were done on all cases in the recovery room and the images were all uploaded to the IMATRI system. Leg length discrepancy, acetabular cup inclinations and anteversion were measured using predetermined morphing systems. Data were then analysed to define accuracy of implant placement. Outliers were also analysed to explain possible reasons.

Purpose

The aim of the study was to assess the efficacy of a cementless acetabular cup without bone grafting in a cohort of patients with protrusio acetabuli who were treated with total hip arthroplasty.

Methods

We retrospectively reviewed the records of a cohort of 45 patients with protrusio acetabuli who received elective total hip replacements between 2009 and 2011 at Tygerberg Academic Hospital. We reviewed pre- and post-operative radiographs and the most recent follow-up radiographs (minimum of three months) to assess cup osteointegration. We classified protrusio acetabuli according to Sotelo-Garza and Charnley into mild, moderate and severe, by evaluating pre-operative radiographs.

Purpose

To assess acetabular component fixation by bone ongrowth onto a titanium plasma sprayed surface as used in revision total hip arthroplasty. Acetabular bone defects, a common finding in revision surgery, and their relation to outcome were also investigated.

Methods

Clinical and radiological results were evaluated for all revision total hip replacements done between 2006 and 2011 that included the use of a specific revision acetabular component. Forty six hips in 46 patients were followed for an average of 2.5 years (range8 months to 6 years). The acetabular defects were graded according to Paprosky's classification.

Purpose of Study

To assess the results of Revision Hip Surgery in which a less invasive technique was utilized in situations where a number of different options was available.

Method

The authors rely on an experience of 3,445 hip arthroplasties by a single surgeon over a period of 20 years, of which approximately 20% were revision cases. Of these 617 cases, we report on 175 in which a minimally invasive option was taken. This does not apply to the skin incision, as all cases were adequately exposed. We have adopted this term to describe cases in which a surgical options was taken that resulted in the least morbidity and the shortest surgical time. We postulated that would lead to the best outcomes with the least complications.

Acetabular revisions: 1) Isolated polyethylene exchange. 2) Liner revision with cement technique in cases of cup malposition or poor locking mechanism. 3) Revision of cup with a primary prosthesis with significant medial bone loss.

Stem revisions: 1) Cement on cement technique. 2) Strut graft and primary stem.

Purpose of study

To determine the onset, incidence and associated symptoms of adverse noise emissions following total hip arthroplasty (THA) with ceramic-on-ceramic (CoC) bearing surfaces

Methods

50 Sequential CoC THA's (45 patients) performed by a single surgeon were interviewed telephonically at an average post-operative period of 12 months. The same group was re-interviewed telephonically 12 months later. Patients who reported noise emissions at either interview were assessed clinically to determine if symptoms could be reproduced.

Introduction

There has been much controversy around metal on metal hip replacements of late due to adverse metal reactions. There is evidence implicating lymphocyte mediated response (type IV delayed-hypersensitivity) to metal debris generated by the implants as one of the main factors responsible for the reactions. Our understanding of these adverse reactions continues to improve but we also recognize that the majority of patients with MOM implants are asymptomatic with well functioning implants. Studies have shown up to 16% allergy to metal ions on pre-operative allergy patch testing. We set out to determine the incidence of hypersensitivity to Cobalt, Chromium and Molybdenum in a arthroplasty population.

Method

We assayed whole blood using a validated optimized lymphocyte transformation test, MELISA as part of a prospective randomized study on large diameter bearing surfaces. We recruited 47 subjects, 19 males, 28 females (35–75 yrs). Specific exclusions included presence of metal implants in the body and industrial exposure to metals.

Introduction

The Human immunodeficiency virus (HIV) has changed all aspects of orthopaedic practice in Durban, South Africa. In our Arthroplasty unit, we have noticed a significant increase in HIV positive patients that required total hip arthroplasty (THR).

Method

We conducted a retrospective, demographic chart review of all patients below the age of 55years undergoing primary THR in our unit from 2004 to 2011.

Purpose of Study

The management of idiopathic clubfoot has changed substantially over the past fifty years with the Ponseti method of treatment gaining increasing popularity in recent years. The advantages of this method are its simplicity and minimal resource requirements with high published success rates. One of the disadvantages is that unless treatment protocols are meticulously adhered to, especially in the bracing stage, recurrence will occur. This study explores the demographics and highlights existing barriers to successful clubfoot treatment outcomes at two academic hospitals.

Description of Methods

A cross sectional study was conducted of all children undergoing clubfeet treatment between June and December 2011. A stratified questionnaire was used at two academic hospitals.

Purpose of study

Serial manipulations and casting for the treatment of congenital clubfoot has long been the practice internationally. There are, however, a great variety of manipulative techniques being practiced with differing results. We aim to determine how the rate of major surgery, ie. a full posteromedial-release (PMR), as initial surgical intervention has changed since introducing the Ponseti method of plastering at our centre in 2002. We also aim to determine whether pre-operative radiographs have any bearing on the type of surgery performed.

Methods

Clinical records and radiographs of all patients presenting to our clubfoot clinic in the years 1999–2000 and 2009–2010 respectively were reviewed. Patients were included if they had clinical clubfoot, and excluded if they presented after 3 months of age, had undergone prior treatment or suffered from associated congenital anomalies. We then determined which patients underwent PMR as primary surgical intervention following serial castings. We also measured the radiographic parameters on all available radiographs (tibiocalcaneal, talometatarsal-I, lateral and AP talocalcaneal angles) and performed a statistical analysis to determine their value in predicting the type of surgery required.

Purpose

The rate of club foot recurrence following Ponseti treatment has been reported in the literature as between 14 and 58%. Recurrence is defined as any child who has been treated and is in need of recasting, surgery or bracing. True recurrence is defined as presentation 6 months after last treatment and incomplete treatment is defined as presentation within 6 months of last treatment. Currently no local data exists to determine the cause of recurrence in this unit. The aim of this study is to review all recurrences to improve the outcome of club foot management.

Methods

A retrospective audit of all club foot recurrences was performed at an academic hospital. The review included the location of initial treatment, initial treatment method and abduction brace compliance as factors contributing to the recurrence rate.

Introduction

A recent retrospective study of distal femoral physeal fractures (DFPFs) suggested closed manipulation alone has a high incidence of re-displacement, malunion or physeal bar formation. The paper concluded that all displaced DFPFs require internal fixation, and breaching the physis with k-wires is safe. We agree that hyper-extension/flexion injuries need stabilisation using k-wires but, in our experience, purely valgus/varus deformities can be successfully managed by manipulation under anaesthesia (MUA) and a moulded cylinder cast.

Method

We prospectively observed DFPFs presenting over 12 months. Departmental policy is to treat varus/valgus deformities by MUA, with cylinder casting providing 3 point fixation. Hyper-extension/flexion injuries are reduced on a traction table. 2mm cross k-wiring is performed, leaving the wires under the skin, and a cylinder plaster applied. A post-operative CT scanogram accurately assesses limb alignment. Patients are mobilised immediately using crutches and weight-bearing as pain allows. Plaster and k-wires are removed after 4–5 weeks. Scanogram is then repeated, and again at 6 months and 1 year.

Purpose

The hip region is the second most common site for tuberculosis following the spine in children

The aim is to describe the variable radiological patterns of presentation and their resemblance to pyogenic infection, tumours and other benign conditions of bone in children.

Methods

The clinical and radiological records of 29 children aged 10 months–13 years with confirmed tuberculosis of the hip region seen between 1990 and 2011 were reviewed retrospectively. Clinical features were pain, limp and flexion, adduction contractures. Abscesses and sinuses were seen in 4 children. The ESR ranged between 7–110 mm/hr. Mantoux was positive in 20 children. All cases were histologically confirmed. Treatment involved biopsy, currettage of bone defects, limited synovectomy and adductor tenotomy. Patients were immobilised for 4 weeks on a spica cast or traction. Antituberculous treatment was administered for 9–12 months

Purpose

Severe osteo-articular infection can be a devastating disease causing local complications, multiple organ failure and death. The aim of this study is to highlight the potential severity and subsequent sequelae of osteo-articular infections in children and to determine causative factors leading to this devastating condition.

Methods

We retrospectively report on six cases treated at two academic hospitals. We included all patients with osteo-articular infections who had multi-organ involvement. All patients had more than one joint as well as another organ involved as a direct result of the bacteraemia. All patients with single organ involvement were excluded. The patient files were recorded as part of a previously published study. Data capture included X-rays, serology for blood culture, FBC, ESR, CRP and HIV. Ultrasound of involved joints, technetium bone scans, echocardiograms and computed tomography of the brain were performed when indicated.

Background and objectives

Positron emission tomography (PET) is a technology widely used in oncology. It is now being increasingly used in orthopaedics, especially in diagnosing bone infection. Diagnosis of bone infection is still a challenge, especially after surgery. Bone scintigraphy, Gallium-67 scintigraphy, and radiolabelled leucocyte scintigraphy are not specific. MRI has problems with definition in the presence of metal. PET uses 18-F Fluoro deoxyglucose(FDG) as a radiotracer. Inflammatory cells use glucose for energy, and the 18F-Fluoride component of FDG is a positron-emitting radionucleotide. We undertook this study to show our experience with the FDG-PET –CT in diagnosing bone infection and to highlight its superiority in diagnosing infected spine implants.

Material and Methods

Medical records of orthopaedic patients referred to the nuclear medicine department in our hospital were retrospective reviewed. We looked at the clinical records, radiographs, bone scintigraphs, MRI and FDG-PET, assessing their diagnostic accuracy, and their value in helping the surgeon plan treatment.

Background

On 22 July 2011 Norway was subjected to two terrorist attacks by a right-wing extremist. The first attack was an explosion from a car bomb against the Government Building (GB) in Oslo. The second attack occurred less than two hours later at a summer camp on the island Utøya, outside Oslo, where 600–700 young members of the Labour Party hold their annual summer camp. The car bomb killed 8 people and 69 persons were shot and killed at Utøya. All seriously injured patients came to Oslo University Hospital, Ullevål (OUH).

Purpose

The purpose of the talk is to describe the incident and the injuries at OUH from an orthopaedic perspective.

Introduction

Surgical complications are common and most of them are preventable. Up to 70 % of surgical errors originate outside theatre and recent studies have shown that pre-op checklists can reduce such problems. We hypothesized that in our institution outcomes could be improved by introducing a safety checklist.

Method

A modified multidisciplinary WHO safety checklist was introduced at our institution on the 1st March 2011. The primary focus was for elective patients admitted in all the units of the division. Prior to that all involved personnel (Consultants in Orthopaedics and Anaesthesia, Registrars in both departments, nursing staff in the wards and theatre and clerical staff) were fully oriented. To further ensure that everyone was familiar with the new checklist the whole month of March 2011 was used as a training month.

We prospectively collected data from daily Mortality and Morbidity (MM) meetings by units from 1/1/2011 to 29/2/2011 (2 months). A pre-induction survey was completed by all Registrars. The same survey was given to the same registrars for comparison at the end of the 2 month implementation period in June 2011.

Purpose of Study

To investigate the level of Orthopaedic Residents' knowledge of safety techniques in the procedures involving the use of C-arm.

Methods

A survey of evidence based questions regarding safety techniques in the use of C-arm was administered to 58 Orthopaedic Residents from three major tertiary hospitals.

Purpose

To evaluate the efficacy of novel biodegradable MAACP/n-HA composite artificial lamina for the prevention of postlaminectomy adhesions and lamina reconstruction.

Methods

Goats were randomly divided into three groups: an experimental group consisting of twelve goats that underwent cervical 4 laminectomies, followed by MAACP/n-HA composite artificial lamina implantations; a control group of nine goats whose cervical 4 vertebra plate were removed; and a normal group of three goats that did not receive any operations or treatments. On weeks 4, 12 and 24, two goats, two goats, three goats in the test group and two, two, two in the control group were selected using X-ray, CT, MRI and subsequently killed for histological examinations and SEM (scanning electronic microscopY). On week 24, the adhesion level of scar tissue was examined according to Rydell's degree of adhesion criteria. Biomechanical measurements were carried out at week 24 on 3 goats in the test group, 3 in the control group, and 3 in the normal group.

Methods

A pericapsular approach was used with capsulotomy and then correction of the lesions both in the pelvic and in the femoral aspects. The traction times and total surgery times for the conventional method and the new out-inside technique were compared.

Results

Conventional Hip Arthroscopy

New out-inside technique of hip arthroscopy

New out-inside technique – E Margalet results

Purpose of study

The outcomes of conservatively managed minimally displaced isolated greater tuberosity fractures are sparsely reported and the aim of this study was to look at the outcome of these fractures.

patients and methods

Twenty-seven patients who had sustained a greater tuberosity fracture were identified. They were all managed by a single surgeon. All patients had a regime of initial immobilisation for 3 weeks followed by physiotherapy and range of motion exercises. They were all x-rayed at 1 week and 3 weeks after injury to monitor for any displacement. Four fractures occurred with an anterior dislocation. In seven patients the fracture was not visible on x-ray but was diagnosed on Ultrasound or MRI. Twenty-three of 27 patients were available for follow-up. For this follow up, the patients were telephonically contacted and the Oxford Shoulder Score (OSS) was completed to assess their outcome.

Purpose of the study

To determine the outcome after the Semi-tendinosis tendon was used in reconstruction of the Medial Patella-femoral ligament using a fixed dynamic stabilising structure.

Method

The Adductor Magnus tendon insertion at the Adductor tubercle of the medial femoral condyle was used as a dynamic and fixed stabilising point preventing patella subluxation. This is a constant landmark in most patients and eliminates the need to find the isometric stabilisation point of the Medial Patella-femoral ligament. The Semi-tendinosus tendon was routed from its distal tibia attachment through a drill hole in the patella from distal to proximal. It was then transferred sub-vastus around the Adductor Magnus femoral attachment and sutured back onto itself at the inferior patella pole. It was tensioned at 30 degrees of knee flexion.

Between 2004 and 2011 forty knees were reconstructed using the Semi-tendinosus tendon combined with an extra-synovial lateral release. All had failed conservative therapy for repeated patella instability. Post-operatively the patients followed a strict rehabilitation protocol. At follow-up the patients were questioned for any symptoms of patella instability or dislocation. Any complications of the surgery were documented. Patients were examined for any signs of patella apprehension or abnormal patella tracking.

Purpose of study

To study the effect of different shoes and orthotics have on patellar tendon tensile forces.

Patellar tendinopathy is an overuse injury that affects tennis players and in high impact sports like basketball, volleyball and running has an incidence of 20%. The tensile forces in the patellar tendon can be reliably measured with an intratendinously placed fibre optic tube and wireless transmission device allows for dynamic testing. The biggest strain differentials have been confirmed in jumps from 30cm height. Tennis is played on 3 major different court surfaces and there is a variety of commercially designed tennis shoes on the market.

Materials and methods

6 male tennis players, ages 18–49 were enrolled for this study. A fibre optic cannula was placed in the middle of the proximal pole of patella tendon from lateral to medial direction in the dominant knee. The patellar tendon tensile forces deform the fibre optic cannula in turn modulating the light signal passing through the optic cannula. The drag in the fibre optic sensor signal was used to measure the tensile forces in the patellar tendon. MLTS 700 goniometer were utilized to measure and record the amount of flexion with each jump to standardize results for different shoes and orthotics.

Background

A variety of cerclage systems are available for the fixation of periprosthetic fractures. The aim of this study was to compare the forces applied by these systems.

Methods

We designed and manufactured a device to measure the forces applied to a cylindrical structure by a cerclage cable. Five different commonly used systems were evaluated. The forces exerted were measured at four different locations on the cylinder and this was compared to the force indicated by the tensioning device.