Leonard Charles Marais

University of KwaZulu-Natal | ukzn · Department of Orthopaedic Surgery

Aim In this study we investigated the effects of non-steroidal anti-inflammatory drugs (NSAIDs) with different cyclooxygenase (COX) selectivity on orthopaedic device-related infections (ODRIs) in a rat model. Specifically, we aimed to measure the impact of NSAID therapy on bone changes, bacterial load, and cytokine levels after treatment with antib...

Aim The aim of this systematic review was to assess the existing published data on tuberculous arthritis involving native joints in adults aged 18 years and older. The specific research questions focused on the diagnosis and management of the disease. Method This study was performed in accordance with the guidelines provided in the Preferred Repor...

Aim To classify Fracture-related Infection (FRI) allowing comparison of clinical studies and to guide decision-making around the main surgical treatment concepts. Method An international group of FRI experts met in Lisbon, June 2022 and proposed a new FRI classification. A core group met during the EBJIS Meeting in Graz, 2022 and on-line, to deter...

Aim Two-stage replacement is a frequent procedure in patients with chronic PJI. However, results in the literature after this procedure differ, ranging from 54% to 100% of infection eradication. Positive cultures at reimplantation, when performing the second stage, are perceived as a risk factor for reinfection. This study aims to determine the imp...

Musculoskeletal (MSK) injuries are one of the leading causes of disability worldwide. Despite improvements in trauma-related morbidity and mortality in high-income countries over recent years, outcomes following MSK injuries in low and middle-income countries, such as South Africa (SA), have not. Despite governmental recognition that this is requir...

Children with osteogenesis imperfecta (OI) frequently present with coxa vara (CV). Skeletal fragility, severe deformity and limited fixation options make this a challenging condition to correct surgically. Our study aimed to determine the efficacy of the Fassier technique to correct CV and determine the complication rate. Retrospective, descriptive...

We investigated the effects of non-steroidal anti-inflammatory drugs (NSAIDs) with different cyclooxygenase (COX) selectivity on orthopaedic device-related infections (ODRIs) in a rat model. We aimed to measure the impact of NSAID therapy on bone changes, bacterial load, and cytokine levels after treatment with antibiotics. We also compared the eff...

Paediatric bone and joint infections remain common in low- and middle-income countries (LMICs). We aimed to determine the complication rate and incidence of disseminated infection in paediatric bone and joint infections in an LMIC setting. Secondly, we aimed to elucidate factors associated with complications and disseminated disease. We retrospecti...

A judicious, well-planned bone and soft tissue debridement remains one of the cornerstones of state-of-the-art treatment of fracture-related infection (FRI). Meticulous surgical excision of all non-viable tissue can, however, lead to the creation of large soft tissue defects. The management of these defects is complex and numerous factors need to b...

Introduction: The aim of this systematic review was to assess the existing published data on the diagnosis and management of tuberculosis (TB) arthritis involving native joints in adults aged 18 years and older. Methods: This study was performed in accordance with the guidelines provided in the Preferred Reporting Items for Systematic reviews and M...

Background The aim of the study was to compare the initial management and the outcomes of patients with open tibia fractures referred to a tertiary orthopaedic unit using a mobile software application (app), Vula Medical Referral (VULA), with those referred by handwritten referral letters (HWRL). Methods A retrospective analysis was performed on da...

Background Proximal interphalangeal joint (PIPJ) contractures are common sequelae following trauma to the hand and represent a treatment impasse in South Africa’s resource-constrained setting. Various splinting techniques are advocated for first line management, but there is no consensus on the optimal splint, and many studies report equivocal outc...

Multidrug chemoresistance (MDR) remains the most significant obstacle to improving survival in osteosarcoma patients. Heterogeneous genetic alterations characterise the tumour mi-croenvironment, and host molecular markers have been associated with MDR. This systematic review examines the genetic alterations of molecular biomarkers associated with m...

Citation: Mdingi VS, Maré PH, Marais LC. Factors associated with dissemination and complications of acute bone and joint infections in children. SA Orthop J. 2023;22(1):34-40. http://dx. Abstract Background

Background: Musculoskeletal (MSK) injuries are one of the leading causes of disability worldwide. Despite improvements in trauma-related morbidity and mortality in high-income countries over recent years, outcomes following MSK injuries in low- and middle-income countries, such as South Africa (SA), have not. Despite governmental recognition that...

This study aimed to describe a novel transphyseal osteotomy (TPO) for acute deformity correction in children with bilateral tibia vara and the atraumatic 'slipped proximal tibial epiphysis' (SPTE) entity. We described the clinical and radiological findings in five children (10 limbs) with tibia vara that were treated with the TPO. The criteria for...

This clinical guideline is intended for use by orthopedic surgeons and physicians who care for patients with possible or documented septic arthritis of a native joint (SANJO). It includes evidence and opinion-based recommendations for the diagnosis and management of patients with SANJO.

BACKGROUND: High energy pelvic and acetabular fractures frequently occur in conjunction with multiple system injuries and have been associated with morbidity and mortality. We aimed to identify the risk factors associated with complications in patients with pelvic and/or acetabular fractures treated surgically in a resource-constrained clinical set...

Introduction: Pin site infections (PSIs) are frequent complications encountered with the use of circular external fixators. PSIs range in severity, and the numerous factors have been suggested to affect the incidence. We aim to perform a systematic review of all comparative studies including circular external fixation applied to the tibia diaphysis...

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...

Introduction: Dead space management following intramedullary debridement and reaming can be challenging and several alternatives have been described. The main objective of this study was to investigate the clinical outcome and resolution rate in patients treated for fracture-related Cierny and Mader anatomical type 1 intramedullary chronic osteomye...

The global burden of fracture-related infection (FRI) is likely to be found in countries with limited healthcare resources and strategies are needed to ensure the best available practice is context appropriate. This study has two main aims: (i) to assess the applicability of recently published expert guidance from the FRI consensus groups on the di...

Aim: To evaluate the results in terms of correction and complications from gradual correction with a computer-assisted hexapod circular external fixator in a mixed cohort of children with Blount's disease. Materials and methods: A retrospective review was performed of the correction and complications of 19 children (25 limbs) with recurrent infa...

Importance The use of perioperative, prophylactic, intravenous antibiotics is standard practice to reduce the risk of surgical site infection after oncologic resection and complex endoprosthetic reconstruction for lower extremity bone tumors. However, evidence guiding the duration of prophylactic treatment remains limited. Objective To assess the...

BACKGROUND: Children with osteogenesis imperfecta frequently present with coxa vara. Skeletal fragility, severe deformity and limited fixation options make this a challenging condition to correct surgically. Our study aimed to determine the efficacy of the Fassier technique to correct coxa vara and determine the complication rateMETHODS: We retrosp...

PurposeThis systematic review determined the reported treatment strategies, their individual success rates, and other outcome parameters in the management of critical-sized bone defects in fracture-related infection (FRI) patients between 1990 and 2018.MethodsA systematic literature search on treatment and outcome of critical-sized bone defects in...

Background: South Africa (SA) has one of the highest gun-related mortality rates in the world - 20 people per day. The available data, however, do not reflect the substantial number of patients suffering non-lethal firearm injuries. Gunshot-related injury has been recognised as a highly costly healthcare problem by individual treating centres in S...

Background This guideline was developed as a response to patients with osteosarcoma presenting late for treatment thereby significantly affecting their prognoses. Healthcare providers recognised the role of culture and the importance of culturally competent communication in addressing this problem. The aim of this guideline is to present healthcare...

Background The deleterious effects of hypoalbuminaemia in the peri-operative period are well documented. We aimed to review serum albumin levels in a cohort of orthopaedic trauma patients to determine the prevalence of hypoalbuminaemia. Secondarily, we aimed to identify factors associated with an increased risk of hypoalbuminaemia.MethodsA retrospe...

BACKGROUND: Children with osteogenesis imperfecta suffer from frequent fractures and deformities due to skeletal fragility. Stabilisation of fractures, correction of deformity and intramedullary rodding result in decreased pain and improved function. Modern expandable intramedullary rods aim to provide lasting stability during growth, without an in...

Objectives: Our observational study's objective was to determine how effective guided growth with tension-band plates was to correct the deformity in Blount's disease. Methods: We reviewed the records of 14 children (18 limbs) with Blount's disease who were treated with tension-band plates as the only surgical intervention at a single institutio...

BACKGROUND: The HIV burden in South Africa is high. HIV-positive patients are at risk of developing avascular necrosis of the femoral head, necessitating total hip arthroplasty (THA) at a relatively young age. The primary aim of this study was to investigate the relationship between HIV infection and the risk of periprosthetic joint infection (PJI)...

BACKGROUND: Significant advances have been made in the global effort to eradicate polio. Vaccine-associated poliovirus, or other enteroviruses, may still affect the anterior horn cell and cause acute flaccid paralysis. Following the acute disease, residual paralysis results in lower motor neuron weakness, altered growth and deformity. Our study aim...

BACKGROUND: The management of end-stage hip disease in children and adolescents is a challenging clinical problem. While total hip replacement (THR) offers the benefit of improved mobility, this is offset by the risk of multiple revisions. Hip arthrodesis remains a salvage option to relieve pain and restore function at the cost of hip movement. Thi...

BACKGROUND: This study aimed to determine whether the addition of a lateral proximal tibial tension band plate, combined with proximal tibial dome realignment osteotomy, would decrease the recurrence rate in a group of children younger than 7 years with infantile Blount's disease (IBD) and high recurrence risk, defined as a medial physeal slope >60...

Background: Late-presenting or recurrent infantile Blount disease (IBD) is characterized by knee instability because of medial tibial plateau depression, multiplanar proximal tibial deformity, and potential distal femoral deformity. The surgical treatment strategy includes medial elevation osteotomy to stabilize the knee, together with proximal ti...

BACKGROUND: The aim of this study was to compare the initial tumour volume in patients with and without pulmonary and/or skeletal metastases at time of presentation. The secondary aim was to compare the value of tumour volume in the prediction of metastases at time of presentation with known predictive factors, namely serum alkaline phosphatase (AL...

Background: The primary objective of this study was to determine the incidence of symptomatic venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), in the hip fracture population. Secondary objectives included determining timing of VTE diagnosis, VTE thromboprophylaxis given, and identifying any factors ass...

Background: This study aimed to determine the recurrence rate in infantile Blount disease (IBD) in a cohort of patients treated with a tibial osteotomy; and also to identify which factors were associated with recurrence. Methods: We reviewed the records of 20 patients, under the age of 7 years, with IBD (35 involved extremities) treated by proxi...

BACKGROUND: The aim of this study was to identify the risk factors associated with the development of early complications in patients with hand infections. A secondary objective was to describe the bacteriology and resistance profile in our study populationMETHODS: This retrospective observational descriptive study was performed at a regional refer...

BACKGROUND: Administration of tranexamic acid (TXA) peri-operatively is a well-recognised strategy used by orthopaedic surgeons to reduce blood loss during total knee arthroplasty (TKA). Furthermore, not using a drain has been advocated to be a safe and effective way to further reduce blood loss. The main aim of this study is to assess the effect o...

Aim: To conduct a systematic review and meta-analysis comparing the incidence of fracture-related infections (FRI) following surgical management of closed and open fractures in HIV-positive and HIV-negative patients. Methods: A systematic literature search was conducted using MEDLINE, ProQuest, Web of Science, The Cochrane Library and Scopus. Ou...

Update This article was updated on July 2, 2020, because of previous errors. On page e44(4), in the legend for Figure 1, the sentence that had read “Diagnosis of fracture-related infection (FRI).” now reads “Diagnosis of fracture-related infection (FRI) ²² .” On page e44(5), the title for Table III that had read “Diagnostic Criteria for Fracture-Re...

BACKGROUND: The coronavirus disease of 2019 (COVID-19) pandemic is taxing South Africa's already over-burdened healthcare system. Orthopaedics is not exempt; patients present with COVID-19 and musculoskeletal pathology and so surgeons should be familiar with the current evidence to best manage patients and themselves. The aims of this scoping revie...

Citation: Brown O, Goliath V, Van Rooyen RM, Aldous C, Marais LC. Communicating about prognosis with regard to osteosarcoma in a South African cross-cultural clinical setting: strategies and challenges. SA Orthop J 2019;18(4):46-51. http://dx. Abstract Background: Effective prognostic communication with patients is a prerequisite for treatment deci...

BACKGROUND: The aim of the study is to determine the prevalence of HIV infection among adult patients with reactivation of haematogenous chronic osteomyelitis METHODS: A retrospective analysis of prospectively collected data from 143 adult patients with chronic osteomyelitis RESULTS: A total of 143 patients were included in the study group, with a...

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a...

BACKGROUND: Segmental tibia fractures historically are treated with special consideration due to their complexity, high complication rate and the propensity for associated injuries. Circular external fixators (CEFs) offer several potential advantages in this situation due to their modularity and minimally invasive application. These advantages have...

Purpose: International and national research regarding the discussion of cancer treatment across cultural boundaries is sparse. This study was conducted in the province of KwaZulu-Natal, South Africa, where healthcare encounters are largely culturally discordant; and this study focused on adult Zulu patients diagnosed with osteosarcoma. The purpose...

Background: A structured approach to perioperative patient management based on an enhanced recovery pathway protocol facilitates early recovery and reduces morbidity in high income countries. However, in low- and middle-income countries (LMICs), the feasibility of implementing enhanced recovery pathways and its influence on patient outcomes is sca...

Introduction: Recent work into the causes of death after non-cardiac surgery has identified a new clinical concept, namely myocardial injury after non-cardiac surgery (MINS). The pathophysiology is related to a supply-and-demand mismatch in the peri-operative period and differs from the traditional model of myocardial ischaemia and infarction. Meth...

INTRODUCTION: Tibial plateau fractures in the elderly pose significant treatment challenges because of coexisting medical problems, pre-existing degenerative joint disease and osteoporosis. While several studies have reported promising results with the use of circular external fixation, little data is available on its use in older patients. This st...

Background: There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa. Methods: We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older...

Abstract Background The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surger...

Background As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. Methods We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary...

This article aims to review the current trends in the pedagogy of orthopaedic surgery, with specific reference to teaching philosophies, training methods and assessments tools that may be used. Our expanding knowledge base and the complexity of skills required, combined with the pressure created by medical negligence litigation increases the emphas...

BACKGROUND: HIV infection causes a relative immunodeficient state, potentially predisposing patients to osseous infection. It is also associated with non-AIDS defining cancers, and has been described in patients with limb girdle sarcomas and malignant fibrohistiocytic tumours. HIV is further known to suppress cells important in bone healing; howeve...

OBJECTIVES: The primary aim of this study was to identify the microorganisms that cause chronic osteomyelitis in a developing world clinical setting and to characterise the antibiotic sensitivity profile of these pathogens. Furthermore, we aimed to determine whether the causative organisms vary in relation to physiological status of the host, the H...

Communicating the diagnosis of cancer in cross-cultural clinical settings is a complex task. This qualitative research article describes the content and process of informing Zulu patients in South Africa of the diagnosis of cancer, using osteosarcoma as the index diagnosis. We used a descriptive research design with census sampling and focus group...

INTRODUCTION: Kaposi's sarcoma and lymphoma are some of the malignancies known to be associated with HIV infection and afflict many people living with HIV/Aids, as published widely in previous literature. In contrast, scarce information is available with regard to the occurrence of other primary musculoskeletal malignancies and whether there may be...

Calcific myonecrosis is a rare condition and is believed to be a late sequela of untreated compartment syndrome. Patients usually present with a progressively enlarging mass, years after the initial injury, that can be misdiagnosed as a soft tissue sarcoma. Calcific myonecrosis following snakebite is extremely rare. The anterior compartment of the...

It is difficult to find fault with the reasoning behind the move towards an evidence-based approach in the teaching and practice of orthopaedics. With numerous options available, treatment strategy selection has to be based on more than just intuition and prior experience. Furthermore, there are several strong arguments for the need to practice Evi...

Background: Tibial nonunions pose significant treatment challenges despite the regularity with which they are encountered. While several studies have reported the outcome of treating different nonunion subtypes with various strategies, few have investigated the factors that influence treatment and outcome. Aims: This study aims to identify factors...

Background Managing cancer in a multicultural environment poses several challenges, which include the communication between the patient and the healthcare provider. Culture is an important consideration in clinical care as it contributes to shaping patients’ health-related values, beliefs, and behaviours. This integrative literature review gathered...

Culturally competent patient–provider communication in the management of cancer: An integrative literature review

BACKGROUND: Human-inflicted bite wounds to the hand are serious injuries that may result in significant morbidity and permanent impairment. Irrespective of the mechanism, they are associated with a high complication rate and this has been attributed to the unique anatomy of the hand and the pathogens involved in human bites. HIV (human immunodefici...

INTRODUCTION: Giant cell tumour of bone (GCT) is a rare primary bone tumour. Little is known about the epidemiology of this tumour in South Africa as most demographic information is based on research from Asia, Europe and North America. This research aims to raise awareness and promote early recognition of these tumours. Materials and methods: A re...

The perceived ability of systematic reviews and meta-analyses to concisely and definitively summarise existing literature regarding a specific medical issue has made them the most highly read and cited form of academic literature. However, the evidence they provide is only as good as the data evaluated and the methodology followed when doing them....

INTRODUCTION: Limited data is available with regard to the epidemiology of primary malignant orthopaedic tumours in the South African clinical setting. As a result, orthopaedic surgeons have to rely on data from other countries when formulating differential diagnoses for malignant bone lesions. Existing data, however, demonstrates variance in the i...

Introduction: Closed distraction of stiff tibial nonunions with a hexapod external fixator can predictably lead to union without the need for additional surgery or bone graft. Indications & contraindications: Step 1 fibular osteotomy: Resect 5 to 10 mm of the fibula, from its distal half or at the level of the fibular deformity if present. St...

Grade III open tibia fractures have previously been shown to have high infection and non-union rates, and the optimal treatment remains controversial. We present the short-term results of 94 consecutive Gustilo-Anderson grade III open tibia fractures, definitively treated with circular external fixators in this retrospective study. A total of 94 pa...

Previous classification systems of chronic osteomyelitis have failed to provide objective and pragmatic guidelines for selection of the appropriate treatment strategy. In this study, we assessed the short-term treatment outcome in adult patients with long-bone chronic osteomyelitis prospectively where a modified host classification system was integ...

Achieving quiescence in chronic osteomyelitis remains challenging. Wide resection of all infected and necrotic tissues improves the chances of achieving remission of the disease. Extensive debridement however decreases the already compromised bone stock that increases the complexity of reconstruction. We report on the outcome of eight patients with...

Femoral non-unions are difficult to treat even for the experienced orthopaedic trauma surgeon. If the non-union follows failure of modern stable internal fixation, the complexity of the management is further increased. We report two cases of stiff hypertrophic femoral non-unions after failed locking plate fixation that were successfully treated wit...

INTRODUCTION: Giant cell tumour of bone is a rare entity in children and seldom involves the distal humerus, even in adult patients. We present a case of giant cell tumour in the distal humerus of a child CASE REPORT: A 12-year-old boy presented to our tertiary level tumour unit with progressive pain in his left elbow and was radiologically and his...

Bone healing is a unique and complex reparative process that results in fractures healing without scar tissue formation. Multiple factors have been implicated in altering this process. This paper reviews the factors that influence the process of bone healing and predispose to non-union development. Cognisance of these factors will assist orthopaedi...

Tibial non-unions represent a spectrum of conditions and are challenging to treat. The optimal management remains unclear despite the frequency with which these diagnoses are encountered. We developed a tibial nonunion treatment algorithm following two retrospective audits of our patient outcomes and evaluated this algorithm in this prospective ser...