SA Orthopaedic Journal最新文献

{"title":"Truth or DAIR? A review of debridement, antibiotics and implant retention","authors":"N. Blair, J. M. van der Merwe, S. Matshidza","doi":"10.17159/2309-8309/2022/v21n4a7","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n4a7","url":null,"abstract":"Debridement, antibiotics and implant retention (DAIR) is a viable treatment option in early postoperative and acute haematogenous periprosthetic joint infections (PJIs) with a stable implant. Despite lower success rates compared to one- and two-stage revisions, DAIR maintains satisfactory outcomes in selected patient groups and, if successful, has similar functional outcomes to primary arthroplasty. DAIR remains an attractive treatment option, providing satisfactory outcomes with decreased healthcare costs, reduced surgical burden on the patient and shorter hospital stays. With success rates of 37-90%, various factors need to be considered when deciding on DAIR as the appropriate treatment option for PJI. The risk of DAIR failure needs to be weighed against the potential benefits of DAIR success. Factors that increase success rates include an open DAIR procedure performed for a low-virulence, antibiotic-sensitive organism, within a short duration between symptom onset and/or index surgery and DAIR. The procedure involves intraoperative exchange of mobile components and copious wound irrigation, followed by an appropriate antibiotic regimen for a minimum of six weeks that can be administered either intravenously or orally in a well-optimised host, without significant soft tissue defects or contraindications to surgery. Factors increasing the risk for DAIR failure include chronic/late PJIs with resistant organisms, especially methicillin-resistant Staphylococcus aureus (MRSA) in poor hosts with significant comorbidities, such as chronic obstructive pulmonary disease (COPD), liver cirrhosis, rheumatoid arthritis, advanced age > 80 years, patients with fracture indications for arthroplasty and those who cannot tolerate rifampicin- and fluoroquinolone-based antibiotic regimens. Unfortunately, there is no definitive factor to serve as an indication of whether DAIR will be successful, but with recent data showing that a failed DAIR procedure does not lower success in future staged revisions, then even in the face of a 50% success rate, DAIR can maintain its role as an initial treatment option in the management of PJIs","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient satisfaction following wide awake local anaesthetic no tourniquet hand surgery","authors":"Michael de Buys, Mluleki Tsama, A. A. Aden","doi":"10.17159/2309-8309/2022/v21n1a6","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n1a6","url":null,"abstract":"ABSTRACT BACKGROUND: Wide awake local anaesthetic no tourniquet (WALANT) hand surgery is a rapidly growing technique for hand surgery whereby a lignocaine/adrenaline/bicarbonate mixture is injected into the hand or fingers where the procedure is to be carried out METHODS: This was a retrospective study with prospective recall analysing satisfaction of patients who underwent WALANT hand surgery at our academic hospital in the first year of its inception. Data collection included a questionnaire to analyse demographics, comparison to dental procedures, subjective and objective experience of the procedure, overall experience, expectations, pain and surgical outcome RESULTS: We included 80 procedures in 67 patients; 87% would prefer WALANT in the future, and 87% would recommend WALANT to friends or family. For 79% of patients (who had dental procedures before), the pain was less or the same as a dental procedure, and 70% of patients said the experience was better than expected. Average pain scores were 3.89/10 during local anaesthetic injection, 1.25/10 during the procedure and 5.20/10 postoperatively; with postoperative pain starting at an average of nine hours. Eighty-five per cent of conditions were cured at follow-up and no cases of digital ischaemia or infection were noted CONCLUSION: Our study suggests WALANT hand surgery is a safe, effective and satisfactory method of performing hand surgery in the South African context Level of evidence: Level 4 Keywords: WALANT, hand surgery, local anaesthetic, carpal tunnel, de Quervain's, ganglion, patient satisfaction","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67480632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wide awake local anaesthesia no tourniquet: a review of current concepts","authors":"A. Rocher, M. O’Connor, O. Koch","doi":"10.17159/2309-8309/2022/v21n3a6","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n3a6","url":null,"abstract":"BACKGROUND: Wide awake local anaesthesia no tourniquet (WALANT) is a local anaesthetic technique that employs lignocaine combined with adrenaline to maintain a pain-free and bloodless field during surgery on an awake patient, without the use of a tourniquet METHODS: This article is a narrative review of the literature on the use of this mode of anaesthesia in orthopaedic and hand surgery RESULTS: The review summarises the existing research pertaining to WALANT. It discusses the anaesthetic solution constituents, administration technique and applications of WALANT, highlighting the safety profile and benefits to patients and healthcare systems alike CONCLUSION: The WALANT technique is safe, economical, and acceptable to patients. It should form part of the orthopaedic surgeon's armamentarium. Future research should investigate the benefits of intraoperative functional assessment of the awake patient Level of evidence: Level 5","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence and spine surgery outcomes: the beginning of a new era","authors":"E. Burger","doi":"10.17159/2309-8309/2022/v21n3a","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n3a","url":null,"abstract":"","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High burnout among the South African orthopaedic community: a cross-sectional study","authors":"M. O'Connor, N. Ferreira, M. Smith, P. Webster, G. Venter, L. Marais","doi":"10.17159/2309-8309/2022/v21n3a1","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n3a1","url":null,"abstract":"BACKGROUND: Burnout is epidemic among physicians, with the orthopaedic speciality displaying one of the highest rates of burnout in international studies. The burnout rate of the South African orthopaedic community is unknown. This study aimed to determine the prevalence and causes of burnout, as well as the coping mechanisms and associations with burnout, in South African orthopaedic surgeons and trainees METHODS: We conducted a cross-sectional, secure, online survey of members of the South African Orthopaedic Association. The survey assessed demographic characteristics, workload, professional fulfilment and burnout (utilising the Stanford Professional Fulfilment Index), associated workplace distress conditions, causes of and coping strategies for burnout. A response was not compulsory for any question. Statistical analysis was performed to assess for independent associations with burnout RESULTS: One hundred and fifty-six respondents, with a median age of 46.5 years (interquartile range [IQR] 37-58) participated. Ninety per cent (139 of 155) of respondents were male. Registrars accounted for 17% (27 of 155), while 83% (128 of 155) were qualified specialists. Respondents were in orthopaedic practice for a median of 17 years (IQR 9-28). Sixty per cent (76 of 127) practise in private, 17% (22 of 127) in public and 23% (29 of 127) in both sectors. The overall burnout rate was 72% (113 of 156). Burnout was associated with being the parent of young children and having fewer hours of sleep on call. Registrars were more likely to have burnout than consultants (OR 5.68, 95% CI 1.3-25.2). Gender, practice setting and subspeciality were not associated with burnout. Self-reported causes of burnout that were found to be associated with actual burnout were: 'hours at work', 'lack of free time' and 'work-life imbalance'. No self-reported coping mechanisms were found to be protective in this cohort, but the use of alcohol as a coping mechanism was associated with an increased likelihood of burnout (OR 3.9, 95% CI 1.4-10.7). Respondents felt that the concurrent experience of the COVID pandemic at the time of running the survey reduced their experience of burnout CONCLUSION: The burnout rate in the South African orthopaedic community is 72%. Trainees were found to be particularly vulnerable. There appears to be a need to develop, assess and implement effective system-related initiatives aimed at reducing the burnout rate among orthopaedic surgeons and trainees in South Africa Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The mechanical testing of a novel interlocking forearm nail","authors":"H. Pretorius, M. Burger, N. Ferreira","doi":"10.17159/2309-8309/2022/v21n4a6","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n4a6","url":null,"abstract":"BACKGROUND: Mechanical testing of newly designed implants provides valuable insight into their mechanical properties. This provides surgeons with information about implant choice for the treatment of fractures and the effect of the implant's mechanical properties on fracture healing METHODS: A novel interlocking forearm nail was subjected to standardised mechanical testing according to the Standard Specification and Test Methods for Intramedullary Fixation Devices (ATSM 126416), using static and dynamic four-point bending and static torsion (ASTM STP 588). Three nails were used for the static bending and torsion and nine for the dynamic bending tests. All nails were catalogued, numbered and photographed before testing RESULTS: The mechanical testing results showed a mean force yield (Fy) of 566 ± 20 N, a moment of yield (My) 10.75 ± 0.37 Nm, a stiffness of 67.10 ± 2 N/mm and structural stiffness of 1.53 ± 0.50 m2. The torsional stiffness of the nail was 0.088 ± 0.002 Nm/°. The four-point dynamic bending test showed a fatigue strength of 5.23 Nm. This value was determined using the semi-log moment/ number of cycles (M-N) diagram and showed a 50% failure at a million cycles. If the moment were reduced to 4.4 Nm, mathematically, the survival rate would improve to 90% CONCLUSION: The results from this mechanical testing show that this novel intramedullary forearm nail can resist mechanical forces experienced during fracture healing and could potentially be used in future clinical studies Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modular prosthetic reconstruction for primary bone tumours of the distal tibia in ten patients","authors":"W. Mugla, H. Bauer, J. Vogel, K. Hosking, N. Campbell, T. Hilton","doi":"10.17159/2309-8309/2022/v21n2a5","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n2a5","url":null,"abstract":"BACKGROUND: Below-knee amputation (BKA) is the safest treatment for benign aggressive and malignant bone tumours of the distal tibia, yielding good oncological and functional results. However, in selected patients where limb salvage is feasible and amputation unacceptable to the patient, limb salvage using a distal tibial replacement (DTR) can be considered. This study aims to present the oncological and functional results of the use of the latter treatment method in our unit. METHODS: A retrospective folder review was performed for all ten patients who received a modular DTR between 1 January 2005 and 31 January 2019 for a primary bone tumour, either benign aggressive or malignant. Six were female and the mean age was 31 (12-75) years. There were five patients with giant cell tumour of bone, four with osteosarcoma and one with a low-grade chondrosarcoma. The patients with osteosarcoma had neoadjuvant chemotherapy before surgery. Function was assessed by the Musculoskeletal Tumor Society (MSTS) score. RESULTS: Two patients had local recurrence treated with a BKA and one other patient died of metastases three years postoperatively. At a mean follow-up of three years, the remaining eight patients had a mean MSTS score of 83% (67-93%). There were no radiological signs of loosening, and no revision surgeries. CONCLUSION: Endoprosthetic replacement of the distal tibia for primary bone tumours can be a safe treatment option in very selected cases. Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triceps-off transfascial sleeve approach, functional outcomes and surgical technique in distal humerus fractures","authors":"W. Nkomo, P. Rachuene, R. Dey, S. Maqungo, S. Roche, M. Solomons","doi":"10.17159/2309-8309/2022/v21n3a2","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n3a2","url":null,"abstract":"BACKGROUND: We aimed to assess functional and clinical outcomes of patients who underwent open reduction and internal fixation of distal intra-articular fractures of the humerus through a previously undescribed approach through the triceps tendon, called the triceps-off, transfascial sleeve (TOFS) approach METHODS: We conducted an ambispective cohort study of ten patients who underwent open reduction and internal fixation of the distal humerus through the TOFS approach at a tertiary hospital between March 2016 and January 2019. Patients were identified from the prospectively kept surgical database. All had AO type C fractures of the distal humerus. The mean age was 36.7 ± 14.9 years (range 19-68). The assessment consisted of a review of their hospital records, range of motion, triceps strength, ultrasound evaluation of triceps tendon integrity, X-rays for union rates and adequacy of reduction, and DASH scores RESULTS: The mean time of follow-up was 10.8 ± 4.7 months (range 6-19). The mean arc of motion was 114.7 ± 25.1 degrees (range 80-150). There was a decrease in mean triceps muscle strength compared to the uninjured side: 66% at 45° of flexion, 70% at 90° and 86% at 120° of elbow flexion. The mean DASH score was 15.7 ± 8.9, indicating mild residual impairment (range 5-31). The DASH score had a strong correlation (r = 0.71; p < 0.05) with the follow-up period. All tendons were intact on ultrasound evaluation. One patient had deep surgical site infection, treated with surgical debridement, antibiotics and plate removal with resolution of sepsis and healing. All fractures united by six months CONCLUSION: TOFS is a successful surgical approach for reduction and fixation of AO type C intra-articular distal humerus fractures, with excellent tendon healing rates. It is, however, associated with mild residual functional impairment and residual triceps weakness Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term outcomes of one-stage bilateral total hip arthroplasty in a South African setting","authors":"Sayed M Mia, J. Rajpaul, Ismail E Goga","doi":"10.17159/2309-8309/2022/v21n3a4","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n3a4","url":null,"abstract":"BACKGROUND: Total hip arthroplasty (THA) is one of the most successful orthopaedic surgical procedures that dramatically improves function, pain relief and quality of life for the patient. In South Africa, we have a high prevalence of osteonecrosis of the femoral head (ONFH) and inflammatory arthropathy affecting a young population. This subgroup of patients is usually between the ages of 30 and 50 years (young) and they require bilateral total hip replacements (BTHA) to allow them to return to their previous level of function and employment. The study aimed to assess the short-term outcomes and complications in patients with bilateral hip pathology managed surgically with a one-stage BTHA METHODS: We retrospectively reviewed a series of 33 patients who underwent a one-stage BTHA at a high-volume arthroplasty unit in a central hospital in South Africa between January 2016 and December 2018. The mean age was 38 years (standard deviation [SD] 9 years), and the most common diagnosis was ONFH (76%). In this cohort, 12 patients (36%) tested HIV positive. We assessed patient folders for diagnosis, perioperative details, postoperative follow-up and complications. Radiographic analysis was also performed RESULTS: There were no revisions or planned surgical interventions for any of the patients at a median follow-up of 22 months (interquartile range [IQR] 11-45 months). Thirty patients reported no hip pain and walked unaided at their most recent follow-up visit. Two patients reported groin pain and continued to walk with a single crutch. One patient demised from unrelated causes approximately one year post-surgery. The only perioperative complication was a urinary tract infection (UTI) in one patient. The median postoperative length of stay was six days (IQR 4-7 days), and no other medical or surgical complications were reported. Radiographic analysis revealed four patients (12%) with Brooker grade 1 heterotopic ossification in six hips CONCLUSION: Our results suggest that surgical treatment with a one-stage BTHA is a good alternative to a two-stage BTHA when performed in a high-volume arthroplasty centre and carefully selected patients. The 30-day mortality rate was 0%, and the complication rate was low Level of evidence: Level 4","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of the COVID-19 lockdown restrictions on orthopaedic trauma admissions in a central academic hospital in Johannesburg","authors":"Matthew Foster","doi":"10.17159/2309-8309/2022/v21n2a1","DOIUrl":"https://doi.org/10.17159/2309-8309/2022/v21n2a1","url":null,"abstract":"BACKGROUND: The novel coronavirus (SARS-CoV-2), commonly known as Covid-19, has caused a global economic and healthcare crisis. Many countries tried to curb the spread of the virus by implementing various lockdown restrictions to reduce transmission. The Republic of South Africa (RSA) implemented an alcohol ban as one of the lockdown restrictions. The objectives were to describe the effect of the lockdown alert levels and alcohol availability on orthopaedic trauma admissions, compared to the preceding two years. METHODS: A retrospective review of clinical records was conducted. Data included orthopaedic trauma admissions for the five-month period in a facility in Johannesburg from 27 March to 31 August in the years 2018, 2019 and 2020. Lockdown alert levels were categorised according to the Department of Health which included the ban, reintroduction and re-banning of alcohol consumption. Data collected for 2018, 2019 and 2020 included demographics of sex and age, as well as fracture location, open or closed injuries, polytrauma patients and gunshot injuries. RESULTS: Overall, 672, 621 and 465 patients were admitted in 2018, 2019 and 2020, respectively. There was a decrease of 25% of orthopaedic trauma admissions during the five-month lockdown period in 2020 compared to 2019 (p-value = 0.020) and 30% from 2020 compared to 2018 (p-value = 0.010). In 2020, admissions increased by 112% (n = 82) from alert level 4, when alcohol was banned, to alert level 3 (3a), when alcohol was reintroduced. Admissions decreased by 33% (n = 51) from alert level 3 (3a) to alert level 3 (3b), when alcohol was re-banned. Motor vehicle accidents (MVAs) were the commonest cause of admissions in alert level 3 (3a), accounting for 41% (n = 56). Covid-19 tests were positive in 10% (n = 34) of the 346 tests performed on orthopaedic trauma admissions CONCLUSION: Our study showed the decrease in orthopaedic trauma admissions due to the Covid-19 lockdown regulations. Furthermore, our study demonstrated the impact of alcohol availability on orthopaedic trauma admissions in a central academic hospital in Johannesburg. Level of evidence: Level 4.","PeriodicalId":32220,"journal":{"name":"SA Orthopaedic Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67481246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}