Purpose of Study:

Various techniques have been described and are still used for treating recurrent dislocation of the patella when conservative measures fail. Among them are distal, proximal and combined realignment techniques and lateral releases. Since being shown proof of the biomechanical importance of the medial patellofemoral ligament (MPFL) in patellofemoral instability, the reconstruction of the MPFL has gained in popularity. The objective of this paper is to present a case series with preliminary clinical results using the gracilis tendon to reconstruct the MPFL.

Method:

Between 01/07 and 03/11 23 knees in 21 patients underwent reconstruction of the MPFL.4 of these patients had had previous surgery. Preoperatively the Caton Deschamps ratio using plain x-rays was worked out and the TT/TG distance was measured using CT scanning. Using these measurements as a guideline, 7 cases underwent a tibial tubercle transfer as an additional procedure. In 6 of the cases an additional cartilage procedure was required. The technique was simplified using intra-operative x-rays to achieve anatomical tunnel placement.

Background:

During the past two decades the medial Patellofemoral ligament has come to the fore as the essential lesion of acute patella dislocation and its reconstruction in cases of chronic instability seems logical. The femoral insertion of the medial Patellofemoral ligament (MPFL) is key to the isometry or desired anisometry of the reconstruction. Radiographic landmarks for the femoral insertion has been described in literature most notably by Schottle et al. AJSM 2007. We examined the consistency of these landmarks of the femoral insertion of the MPFL.

Methods:

24 unpaired knees of cadavaric specimen were dissected for the origin of the MPFL.

A radiographic marker was then placed in the centre of the femoral attachment of the MPFL and a direct lateral X-ray obtained of the distal femur. The sweet spot was defined according to the landmarks described by Schottle et al and deviation from the sweet spot was measured.

Introduction:

High tibial osteotomy (HTO) is a common treatment for medial compartment arthritis of the knee in younger, more active patients. The HTO shifts load away from the degenerative medial compartment and into the lateral compartment. This change can be accomplished with either a lateral closing or a medial opening wedge HTO. An HTO also potentially affects leg length. Mathematical models predict that the osteotomy type (opening versus closing) and the magnitude of the correction determine the change in leg length, but no in vivo studies have been published. The purpose of this study is to quantify and compare leg length change following opening and closing wedge HTO.

Study Design:

Retrospective cohort study – Level III evidence

Purpose:

A higher posterior tibial slope can potentially result in kinetic and kinematic changes of the knee. These changes may influence knee functionality in ACL-deficient and ACL-reconstructed subjects. The purpose of this study was to investigate the relationship between knee functionality and posterior tibial slope in ACL-deficient and ACL-reconstructed subjects.

Methods:

Subjects with isolated ACL injuries and subjects who underwent ACL-reconstruction with bone-patella-bone-tendon (BPTP) between 18 and 24 months post surgery were included in the study. Posterior tibial slope was measured on a lateral radiograph using the posterior tibial cortex as a reference. The Cincinnati scoring system was used to assess knee functionality.

Introduction:

South Africa has a very sports orientated population and a high blunt trauma prevalence. In August 2008, we re-established the soft tissue knee service at our academic hospital. Our clinic is staffed by a sessional Consultant, a Registrar, and is overseen by a senior honorary Consultant. Here we present a review of our first 2 years experience.

Methods:

The clinic operates on a referral basis. All patients have all their clinical and demographic data and referral data entered into a Soft Tissue Database. The Data for 2009 and 2010 data were collated and analysed.

Background:

The aim of this study was to investigate the outcome after ACL reconstruction between a group of patients receiving a standardized supervised physiotherapy guided rehabilitation program and a group of patients who followed an un-supervised, home-based rehabilitation program.

Methods:

40 patients with isolated anterior cruciate ligament injuries were allocated to either a supervised physiotherapy intervention group or home-based exercise group. Patients were investigated by an independent examiner pre-operative, 3, 6, 9 and 12 months post-surgery using the following outcome measures: Lysholm Score and Tegner Activity Scale, functional hopping tests, isometric and isokinetic strength assessments.

Purpose:

This study attempts to establish whether biomechanical manipulation through distraction can result in fracture union.

Method:

A retrospective clinical audit of 15 patients with delayed or hypertrophic non-unions treated successfully with closed distraction in circular external fixation. Average time to union, complications and complication rates were also reviewed. Inclusion criteria: all patients with delayed or hypertrophic non-union, treated by closed distraction between 2004 and 2011.

Purpose of study:

In polytrauma patients (ISS > 16) early long bone and pelvic fracture fixation (< 24 hours post injury) has been shown to be beneficial. Surgery in the presence of subclinical hypo perfusion (SCH) (normal vital signs with a serum lactate > 2.5 mmol/L) may be detrimental. This study aimed to investigate the effect of fracture fixation in polytrauma patients with SCH.

Description of methods:

We performed a retrospective database review of polytrauma patients (ISS > 16) with significant long bone or pelvic fractures (extremity NISS> 9) who underwent surgical fracture stabilisation within 48 hours of injury. In the group of patients with normal vital signs (mean arterial pressure (MAP) > 60 mmHg and heart rate (HR) < 110 beats/min) we compared outcomes of those with normal lactate (< 2.5 mmol/L) prior to surgery with patients that had a raised lactate (> 2.5 mmol/L).

Purpose of study:

Up to 30% of distal femur fractures treated with a locked plate have problems with union. Distal femur locked plates have become a very popular means of internal fixation because of their ability to provide stable distal peri-articular fixation. In spite of this enthusiasm however several studies have reported significant problems with healing. In the distal femur it is recognized that locked plate fixation may be too rigid if used in certain configurations preventing the essential micro movement required for biological healing. Implant failure may arise from rigid configurations that cause excessive hardware stress concentrations. In an attempt to address these problems longer plates and an increased working length have been proposed to reduce construct rigidity. The purpose of our study is to investigate whether an increased working length translates into improved healing.

Description of method:

We undertook a retrospective review of 92 consecutive cases performed at our institution from 2007–2010. Case notes and X-rays were reviewed. Working length, plate to fracture zone ratios and working length to fracture zone ratios were calculated. Union was assessed radiographically and clinically. Covariates of smoking, age, sex and fracture severity were included. Outcomes considered were union or established non-union. Delayed union was defined as union after 20 weeks.

Introduction:

Open bone graft harvesting continues to be recognized as the gold standard of obtaining autograft in patients needing bone graft. Conventional bone graft harvesting using the iliac crest is often cited as having significant donor site morbidity and complications. Intramedullary harvesting, using a reamer irrigation aspiration system (RIA) has recently become available.

Method:

We performed a retrospective case series on 16 patients, where this system was used. A single pass reaming technique to harvest autograft from the femoral canal was performed. Fluoroscopy was used to size the canal and to confirm placement of a guide wire. Bone harvest volumes, complications encountered and donor site satisfaction post operatively was assessed. Patient satisfaction was determined via telephonic interviews at regular intervals with follow-up times up to 2 years.

Background:

Glomus tumours of the hand are rare benign vascular tumours. The literature shows a limited number of case series with few patients treated over several years.

Methods:

Patient records and the literature were reviewed.

Patients and Methods:

A retrospective study of follow ups was done on fifty six patients treated for chondrosarcoma at the Pretoria musculoskeletal tumour unit from 1987–2009, evaluating the outcome and presence of local recurrence. The lesions were divided into four histological grades; atypical enchondroma (grade 0), low grade chondrosarcoma (grade 1), intermediate grade chondrosarcoma (grade 2), and high grade chondrosarcoma (grade3).

Results:

Biopsy revealed forty-six patients with low grade chondrosarcoma (82%), nine cases of grade 2 chondrosarcoma (16%), and one patient with a metastatic mesenchymal chondrosarcoma. The femur and humerus were the commonest sites involved, while the axial skeleton was only affected in three cases, all of whom had more aggressive lesions. Forty-nine patients had no recurrence after a mean period of 57.5 months follow up. Forty- two of those had low grade lesions, and seven patients had grade 2 lesions. Two patients with low grade lesions were lost to follow up. Three patients involved in the study presented with local recurrence, but no metastases were detected radiographically. Two patients died, one with metastatic mesenchymal chondrosarcoma involving the scapula, and the other with a grade 2 lesion of the pelvis.

Purpose:

To assess the outcomes of osteosarcoma cases managed between January 2006 & December 2010 in a tertiary centre.

Methods:

A retrospective review of patient records.

Purpose of study:

To analyse the bacteriological spectrum, identify most appropriate antibiotics for hand infections, and to characterize patterns and sites of hand infections. This information was collected against the background of a high prevalence of HIV infected patients and increasing antibiotic resistance.

Description of methods:

This was a prospective, cross-sectional, analytical study done on 66 patients presenting with hand infections at a public hospital from January to June 2009. A standardised treatment protocol was followed in managing these patients. Data was collected from each participant, and laboratory reports were followed up for the identity and antibiotic susceptibility of causative organisms. All patients were counselled for HIV status and consenting participants were tested.

Introduction:

During the Christmas period a number of patients are admitted to the Chris Hani Baragwanath Academic Hospital (CHBAH) Hand Unit with explosive injuries to their hands caused by firecrackers. South African legislation restricts the sale and use of fireworks to adults, with a limitation being placed on the size of explosive and type of commercial outlet. Despite this an inordinate amount of explosive hand injuries are admitted over the festive season.

Aim:

To evaluate the epidemiological pattern of firecracker injuries to the hand during the Christmas festive period and assess contributing factors. Comparison to a previous study in 2008 will also be evaluated.

Methods:

A spirit level application was downloaded to the Smartphone. The acetabulum inclination was measured on the pre-operative X-Rays. The phone is placed in a sterile bag and then used intra-operatively, to measure and set our acetabular cup orientation to our pre-operative measurements. The inclination level was measured before and after final placement of the acetabular cup. This was compared to the acetabular cup inclination in our post-operative X-Rays.

Results:

In our series of 50 cup placements we found high accuracy. The results show less than 5° deviation between our pre-, intra- and post-operative measurements.

Materials.

The results of use of the Lautenbach suction-instillation system were studied prospectively in 100 patients over a 7 year period.

Results.

Sixty cases followed wide excision of musculoskeletal tumours and 40 were caused by complex trauma. Due to logistics, many tumour cases were managed post-operatively in a septic orthopaedic ward. Immediate soft tissue cover was achieved in all tumour cases, utilising flaps where necessary, but cover was delayed for up to 3 weeks in some trauma cases. One late infection (2 years post-op) in a bulk allograft reconstructed sarcoma patient and 1 trauma infection were noted. Both were successfully eradicated with a secondary debridement & Lautenbach suction-instillation.

Purpose:

The purpose of this audit is to identify the orthopaedic related health events that occur within the Soweto population being serviced by the Chris Hani Baragwanath Hospital, and in doing so be used as a tool to improve orthopaedic related patient care and outcomes in public health services.

Method:

A retrospective review was conducted for a period of one year. This included all orthopaedic admissions, theatre cases performed, and outpatient assessments. Statistics were taken from registers incorporating OPD, Wards, Casualty and theatre.

Background:

We studied the effect of posterior condylar offset on maximum knee flexion after a posterior stabilised total knee arthroplasty. We also looked at gender difference and the post-operative change in posterior condylar offset.

Methods:

Eighty consecutive computer navigated posterior stabilised total knee replacements were prospectively assessed intra-operatively for maximum knee flexion. The flexion angle was measured and recorded with an imageless computer navigation system (Brainlab) before and after implantation of the prosthesis. This was correlated with a radiological review of the posterior condylar offset pre- and post-operatively, as defined by posterior condylar offset ratio (PCOR) originally described by Soda (2007) and modified by the Bristol Knee Group (2010).

Material:

2084 IB II and NexGen knee replacements were reviewed from our database and implant size was correlated to patient height.

Results:

Methods.

This study presents a review of several multicenter investigations exploring the clinical benefits and validity of focal resurfacing in 78 patients, ages 35–67, with a follow-up ranging from 2 to 6 years.

All patients were treated with a 15 or 20 mm contoured resurfacing implant on the medial or lateral femoral condyle.

Results.

At 2 years follow up, average scores for WOMAC domains improved by over 100% (40 preop to 86 postop where 100 = best). At 3 year follow-up KOOS scores were within 88 to 102% of a normal aged matched population (domain range 72–91 where 100 = best). At a minimum of 5 years, the KOOS domains were close to normative reference levels on pain relief, symptoms, and activities of daily living (range 83–89% of normal). Radiographic results demonstrated solid fixation, preservation of joint space, and no change in the osteoarthritic stage.

Background:

The literature is unclear about the optimal rotation of the femoral component during TKR. Measured resection techniques rely on the use of bony landmarks, while the balanced gap technique relies on soft tissue tensioning to guide the surgeon in rotating the femoral component. All these techniques still result in a wide range of component rotation. We compared the functional flexion axis (FFA) of 20 replaced knees to that of the contralateral normal knee to determine whether a balanced gap technique allowed us to recreate this normal anatomy.

Methods:

We reviewed the records of our TKR's from Jan 2008 to Dec 2010 and included all patients who had a normally functioning contralateral knee, tibial cut <3° from perpendicular to the mechanical axis performed by/under supervision of a single surgeon. These patients were contacted for follow up and axial flexed knee x-rays to measure femoral rotation and FFA (angle between clinical transepicondylar line and mechanical axis of tibia). These values were compared between replaced and normal knees using Students T-test.

Materials:

333 of 2084 patients having primary total knee replacements needing bilateral replacements were reviewed retrospectively.

Results.

245 patients were seen initially with bilateral arthritis of the knee and needed bilateral TKR, while 88 patients developed arthritis in the contralateral knee following TKR.

No patients had simultaneous bilateral TKR's; operations were done sequentially and the average time between the TKRs was 20.77 months with a range between 1.5–111 months.

Most patients had the contralateral knee replaced within two years of the first knee replacement but 81 patients actually waited between 2 and 10 years before coming in for the second TKR.

Method.

We prospectively investigated the radiological outcomes of the uncemented Oxford medial compartment arthroplasty in 231 consecutive patients performed in a single centre with a minimum two year follow up.

Results.

The functional outcome using the Oxford knee score and the High Activity Arthroplasty Score were significantly improved on the pre-operative scores (p<0.001). There were 196 patients with a radiological examination that was acceptable for analysis of the bone-implant interface. Of the six tibial zones examined on the anteroposterior radiograph there were only three with a partial radiolucent line (3 out of 1176 zones). All were present in the medial aspect of the tibial base plate (Zone 1) and all were <1 mm in size. All of these patients were asymptomatic. There were no radiolucent lines seen around the femoral component or on the lateral tibial view. There was one revision for mal-seating of the tibial component.

Background:

Appropriate positioning of total knee arthroplasty (TKA) components is a key concern of surgeons. Post-operative varus alignment has been associated with poorer clinical outcome scores and increased failure rates. However, obtaining neutral alignment can be challenging in cases with significant pre-operative varus deformity

Questions:

1) In patients with pre-operative varus deformities, does residual post-operative varus limb alignment lead to increased revision rates or poorer outcome scores compared to correction to neutral alignment? 2) Does placing the tibial component in varus alignment lead to increased revision rates and poorer outcome scores? 3) Does femoral component alignment affect revision rates and outcome scores? 4) Do these findings change in patients with at least 10 degrees of varus alignment pre-operatively?

Methods:

We compared our experience using standard jigs and mini-robotic jigs in knee replacement. A cohort of patients involved in a study comparing navigated and standard total knee replacements received TKA using a Bi-Cruciate Stabilised Knee System. A pilot cohort of patients received total knee replacement using standard computer navigation by the pi galileo system without the mini-robots while awaiting acquisition of the mini robot system. We compared our experience using the same pi galileo system with mini robotic cutting jigs to the cohort without the mini-robotic cutting guides.

Results:

Reduction in surgical time was statistically significant when using the motorized mini robotic jigs. Blood loss was identical in both cohorts, and cut precision was better in the cohort with the motorized mini robotic jigs.

Introduction:

Two-stage revision is a widely accepted and performed intervention for septic total knee arthroplasty (TKA), with an infection eradication rate exceeding 90% in most studies. The ‘2-in-1’ single stage revision has recently been reported to have favourable results.

Aim:

To evaluate the early clinical results of single-stage reimplantation of infected TKA using stepped metaphyseal femoral and tibial sleeves.

Introduction:

Gait analysis is an important tool to measure function following total knee replacement. It is currently unknown whether there is a correlation between subjective and objective outcome. The purpose of this study was to analyse relationships between subjective outcome scores and kinematic and kinetic data.

Methods:

25 consecutive patients (15 males, 10 females) were selected (mean age 68 years, BMI 31.8). All subjects were tested a minimum of 24 months following total knee replacement. SF12, Oxford knee score, knee society and KOOS scores were collected. Muscle strength was assessed using a Biodex dynamometer and symmetry indices were analysed. A timed up and go test and KT2000 measurements were performed.

Purpose:

The objective of this study was to determine the tensile strength of the different components of the rotator cuff tendons and their relationship to rotator cuff tears.

Method:

The tests were done on a newly designed and built test-bench that performed the tests at a consistent rupture speed. The tests were done on four fresh frozen cadaver shoulders. The capsular and tendinous layers of the rotator cuff were divided leaving them only attached on the humeral side. Separate tensile tests were done on these tendons, after they were divided into 10 mm wide strips before testing. The tendon thickness was also measured.

Purpose:

Despite advances in limb reconstruction, there are still a number of young patients who require trans-tibial amputation. Amputation osteoplasty is a technique described by Ertl to enhance rehabilitation after trans-tibial amputation. The purpose of the present study was to evaluate the results of the original Ertl procedure in skeletally immature patients, and to assess whether use of this procedure would result in a diminished incidence of bony overgrowth.

Methods:

Four consecutive patients (five amputations) treated between January 2005 and June 2008 were reviewed. Clinical evaluation consisted of completion of the prosthesis evaluation questionnaire (PEQ) and physical examination. Radiographic analysis was performed to evaluate bone-bridge healing, bone overgrowth and the medial proximal tibial angle (MPTA).

Purpose of Study:

To perform a retrospective audit of the spectrum of management of tibial pseudarthrosis by a single surgeon over a seven year time period.

Description of Methods:

All discharge summaries and operation logs from 2004 to 2011 were reviewed to identify patients, and their case notes and x-rays were examined. Patients were contacted telephonically for follow-up examination.

Purpose of the Study:

Spontaneous intraarticular haemorrhages are the most frequent bleeding episodes encountered in the haemophiliac population, causing pain, joint deformity and arthropathy. Chronic haemophiliac arthropathy is characterised by persistent joint swelling, proliferative synovitis, and damage to or loss of articular cartilage. Elimination of the synovitis is the key to prevention of recurrent intraarticular haemorrhages and joint damage. The purpose of the study was to investigate the indications for, and outcome of, radioactive synoviorthesis for haemophiliac arthropathy.

Methods:

A retrospective study was done to assess the results of 12 intra-articular injections of radioactive Yttrium-90 colloid, performed in 10 patients from November 1993 to December 2006. Patients were referred by the Haematology Unit if they had a target joint, as defined as >2 bleeds into the same joint in the preceding 6 months. Follow up was conducted at 6 monthly intervals, assessing clinical and radiological outcomes.

The radiological involvement of the target joint, the pre- and post-treatment range of movement, presence of synovitis and bleeding events were compared from presentation to that at follow up. Range of movement of each target joint was assessed and compared to that at follow-up.

Background:

In recent times there has been an increasing trend towards surgical intervention in paediatric femoral shaft fractures with widening indications. Titanium elastic nails and external fixation are two widely practiced procedures for such fractures.

Materials & Methods:

We report a series of 48 children with 52 fractured femurs, 18 being managed by TENS and 34 in a linear external fixator. Children were aged between 3.5 to 12 years and the fractures were stabilised after an optimal closed reduction on a normal theatre table under image intensifier control. Fracture site distribution was nearly uniform in both the groups. Though most children were assigned to any of the groups at random, external fixators were applied on many younger children and those having financial constraints.

Purpose of Study:

To review the outcome of paediatric patients with radius and ulna fractures treated with titanium elastic nails.

Description of methods:

Paediatric patients with radius and ulna fractures who fulfilled the criteria for TENS nailing were used. The criteria included failed closed reduction, instability (>15°angulation, >5°rotation) and open fractures. The patients were treated with retrograde TENS nailing of the radius and ulna. The patients were followed up at a paediatric orthopaedic outpatient clinic at 1, 3, 6 and 12 weeks with a final visit at 6 months. Data was collected at every visit looking at range of motion (pronation and supination), clinical and radiological signs of union and complications.

Purpose:

To highlight the outcome of acute pyogenic osteomyelitis of the forearm bones in children.

Methods:

Eleven children were treated for osteomyelitis of the radius (6) and ulna (5) over 15 years. Staphylococcus aureus was cultured following initial incision and drainage. Two had signs of compartment syndrome.

Late complications included gap defects of 2–6 cm (radius 1 and ulna 2). Larger defects with physeal involvement were seen in the distal ulna (4) proximal radius (1) and whole radius (1).

The late clinical features included pseudarthrosis (9), distal radioulnar instability (3), radial head dislocation (3) and “radial clubhand” type deformity (1).

Background:

Early diagnosis of septic arthritis and osteomyelitis in children is essential to prevent long term sequelae. The diagnosis for these orthopaedic emergencies can be difficult and challenging especially in infants. Standard blood tests used for diagnosis have a low specificity. Procalcitonin (PCT) is significantly elevated in bacterial infections and remains low in viral infections and inflammatory conditions. Good positive predictive values for PCT have been obtained in various studies used in paediatric infections, but limited studies have examined the role in orthopaedic infections.

Aims:

To introduce PCT testing in the work up of Septic Arthritis (SA) and Acute Osteomyelitis (OM) and to see if the test is useful in the diagnosis. Also to determine whether 0.2 ng/ml is a suitable cutoff level as indicated by previous studies.

Purpose of study:

Congenital hallux varus is a rare condition presenting with medial deviation of the big toe. It consists of 2 variants: classical congenital hallux varus caused by an abnormal metatarsal-phalangeal articulation, and a more recently described variant due to a “bracket physis” of the first metatarsal.

Our aim was to perform an audit of the spectrum of presentation of congenital hallux varus with its management and complications in our unit over a five year period.

Description of methods:

A retrospective review of congenital hallux varus treated by a single surgeon was performed. Clinical notes, photographs and x-rays were reviewed. Two surgical methods of treatment were used as directed by clinical and radiological findings.

Purpose:

To describe a plating technique for the Lapidus procedure as an alternative to the traditional screw fixation technique. To look at the complications experienced during the Lapidus procedure and to find possible solutions to prevent these complications.

Methods:

A retrospective study of 34 Lapidus procedures in 26 patients (8 bilateral) between 2006 and 2009 was performed. All were done with a plating technique and a primary bone graft.

The indications were:

Purpose:

Non-contiguous spinal injury can add significant complexity to the diagnosis, management and outcome in children. There is very little in the paediatric literature examining the nature, associated risk factors, management and outcomes of non-contiguous spinal injuries. The objective is to determine the incidence and clinical characteristics of non-contiguous spinal injuries in a paediatric population. The secondary objective is to identify high risk patients requiring further imaging to rule out non-contiguous spinal injuries.

Methods:

All children up to 18 years of age with a spinal injury, as defined by ICD-09 codes at one paediatric trauma hospital were included (n=211). Data for patient demographics, mechanism of injury, spinal levels involved, extent of neurologic injury and recovery, associated injuries, medical complications, treatment and outcome were recorded.

Introduction:

Trauma is endemic in South Africa. The upper thoracic spine is extremely difficult to image and assess clearly with frontline x-rays resulting in up to 22% of proximal fractures being missed.

Aim:

To review a series of patients with proximal thoracic fractures.

Objective:

To report long-term, minimum 5 years, clinical and radiological outcome of our series of patients with traumatic spondylolysthesis of the axis managed non-operatively

Method and material:

Thirty patients had traumatic spondylolysthesis of the axis over a period of five years (January 2005 to December 2010). There were 22 males and eight females with an average age of 36 years. Plain X-rays and CT scans were obtained to evaluate the injury. All patients were managed non-operatively.

Purpose:

The purpose of the study was to evaluate the safety and efficacy of fixation of the lumbar spine, without fusion, using the Cosmic Pedicle Fixation System.

Method:

Prospective study of 107 patients selected to have either a completely non fused fixation (40 patients), and 67 who underwent a hybrid fusion. During the same period 299 standard fusions were performed at same institution.

Enrolment was from January 2006 to August 2008. Appropriate consent was obtained, but the choice of which levels to fuse and which levels to fix only was the surgeon's choice. Pre-operative ODI and VAS scores were obtained as well as parameters of sitting, standing and walking potential. Regular follow-up visits were done, and these parameters were controlled together with regular x-rays at each visit at 6 weeks, 6 months and 12 months and annually thereafter. Intra-operative blood loss, hospital stay and any adverse reaction or complications were documented.

Introduction:

Circumferential arthrodesis of the spine may be achieved by posterior-only or anterior and posterior surgery. Posterior-based interbody fusions have significant limitations including unreliable improvement of segmental lordosis and variable rates of post-operative radiculopathy. Combined anterior and posterior surgery introduces significant cost and peri-operative morbidity. The purpose of this paper is to report the radiographic and clinical outcomes of posterior-based circumferential arthrodesis using a novel expandable interbody cage.

Methods:

A prospective pilot clinical trial with one year follow-up of the only expandable cage approved by the FDA for interbody application. Clinical outcomes measured include ODI and VAS for back and leg. Radiographic outcomes include arthrodesis rates based upon CT scan. Statistical significance for change in health status was calculated using Student's t-test.

Introduction:

Skeletal TB has a paucibacillary nature. It is often found in poorly accessible areas for biopsy purposes. Retrieved samples may have a poor representation of the underlying disease process. Additionally, patients have normally commenced anti-tubercular medication that further decreases the number of bacilli. This has resulted in poor sensitivity and specificity outcomes for the tests that are traditionally done.

The polymerase chain reaction (PCR) has been proven to be a useful test for the demonstration of extrapulmonary TB. It has a high specificity and sensitivity.

Objective:

The study measures the sensitivity and specificity of PCR done on fresh biopsies from patients suspected of a tuberculous spinal infection.

Methods.

A retrospective chart review was conducted on 14 patients who developed MRSA infection in our unit, over a period of six years. Data included: age, gender, neurological status, length of hospital and ICU admission, type of procedure performed, HIV status, co-morbidities, nutritional status, haemoglobin, sensitivities and treatment.

Results.

Age ranged from 2 to 52 (mean 15.75 years) and included four males, six females, and four children. Of the thirteen patients who developed Surgical Site Infection (SSI), nine were posterior surgical wounds.

Two patients were HIV positive. Mean albumin and lymphocyte count was 34.88 and 2.37 respectively. The average wait to surgery was 23.8 hospital days, average length of ICU admission was 5.01 days. Signs of SSI developed at 11.75 days on average. Four cases showed sensitivity to Vancomycin, while ten were sensitive to Clindamycin. Patients were treated for a total of six weeks with antimicrobial therapy. Five patients required debridement, two required implant removal for chronic infection. Infection subsequently resolved in all patients.

Introduction and aim:

With up to 70% of adults with tuberculosis in Sub-Saharan Africa infected with human immunodeficiency virus (HIV), severe spinal tuberculosis presents a different set of clinical and surgical challenges. To overcome the disadvantages of various traditional techniques, particularly in patients who are HIV-positive with opportunistic pulmonary pathology, and to obviate the need to violate the diaphragm in the lower thoracic and upper lumbar spine, a posterior vertebral column resection through a single posterior approach was proposed. The aim of this study is to report on the early results of the single-stage posterior only vertebral column resection.

Method:

A total of 12 patients (10 females and 2 males) seen at CMJAH between January 2007 and January 2011 underwent a single-stage posterior only posterior vertebral column resection, and were retrospectively reviewed. The indications for PVCR are essentially the same as those for 360 degrees decompression and fusion. The mean follow-up period was 15.8 months (range 5 to 44 months).

Aim:

Historically, anterior decompression followed by posterior fusion has been the surgical management of choice in spinal tuberculosis. Due to theatre time being at a premium, we have evolved to performing anterior only debridement, allograft strut reconstruction and instrumentation for tuberculosis in the adult thoracic spine.

The aim of this study is to review the safety and the efficacy of this treatment.

Methods:

Twenty-eight adult thoracic tuberculosis patients were identified where anterior only surgery had been performed. These were all in the mid-thoracic spine as circumferential surgery is still favoured in thoracolumbar disease. The surgery was performed by a single surgeon at a tertiary hospital.

Following transthoracic aggressive debridement, allograft humeral shafts were cut to size and inserted under compression and the spines instrumented with the use of screw-rod constructs into the body above and below.

A retrospective review of clinical notes and radiological studies was performed.

Objective:

To observe the incidence of intra-operative vascular injuries during anterior cervical decompression and fusion (ACDF). Secondly, management and monitoring of the outcome post vascular injury during ACDF.

Methods:

This a prospective study. A review of all spinal patients' records was performed from June 2006 to April 2011. A comprehensive literature review was also utilized. Inclusion criteria – all patients had ACDF post trauma. All non-traumatic cases were excluded.

Background:

The reported prevalence of sciatica ranges from 1.2% to 43%. Epidural injections are the most commonly performed interventions for sciatica

Setting:

A provincial based spinal unit

Aim.

The purpose of this survey was to establish a patient profile, risk factors, previous management and care strategies for patients presenting to the Orthopaedic Out Patient Department at an Academic Hospital with low back pain.

Method.

We reviewed 257 patients during a 6 month period from July 2010- December 2010.0.

Patients were excluded if there were: XR deformities (eg. spondylolistheses, masses, cysts etc); associated neurology, incontinence or constitutional symptoms; previous vertebral column fracture or surgery or current malignancy. Patients referred for first visits were also excluded.

Purpose of study:

Reverse shoulder arthroplasty is effective in the management of symptomatic arthritic shoulders with a non-reconstructable rotator cuff. Optimal orientation and initial fixation of the glenoid component is correlated with improved outcomes. This may be difficult to achieve with distorted glenoid morphology. The authors present a previously undescribed system for accurate, consistent and reliable screw placement for fixation of the glenoid component with the desired version during reverse shoulder arthroplasty.

Description of methods:

The pre-operative CT scan images are used to construct a scapula model (Medical Image Processing software, CustomMed Orthopaedics)allowing the surgeon to determine the optimal position for screw placement based on available bone stock. A custom drill guide is made from polyamide, which is sterilized in an autoclave and fitted to the glenoid intra-operatively prior to reaming. The system minimizes the likelihood of malposition of glenoid components and is compatible with all arthroplasty systems.

Purpose:

Malpositioning of the acetabular cup component in total hip arthroplasty can result in increased wear, early nonseptic loosening and is the most common cause of dislocation. Previous research has defined a safe zone with an inclination of 40±10 degrees and anteversion of 15±10 degrees. The purpose of this study was to compare cup placement using imageless navigation to a matched control group using CT based measurements.

Methods:

30 patients receiving a primary hip replacement were included. Alignment of the implant is based on the acquisition of landmarks (ASIS and pubic tubercle) and placement of tracking pins into the ASIS. The target position for all patients was 45 degrees of inclination and 15 degrees of anteversion. A multi-slice CT scan was used to assess cup position.

Purpose:

Crosslinking of polyethylene has become synonymous with longevity in total hip replacement. In the USA 70–85% of all polyethylene cups underwent crosslinking since 2008. Three publications appeared in the autumn 2011 volume of the “SA Orthopaedic Journal,” on the 10–33 year follow-up of the original SA crosslinked implant. The purpose of this study is to illustrate and confirm statistically, the improvement of the bone cement interface, provided that wear of polyethylene can be reduced to an absolute minimum.

Method:

Complete follow-up included Merle D'Aubigne clinical follow-up and radiological studies of the interface. Interpretation of radiological measurements was according to the D.M. (Digital Magnification) method, as published in 2007. This information was digitally analysed by the Department of Statistics, University of Pretoria. Follow-up was at six months post op and again at end of study. All cups were crosslinked with fixed-dose Gamma-rays, in a saturated acetylene environment, acting as mediating gas. This resulted in enhanced crosslinking in the superficial 300µ of the pre-manufactured implant.

Purpose of study:

A retrospective clinical and telephonic survey of AMIS patients. Minimally Invasive Anterior Hip Replacements have been performed according to the AMIS technique in two centres in South Africa on a regular basis since 2 February 2007.

We report on the first 335 cases that were done from February 2007 till October 2009 in these two centers, by two surgeons.

Description of methods:

The data reported from these patients was collected from clinical notes, hospital records and telephonic questionnaires. Of the 335 cases that were performed data could be collected from 283 patients. Patients lost to follow up were 16 deceased, 24 could not be reached and 12 others had co-morbidities like Alzheimers, Total deafness and CVA.

Purpose of Study:

To look at the difference in metal ion levels using Ceramic on Metal (COM) and Metal on Metal (MOM) bearings in Total Hip Replacements, comparing the results between well placed and poorly placed cups.

Methods:

Metal ion levels using the ICP-MS method of assay have been studied as part of a prospective randomised trial between 4 different bearing combinations. The ion levels have been raised in the COM and MOM bearings. Metal ions are not raised in the Ceramic on Ceramic (COC) and Ceramic on X linked Poly(COP) bearings, showing that no other material in the study prosthesis aside from the bearing surfaces contribute to raised ion levels. Cup inclination and cup anteversion has been measured in all patients.

Method.

An electronic stethoscope was successfully used to record sounds from the hips of participants with different bearing surfaces. The sounds were recorded while conducting a standardized movement sequence. A 5th order Savitzky-Golay filter with a window width of 21 points was used to remove background noise. The recordings were also listened to by ear and three primary classes of sounds were identified. Frequency components contained in the classes were identified using spectrograms and Welch power density spectra. The sounds were correlated with different patient factors including component positioning, BMI and length of time that the implant was in situ. The skewness and kurtosis of the power spectra were calculated and found to be different for each class. Further frequency analysis was conducted with the aid of the discrete wavelet transform. This met with some success as different frequency levels were found in each sound class.

Results.

All bearing surfaces produced some noise. The most sounds were produced by the ceramic-on-metal group, even though not in the audible range, and those participants with a body mass index in the obese range. Sounds were also detected in the ceramic-on-polyethylene implants. However, no consistent links between these factors and the sounds produced could be identified. Specifically, the lack of correlation between sound occurrence and length of implantation indicates that this technique is not useful in predicting possible failures or future complications in real time.

Purpose of the study:

Recent literature raised concern on the adverse effects, incidence of pseudo tumours and raised blood and urine Chromium and Cobalt levels in patients with a metal on metal articulation. The purpose of this study was to follow up a cohort of patients that received a metal on metal total hip replacement with minimum follow up of ten years and to compare the results with the literature.

Methods:

All the available patients that underwent metal on metal total hip replacements during 1999 to 2000 with a minimum follow up of 10 years were clinically examined and evaluated with the Harris Hip Score; X-rays; Full Blood Count; CRP; LFT; U, K & E; blood and urine Chromium and Cobalt levels and Ultrasonic examination of the hip. The ultrasound was done by an independent experienced ultrasonographist in each case to exclude pseudo tumours or fluid collections. The patients were clinically examined to try and find any adverse effects of the metal on metal articulation.

Purpose:

Imageless navigation has improved the accuracy of acetabular cup placement but relies on manual identification of pelvic anatomy. Thick soft tissues in obese patients could obscure these landmarks and result in large variances of cup placement. The purpose of this study was to investigate the relationship between BMI, soft tissue thickness, navigated cup and final post-operative cup position.

Methods:

Thirty patients with an average age of 66.5 years underwent primary navigated THA. Final intra-operative cup position was recorded. Soft tissue thickness and final post-operative cup alignment were measured on a multi-slice pelvis CT scan.

Methods.

As part of a prospective randomised trial of different bearing surfaces, whole blood metal ion levels were monitored. This included four cohorts of patients, namely ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoP), ceramic-on-ceramic (CoC) and ceramic-on-metal (CoM). Serial whole blood metal ion levels in the non-metal bearings, namely CoC and CoP, were analyzed.

Results.

There was no consistency in these whole blood metal ion levels. Intra-patient variations in these levels over a period of time could not be due to bearing-produced metal ions as these were all metal free, and thus not the source of any endogenous ions. These intra-patient variations may reflect changes in exogenous exposure to these metal ions, fluctuations in these patient's metabolic functions or production of metal ions from non-bearing prosthetic sources.

Purpose:

Correct placement of the acetabular cup is a crucial step in hip replacement to achieve a satisfactory result and remains a challenge with free hand techniques. Imageless navigation may provide a viable alternative to freehand technique and improve placement significantly. The purpose of this project was to assess and validate intra-operative placement values as displayed by an imageless navigation system to postoperative measurement of cup position using high resolution CT scans.

Methods:

Thirty-two subjects who underwent primary hip joint arthroplasty using imageless navigation were included. The average age was 66.5 years (range 32–87). 23 non-cemented and 9 cemented acetabular cups were implanted. The desired position for the cup was 45 degrees of inversion and 15 degrees of anteversion. A pelvic CT scan using a multi-slice CT was used to assess the position of the cup radiographically.

Patients and methods:

Using data collected prospectively we looked at 2 groups of consecutive patients undergoing THR. The protocol was the only factor changed during the period studied. Initially we used subcutaneous dalteparin injections and continued use of aspirin in peri-operative period following total hip replacements (Group I–317 patients).

A new protocol was introduced involving rivaroxaban for thrombo-prophylaxis with its first dose at least 8 hours from skin closure and stopping aspirin at least 7 days before operation. In addition tranexamic acid was given in a dose of 500 mg (or 1 gm in obese patients) intravenously just prior to incision (Group II–348 patients).

We compared these two groups regards Hb drop at 24 hours and blood transfusion requirement.

Results:

The average Hb drop at 24 hours postop in group I was 3.08 gm/dl compared to 2.31 in group II. (p<0.001). 62 (19.6%) patients in group I required blood transfusion compared to 11 (3.2%) in group II. (p = 0.001) Perioperative blood loss and length of stay reduction was also significantly different.

There was no increase in number of DVT/PE, but the sample size was too small to assess this statistically.

Purpose of study:

The purpose of the study is to evaluate the changes in peri-prosthetic bone mineral density following cemented and cementless total hip arthroplasty over a follow up period of 1 year.

Description of methods:

Ethics approval was sought and granted by the South African Medical Association Research Ethics Committee (SAMAREC). Patient consent for participation was obtained. Recruitment of the cohort took place over 2 years. Patients received an uncemented (Synergy) or cemented (Spectron) prosthesis as clinically appropriate. Functional status according to the University of California Los Angeles activity scale (UCLA scale) and bone mineral density as measured by Dual Energy X-ray Absorptiometry (DEXA) was assessed pre-operatively and at 3 months, 6 months and 12 months post-operatively. An independent Contract Research Organisation was used to monitor the site.

Purpose of the study:

To determine the outcomes of cases converted from an external fixator to an internal fixation device in the management of limb reconstructions and deformity corrections.

Method:

A retrospective review of 18 patients, that underwent a conversion procedure to internal fixation following long term external fixation use, was done. This comprised 24 limbs. Inclusion criteria: All cases of long term external fixator use converted to internal fixation over a 5 year period. Average external fixation time, pin site care, conversion timing, surgical device used as well as outcome were documented.

Purpose of the study:

Is circular external fixation a safe and effective method of managing closed distal third tibia fractures. These fractures are conventionally treated with plaster casts, intramedullary nails or plate fixation. These treatment modalities have complication rates in the literature of up to 16% malunion, 12% non-union, and 17% deep infections.

Description and Methods:

Retrospective review of 18 patients with closed distal third tibia fractures, with or without extension into the ankle joint, treated with circular fixator systems and minimal percutaneous internal fixation of the intra-articular fragment if required. Patients were followed up for time to union, malunion incidence as well as incidence of pin tract and deep infection. Distal third fractures which were extra articular or with simple intra articular extension were included. (AO 43 A, B1, C1, C2 + AO 42 in distal third) Patients with pilon fractures (AO 43 B2, B3 and C3) were excluded.

Purpose.

The aim of this study was to assess the outcome of the Versajet Hydrosurgery system in the treatment of Gustilo and Anderson grade III A and III B open tibial fractures using a pilot scale prospective randomised controlled trial against conventional surgery. The primary variable was the total number of debridements until wound closure.

Results.

A total of 40 patients were recruited: 16 patients had Versajet Plus (Smith & Nephew) hydrosurgery and 24 patients standard surgical debridement. Baseline characteristics were well balanced with respect to the age, mechanism of injury, contamination, wound area, depth, and displacement of the bone. There was some imbalance between treatment groups where more (68.8%) Versajet patients had III A classification; vs. (37.5%) standard surgical debridement patients.

The numbers of debridement procedures before wound closure for Versajet were: 1 debridement procedure for 11 patients (69%), 2 for 3 patients (19%) and 3 for 2 patients (12.5%). For standard surgical patients: 1 debridement procedure for 1 patient (4.3%), 2 for 19 patients (83%) and 3 for 3 patients (13%). There was significant evidence (p<0.001) that Versajet patients required fewer debridement procedures than standard surgical debridement prior to wound closure (ratio Standard: Versajet = 1.747:1). There was no evidence that the number of debridement procedures to achieve wound closure differed between the Gustilo and Anderson grade IIIA and grade IIIB classifications (p=0.692). The median time to wound closure was 3 days (95% CI 3 days, 5 days) for Versajet and 5 days (95% CI 4 days, 8 days) for standard surgically debrided wounds, but the difference was not statistically significant (p=0.275). There was no evidence (p=0.397) of a difference in the total number of surgical sessions (debridement or debridement with closure) required to close the wound (ratio Standard: Versajet = 1.040; 95% CI (0.950, 1.137). There were no instances of post-operative infection.

Methods.

We conducted a single centre prospective observational study comparing post-operative infection rates in HIV positive and HIV negative patients presenting with tibial shaft fractures managed with surgical fixation.

Results.

Twenty eight patients were incorporated over a six month period and followed up for three months post operatively. 25 open fractures including 6 HIV positive patients and 3 closed fractures including 1 HIV positive patient were assessed for signs of wound sepsis assessed with the asepsis wound score. 21 patients treated with external fixation including 4 HIV positive patients were also assessed using Checkett's scoring system for pin site infection.

There was no significant difference in post-operative wound infection rates between the HIV positive (mean wound score = 7.7) and HIV negative (mean = 3.7) patients (p=0.162). HIV positive patients were also found to be at no increased risk of pin site sepsis (p=0.520). No correlation was found between CD4 counts of HIV positive patients and wound infection rates.

Material and methods:

Fifteen patients sustaining high energy Gustilo 3B injuries of the tibia were treated from 2003 to 2009 with initial debridement followed by application of an external fixation device allowing immediate acute shortening of the bone gap. The bone defects ranged from 3 cm to 5 cm. Wound management was achieved with a vacuum assisted closure device (VAC) until granulation tissue covering the exposed bone made coverage with split skin grafting possible. A delayed progressive lengthening procedure was used to equalize the leg length discrepancy after wound cover was achieved.

Results:

The mean age of the 15 patients was 30 years and treatment times varied from 4 to 12 months. All fractures united with acceptable alignment and equalization of the leg length discrepancy. One patient required repeat procedures for a pin site infection by changing a wire. There was no deep sepsis.

Purpose of study:

To assess the effectiveness of a novel locked intra-medullary device in the treatment of acute clavicle shaft fractures.

Description of methods:

Patients admitted with midshaft clavicle fractures were assessed for inclusion in the study. Inclusion criteria were mid shaft clavicle fractures with 100% displacement; more than 1, 5 cm of shortening or containing a displaced butterfly segment. Fractures were assessed for suitability to intra-medullary fixation (fracture distance from the medial and lateral end of the clavicle, medullary diameter and fracture type). 35 patients were treated operatively using the device by the author. Post-op, patients were kept in a master sling for a period of 6 weeks and followed up for a period of at least 3 months. Fracture reduction, fracture progression to union, scar size, Dash score, Constant Shoulder score, patient satisfaction and complications were assessed at follow-up by the surgeon, a radiologist and an occupational therapist.

Purpose:

Paediatric forearm fractures are commonly seen and treated by closed reduction and plaster cast application in theatre. Historically, cast application has been subjectively evaluated for its adequacy in maintaining fracture reduction. More recently emphasis has been placed on objectively evaluating the adequacy of cast application using indicators such as the Canterbury index (CI). The CI has been used in predicting post-reduction, re-displacement risk of patients by expressing the casting and padding indices as a ratio.

The CI has been criticized for not including cast 3 point pressure, fracture personality and lack of standardization of X-ray views as well as practical requirement of physical measurement using rulers.

The aim of this study was to determine whether subjective evaluation of these indices, on intra-operative fluoroscopy and the day 1 to 7 postoperative X-ray, was accurate in predicting a patient's ultimate risk of re-displacement, following reduction and casting.

Materials and Methods:

In total, 22 X-rays from 11 patients were evaluated by 20 orthopaedic registrars and 8 consultants, before and after a tutorial on the Canterbury index.

Results

During this time period 633 paediatric patients where admitted with trauma related injuries; only 19 had pelvic fractures, an incidence of 0.03%.

The majority of these patients (13) were involved in PVA's; while MVA (3), fall from height (1) and sports injuries (1) made up the rest. Males (13) were injured more commonly and the average age of the patients was 9 years (3–14).

There is debate of over the ideal paediatric pelvic fracture classification system in the literature. However, 13 pelvic fractures were classified stable; 3 were unstable fractures with disruption of the pelvic ring. In addition 2 iliac wing fractures and 1 avulsion (apophyseal) fracture were found.

58% of the patients had associated injuries, however, only 2 of the 19 had associated abdominal viscus injuries. Neither of these required exploratory laparotomy and were managed conservatively.

The treatment of these pelvic fractures in our unit was patient specific and largely conservative. 17 patients' pelvic fractures were treated with bed rest, analgesia and mobilisation as pain allowed while the remaining 2 had pelvic external fixators. No ORIF's were performed. Associated orthopaedic injuries were managed accordingly.

The average hospital stay of a patient with a pelvic fracture was 15 days (3–48 days).

There were no mortalities during this time period.

Purpose:

To review the union rates, outcomes and complications of angular stable plating of lateral third clavicle fractures.

Method:

Between 2007 and 2010 angular stable plates were used in the fixation for seventeen patients with displaced lateral third clavicle fractures (Allman Group II, Type 2). These were identified from surgical log books and operation codes. The surgical and clinical notes as well as X-rays were reviewed. The patients were contacted telephonically. An Oxford Shoulder Score and questions relating to plate removal, scar pain and return to activities were asked. Three patients were not contactable.

Aim:

To audit pertrochanteric fractures treated with a cephalomedullary device in a public health institution.

Method:

A retrospective 3 year analysis from January 2007 to December 2010 using theatre records and patient files.

Analysis was done in terms of age, time to surgery, duration of surgery, elective or emergency, type of device used, perioperative complications and other factors.

Purpose of study:

Total elbow replacement (TER) is one of the surgical options for treatment of severe haemophilic arthropathy of the elbow. There are only a few small series described in the literature. The goal of our study was to evaluate our cases and add these data to the known literature.

Methods:

A retrospective analysis of a series of 8 TER's (5 patients) was performed. Patients were seen in clinic and evaluated by physical examination, a VAS score for pain, the Mayo Elbow Performance Score (MEPS, 100 points=excellent) and X-rays of the affected elbow. Mean follow-up was 91 (4–236) months, and 103 months when we excluded a patient with only 4 months follow-up. Primary diagnosis was Hemophilia type A in 4 and von Willebrand disease in 1 patient. 2 patients were positive for Hepatitis C and 3 for HIV. Mean age at primary surgery was 46.7 (31.8–63.1) years.

Purpose:

Interposition arthroplasty is a salvage procedure for patients with severe osteoarthritis of the elbow where conservative treatment failed. It is mostly performed in younger patients where total joint replacement is contraindicated and an arthrodesis is unattractive. Although one of the oldest reconstructive options for elbow arthritis, the procedure is not without complications. There are only a few case series described in the literature. The purpose of our study is to review our cases and report their outcome.

Method.

We retrospectively reviewed 18 consecutive cases of interposition arthroplasty between 2001 and 2010. 2 cases were excluded due to incomplete records. The mean patient age was 41.3 (19.4–58.6) years at time of surgery. The primary diagnosis was post-traumatic osteoarthritis in 11 cases and inflammatory osteoarthritis in 5 cases. The mean follow up was 4.7 (0.4–10) years. Pre- and post-operative pain and function was evaluated using the Visual Analogue Scale (VAS) and Mayo Elbow Performance Score (MEPS). The complications and the number of re-operations and revisions were recorded.

Purpose:

To determine the insertion of the different layers of the rotator cuff and apply it to rotator cuff tears. Anatomical insertion of the rotator cuff holds the key to a proper anatomical repair.

Method:

A study of the rotator cuff insertion was done in conjunction with MSc student department Anatomy. The rotator cuff consists of a capsular and tendinous layer. They have different mechanical properties. The capsular layer inserts ± 3 mm more medially on the tuberosity and the tendinous layer more laterally. It was shown that the superficial layer extends beyond the greater tuberosity and connects the supra-spinatus tendon to the sub-scapularis tendon via the bicepital groove. This connection was called the “rotator hood”. The “rotator hood” has a mechanically advantageous insertion, is a strong structure with a compressive force on the proximal humerus.

Method.

A retrospective analysis of 7 patients' notes, radiology and arthroscopic findings between 2006 and 2010.

Results.

There were 5 females and 2 males, with an average age of 50 years 3 months. The indications for using these anchors varied; 5 patients had rotator cuff repairs, 1 had a SLAP repair and the other had a Bankart repair. Patients complained of pain (3), a noisy shoulder (2), deformity (1) and symptoms similar to an infection (1). Average time from surgery to symptoms varied, with the shortest time being 3 months and the longest being 4 years 2 months.

Some had dramatic MRI changes showing significant lysis around the anchors. Arthroscopic findings included anchor debris in the joint, loose anchors with significant defects and resultant irreversible cartilage damage.

Purpose of the study:

The purpose of the study was to evaluate the possible causes or risk factors for the occurrence of venous thrombotic events (VTE) after shoulder arthroscopy.

Methods:

Two cases that occurred in the practice were evaluated for the study. Evaluation of their medical history, procedures and post-operative care was made. The information was evaluated for possible risk factors that could have led to the VTE. Literature reports were also evaluated. All the relevant data (personal and literature) was used to determine risk factors that could help identify high risk patients undergoing arthroscopic shoulder surgery.

Purpose of the study:

Improved technology, increasing experience and techniques warrant an analysis of cost effective ways of medical management in general and shoulder decompression specifically. The question raised was whether a less invasive technique is necessarily the most cost effective way or merely the surgeons' preferred technique.

This is a retrospective study of patients at Tertiary Academic Institution who underwent an open or arthroscopic shoulder decompression in the past 3 years.

The aim of the study is to do a cost analysis of shoulder surgery as private health care (medical aid) is demanding more cost effective procedures and we have limited funds in the Government setting.

Methods:

We focused on the following: the surgeon; the procedure; operating time; inpatient time; intraoperative block; physiotherapy costs, time off work and the cost of instrumentation used. Patients had to comply with specific inclusion and exclusion criteria.

Inclusion: All patients that had shoulder decompression surgery in the past three years by a qualified orthopaedic surgeon; Exclusion: sepsis, tumours, rotator cuff tears, conversion of an arthroscopic procedure to an open procedure intraoperatively, inadequate notes, multiple surgical procedure under the same anaesthetic (e.g. scope with a trapezium excision).

Material.

Our indications for the reverse prosthesis in fracture management were:

Results.

There were a total of 14 cases treated for fractures out of 123 reverse shoulder arthroplasties performed. The average age for the fracture cases was 68 years (range 47–87) and for non-fracture RSA cases 73 years (range 51–88). The average follow-up Constant Score was 53 for fracture cases and 67 for non-fracture RSA cases.

Complications included 1 dislocation and 1 deep infection. The problem with treatment of complex cases is there is an increased risk of complications.

Problems encountered in the use of reverse shoulder arthroplasty in complex diagnoses include: instability, notching of scapula, scapula fractures, sepsis, lack of bone stock, poor quality soft-tissue and deficient deltoid muscle due to numerous previous surgical procedures, distortion of anatomy due to trauma, subscapularis deficiency and problems encountered from metal implants in situ.

Purpose:

We aimed to assess the short and medium term complications of patients who had undergone Latarjet procedures. We also compared this to a group of patients who over a similar period underwent an open Bankhart procedure to assess the complication profiles between the two groups.

Method:

We retrospectively reviewed the notes and X-rays of all patients identified by surgical log books and or operation codes for instability. Eighty seven patients (88 shoulders) underwent Latarjet procedures between 2002 and 2010. Patients were phoned to obtain a telephonic Oxford shoulder score. There were 44 patients with 46 shoulders in the open Bankhart group.