Sithombo Maqungo

• MBChB, FC Ortho, MMed
• Head: Orthopaedic Trauma Service at University of Cape Town

Femoral shaft fractures are significant injuries and if not managed appropriately can result in high complication rates and long-term disability. These complex injuries occur at a higher rate across low and middle income countries and sub-Saharan Africa is thought to have a higher incidence than other regions across the world. This study aims to su...

Aims HIV and musculoskeletal injuries both disproportionately affect individuals living in low- and middle-income countries (LMICs), leading to a significant number of fractures in HIV-positive patients. Despite this, little is known about the long-term outcomes for these patients. This prospective cohort study investigated whether HIV infection is...

Background In low- and middle-income countries, trauma is the leading cause of death among youth and it is also a major cause of disability. Globally, more than 1,600 children and adolescents below the age of 19-years die every day from preventable injuries. Traffic-related injuries, falls, sports-related injuries, assaults, burns, and drownings ar...

Background Thoracic trauma is the third most common cause of death after abdominal injury and head trauma in polytrauma patients. The identification of a patient at risk of thoracic trauma mortality is necessary to avoid delays that may lead to morbidity and mortality. Therefore, the objective was to assess the factors associated with mortality amo...

Background: In low- and middle-income countries, trauma is the leading cause of death among youth and it is also a major cause of disability. Globally, more than 1,600 children and adolescents below the age of 19-years die every day from preventable injuries. Traffic-related injuries, falls, sports-related injuries, assaults, burns, and drownings a...

Introduction Little is known regarding health care seeking behaviors of women in sub-Saharan Africa, specifically Cameroon, who experience violence. The proportion of women who experienced violence enrolled in the Cameroon Trauma Registry (CTR) is lower than expected. Methods We concatenated the databases from the October 2017-December 2020 CTR an...

Purpose Removal of bullets retained within joints is indicated to prevent mechanical blockade, 3rd body wear and resultant arthritis, plus lead arthropathy and rarely, systemic lead poisoning. We aimed to report on the largest series of removal of bullets from the hip joint using open surgical techniques. Methods This is a retrospective cohort stud...

Purpose Numerous classification systems have been developed for neck of femur fractures, but none have been tested for reliability in gunshot injuries. Our primary objective was to assess the inter-observer and intra-observer reliability of the AO/OTA classification system when applied to intracapsular neck of femur fractures secondary to low-veloc...

Objective The objective of this study is to determine research priorities for the management of major trauma, representing the shared priorities of patients, their families, carers and healthcare professionals. Design/setting An international research priority-setting partnership. Participants People who have experienced major trauma, their carer...

Background The burden of alcohol use among patients with trauma and the relative injury risks is not routinely measured in South Africa. Given the prominent burden of alcohol on hospital trauma departments, South Africa needs practical, cost-effective, and accurate alcohol diagnostic tools for testing, surveillance, and clinical management of patie...

Objectives Uniformly classifying long bone open fractures is challenging. The purpose of this study was to propose a modified Orthopaedic Trauma Society (OTS) Open Fracture Classification System, developed in a setting with a high incidence of civilian gunshot fractures. Methods From our prospectively collected database, we identified all patients...

Introduction Alcohol consumption is a key driver of the burden of violence and injury in South Africa (SA). Hence, we aim to validate various alcohol assessment tools against a blood test to assess their utility for improving national health practice and policy. Methods We conducted a cross-sectional pilot study from 3 to 19 August 2022 at Groote...

Septic arthritis is an orthopaedic emergency with an incidence of 2 to 10 per 100 000 patients in the general population. Mortality rates between 3 and 29% can be expected. Local knowledge of microorganisms and antibiotic sensitivities will facilitate expedited and effective treatment. The aim of the study was to review and analyse the microbiologi...

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...

Removal of bullets retained within joints is indicated to prevent mechanical blockade, 3rd body wear and resultant arthritis, plus lead arthropathy and systemic lead poisoning. The literature is sparse on this subject, with mostly sporadic case reports utilizing hip arthroscopy. We report on the largest series of removal of bullets from the hip joi...

Objectives Open fracture classification systems are limited in their use. Our objective was to classify open tibia and femur fractures using the OTS classification system in a region with high incidence of gunshot fractures. One hundred and thirty-seven patients with diaphyseal tibia and femur open fractures were identified from a prospectively col...

Acetabulum fractures caused by civilian firearms represent a unique challenge for orthopaedic surgeons. Treatment strategies should include the assessment of infection risk due to frequently associated abdominal injuries and maintenance of joint function. Still, internationally accepted treatment algorithms are not available. The aim of the study w...

BACKGROUND The burden of alcohol use among trauma patients and the relative injury risks is not routinely measured in South Africa (SA). Given the prominent burden of alcohol on hospital trauma departments, SA needs practical, cost-effective and accurate alcohol diagnostic tools for testing, surveillance and clinical management of trauma patients....

Purpose The purpose of this study was to report our 5 years surgical experience and the rate of neurovascular injury following gunshot fractures of the distal humerus in a in level-1 Trauma Centre in South Africa. Methods A retrospective case series of 25 consecutive adult gunshot injuries to the distal humerus. Demographic and injury data were ex...

Objective: Open tibial shaft fractures are a leading cause of disability worldwide, particularly in low and middle-income countries (LMICs). Guidelines for these injuries have been developed in many high-income countries, but treatment patterns across Africa are less well-documented. Methods: A survey was distributed to orthopaedic service provider...

Objective:. Human immunodeficiency virus (HIV) infection has been suggested to be associated with an increased risk of the development of nonunion after a fracture. This prospective matched case–control study in South Africa investigated common risk factors, including HIV status, that influence the development of a nonunion after a femur or tibia f...

Background: Injuries are one of the leading causes of global death and disability and commonly have substantial economic implications. The economic impact of injuries is particularly pronounced in low- and middle-income countries, where 90% of injuries occur. In this study, we aimed to assess return-to-work rates of individuals who sustained a low...

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...

Background: Hip fractures are common, and account for significant morbidity and mortality. While surgical intervention remains the gold standard, nonoperative treatment protocols are seldom analysed and may be of value in select settings. Objectives: We sought to review our conservatively treated pertrochanteric fractures and present a case seri...

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 The burden of alcohol use among trauma patients and the relative injury risks is not routinely measured in South Africa (SA). Given the prominent burden of alcohol on hospital trauma departments, SA needs practical, cost-effective and accurate alcohol diagnostic tools for testing, surveillance and clinical management of trauma patients...

BackgroundWe 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. MethodsWe conducted an ambispective cohort...

In low and middle-income countries (LMICs), individuals suffer from a disproportionately higher number of musculoskeletal (MSK) injuries compared with those living in a high-income setting. However, despite the higher burden of death and disability from MSK injuries in LMICs, there has been little policy, research, and funding invested in addressin...

BackgroundIntramedullary nail fixation is an option to manage highly comminuted fractures of the radius shaft resulting from gunshot wounds. However, complications including nail migration and malunion are well documented. We have noticed some patients presenting to our clinic with radiological shortening following nail fixation. This may result in...

Objectives The Radiographic Union Score for Tibia (RUST) scoring system has been validated in multiple studies assessing the healing of tibial fractures. Our objective was to assess the interobserver and intraobserver reliability for the RUST in diaphyseal femoral fractures treated with intramedullary (IM) nailing.Patients and methodsA total of 60...

Background: Initial local and global evidence suggests that SARS-CoV-2-infected patients who undergo surgery, and those who become infected perioperatively, have an increased mortality risk post surgery. Objectives: To analyse and describe the 30-day mortality, presurgical COVID-19 status and hospital-acquired SARS-CoV-2 infection rates of patie...

The incidence of civilian gunshot injuries is on the rise worldwide.Unfortunately, there is a lack of high-level evidence guiding management. The treatment of orthopaedic injuries from gunshots is complex and requires consideration of multiple aspects, including energy transfer to the tissue, severity of the wound, possible contamination, presence...

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...

A femoral traction splint is a mechanical device that uses traction to align and provide stability to femoral fractures. The use of this device has many benefits however there is still limited availability in low- and middle-income countries. This article provides the reader with a step by step guide to improvise a femoral traction splint built fro...

An “epidemic” is an event in which a disease, infectious or non-infectious, is actively spreading within a population and designated area. The term “pandemic” is defined as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”. The global response to the COVID-1...

Background: Human immunodeficiency virus (HIV) reduces bone mineral density, mineralisation and turnover, and may impair fracture healing. Setting: This prospective cohort study in South Africa investigated whether HIV infection was associated with impaired fracture healing following trauma. Methods: All adults with acute tibia and femur fract...

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 There is little research investigating how human immunodeficiency virus (HIV) affects outcomes in orthopaedic surgery. With advances in treatment, HIV has become a chronic health problem and the chance of orthopaedic surgeons encountering it in clinical practice is increasing. AIM To ascertain the quantity and quality of peer-reviewed pu...

South Africa and Israel have significantly different health systems. As South Africa is geographically 500 times as large and has a population nearly 7 times as large as the state of Israel, major differences in the challenges and subsequent handling of the pandemic between these countries were to be expected. South Africa's challenges included bei...

Background Spinal injuries are present in 16–31% of polytraumatized patients. Rapid identification of spinal injuries requiring immobilization or operative treatment is essential. The Lodox-Statscan (LS) has evolved into a promising time-saving diagnostic tool to diagnose life-threatening injuries with an anterior-posterior (AP)-full-body digital X...

Background: The COVID-19 pandemic has impacted on the global surgery landscape. Objectives: To analyse and describe the initial impact of the COVID-19 pandemic on orthopaedic surgery at Groote Schuur Hospital, a tertiary academic hospital in South Africa. Methods: The number of orthopaedic surgical cases, emergency theatre patient waiting time...

Introduction: Orthopaedic injuries constitute a major aspect of morbidity and mortality following train accidents. The pattern of orthopaedic/musculoskeletal injuries sustained following these accidents has not been fully characterised. The main aim of this study is to describe the range of orthopaedic injuries reported in a major trauma centre an...

Background: In response to the coronavirus pandemic, lockdown restrictions and a ban on alcohol sales were introduced in South Africa. Objectives. To investigate the impact of lockdown measures on the number of patients who visited a tertiary urban trauma centre. Methods. The period of investigation was from 1 February to 30 June 2020 and was segm...

Background Spinal injuries are present in 16-31% of polytraumatized patients. Rapid identification of spinal injuries requiring immobilization or operative treatment is essential. The Lodox-Statscan (LS) has evolved into a promising time-saving diagnostic tool to diagnose life-threatening injuries with an anterior-posterior (AP)-full-body digital X...

Gunshot wounds to the hip region are likely to cause complex peritrochanteric fracture. The fracture patterns are often highly comminuted and accompanied by injuries to local structures and abdominal viscera. Our case series analyses 25 orthopaedic procedures performed. The overall union rate for primary fixation was 66%. Two patients underwent rev...

Background: High-energy Lisfranc injuries are relatively uncommon but can lead to severe disability and morbidity. Primary fusion is a treatment option that can improve outcomes and reduce the reoperation rate. The aim of this study was to evaluate our series of primary fusions for high-energy Lisfranc injuries, looking specifically at type of fusi...

Despite the same latitude on earth, Israel and South Africa have a wide variety of healthcare systems and approaches. Israel is a developed country with life expectancy within the first decile of the modern world. South Africa is a developing country where available resources and health care varies greatly across the country. Israeli policy makers...

Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods: HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17...

Background : To perform a bibliometric analysis and quantify the amount of orthopaedic and trauma literature published from low-income countries (LICs). Methods and methods : The Web of Science database was utilised to identify all indexed orthopaedic journals. All articles published in the 76 orthopaedics journals over the last 10 years were revie...

Background: Upper extremity gunshot fractures are generally treated conservatively or surgically using open reduction and internal fixation (ORIF), intramedullary nails (IM) or external fixators. However, there is no gold standard for the management of these complex, multi-fragmentary upper extremity fractures. The aim was to describe and identify...

Citation: Engelmann EWM, Maqungo S, Laubscher M, Hoppe S, Roche S, Nicol A, Navsaria P, Held M. Epidemiology and injury severity of 294 extremity gunshot wounds in ten months: a report from the Cape Town trauma registry. SA Orthop J 2019;18(2):31-36. http://dx. Abstract Aims: To describe the epidemiology and injury severity of patients with extremi...

Citation: Bernstein BP, du Plessis JP, Laubscher M, Maqungo S. Management of complex proximal humerus fractures in the elderly: what is the role of open reduction and internal fixation? SA Orthop J 2019;18(2):37-43. http://dx. Abstract The ultimate goal of management of proximal humeral fractures in the elderly patient is to get the patient indepen...

Background Upper extremity gunshot fractures are generally treated conservatively or surgically using open reduction and internal fixation (ORIF), intra-medullary nails (IM) or external fixators. However, there is no gold standard for the management of these complex, multi-fragmentary upper extremity fractures. The aim of this study was to describe...

Outcomes of arthroplasty in sub-Saharan Africa are not widely reported. To our knowledge, this systematic review is the first to explore this topic. Scopus, EMBASE, Medline and PubMed databases were searched, utilising MeSH headings and Boolean search strategies. All papers from South Africa were excluded. Twelve papers reporting 606 total hip repl...

Introduction: The management of long bone lower limb fractures secondary to gunshot wounds (GSWs) in the civilian setting are complex and there is currently no consensus regarding the optimal approach to managing such fractures. This study aims to address the relationship of implant related sepsis in fractures secondary to GSWs. Methods: A systemat...

BACKGROUND: Human immunodeficiency virus (HIV) and antiretroviral therapy (ART) have both been shown to reduce bone mineral density, mineralisation and bone turnover. Our study group and other researchers have suggested that HIV may impair fracture healing, based on extrapolation from basic science. These observations prompted this study as the tru...

Objectives: To prospectively evaluate the incidence of superficial and deep wound sepsis in a cohort of patients who sustained low velocity transarticular gunshot wounds. Methods: We performed a prospective, randomised, non-blinded pilot study of all adults presenting to a single institution between November 2011 and January 2015 that sustained a t...

Purpose: (1) To determine the overall accuracy of synovial alpha-defensin, synovial C-reactive protein (sCRP), interleukin-6 (sIL-6), and leukocyte esterase (sLE) as diagnostic markers for periprosthetic joint infection (PJI) and (2) to independantly evaluate the accuracy of both the laboratory-based ELISA alpha-defensin test and the Synovasure™ a...

BACKGROUND: Dislocation is one of the most common orthopaedic complications after primary total hip arthroplasty (THA). The reported dislocation rate in elective THR is 5-8%. This number increases up to 22% for THA done for neck of femur (NOF) fractures. Larger femoral head sizes increase the head-neck ratio and range of motion before impingement,...

PURPOSE: The Oxford Shoulder Score (OSS) is a robust and universally utilised shoulder score that has been translated for use in Western and Asian countries. This study aimed to translate, cross-culturally adapt and psychometrically validate the Afrikaans version of the OSS for use in Africa. METHODS: Translation and cross-cultural adaptation was p...

Complications following retained intra and juxta-articular bullets and bullet fragments include mechanical blockade to movement, direct cartilage destruction, joint sepsis, lead arthropathy and even systemic lead poisoning (plumbism). It is therefore recommended that all intra and juxta-articular bullets or bullet fragments should be removed. Remov...

BACKGROUND: Subtrochanteric femur fractures remain challenging injuries to treat. There is paucity of literature evaluating their outcomes and complications following low-velocity civilian gunshots. The purpose of this study is to evaluate the results of intramedullary nailing of subtrochanteric femur fractures secondary to low-velocity gunshots. M...

Background. Injuries inflicted by gunshot wounds (GSWs) are an immense burden on the South African (SA) healthcare system. In 2005, Allard and Burch estimated SA state hospitals treated approximately 127 000 firearm victims annually and concluded that the cost of treating an abdominal GSW was approximately USD1 467 per patient. While the annual num...

Introduction: A growing burden of gunshot injuries demands evidence-based ballistic trauma management. No comprehensive systematic overview of the current knowledge is available to date. This study aims to identify and analyze the most influential publications in the field of orthopedic ballistic trauma research. Material and methods: All databa...

BACKGROUND: The availability of and advances in interventional angiography and embolisation for the management of high-energy pelvic ring injuries with uncontrolled haemorrhage have expanded considerably during the last decade. Its routine use, however, still remains controversial. The delay in performing angiography is often cited as a major limit...

BACKGROUND: Open tibia fractures are notoriously difficult to treat, with a high rate of union problems and infection. Gunshot wound-associated fractures of the tibia compound these issues further by causing extensive bone comminution and soft tissue damage. No universally accepted management protocol exists, but intramedullary (IM) nailing of thes...

An unusual case of an immunocompetent young adult with osteomyelitis and pyomyositis of his right thigh is presented. Despite the absence of typical clinical signs, a high index of suspicion and 16S RNA PCR led to an early diagnosis of Fusobacterium infection and subsequent successful multidisciplinary treatment.

Introduction: The aim of this study was to audit the use of Computerised Tomographic Angiography (CTA) in assessing extremity vascular injuries at our institution and to compare it to international standards. The primary aim was to assess the number of CTAs performed and the indications for doing them. The secondary aim was to look at CTA results...

INTRODUCTION: The wound complication rate for open reduction and internal fixation of calcaneus fractures through the extensile approach is 30%. Due to this high rate of wound complications, many surgeons prefer conservative management. If post-traumatic arthritis develops, the clinical results of a subtalar fusion are better if the posterior facet...

BACKGROUND: The treatment goals in diaphyseal radius fractures are to regain and maintain length and rotational alignment and stability. Open reduction and plating carries the inherent problems of soft tissue disruption and periosteal stripping. Intramedullary nailing offers advantages of minimally invasive surgery and minimal soft tissue trauma. A...

BACKGROUND: Knee dislocations are reported to have an incidence of popliteal artery injuries between 7% and 64%. The purpose of this study was to determine the incidence of injuries to the popliteal artery as well as early limb loss in knee dislocations at a level-1 trauma hospital in South Africa METHODS: Twenty-eight patients with popliteal arter...

Aims: To investigate and quantify the clinical benefits of early versus delayed application of Thomas splints in patients with isolated femur shaft fractures. Materials and methods: Level IV retrospective clinical and radiological analysis of patients presenting from January to December 2012 at a Level 1 Trauma Unit. All skeletally mature patien...

The presence of a L5 transverse process fracture is reported in many texts to be a marker of pelvis fracture instability. There is paucity of literature to support this view. Only two previous studies have been performed on this subject with statistical analysis. We conducted a retrospective cross-sectional review of all abdominopelvic CT scans per...

PURPOSE OF STUDY: Percutaneous screw fixation of sacroiliac joint dislocations, fracture-dislocations and sacral fractures is a well-recognised technique first described by Routt and has increasingly gained popularity in recent times. This method is biomechanically comparable to open reduction and internal fixation with plates and screws but offers...

We present a previously undescribed lesion of a fractured proximal radius associated with a proximal radio-ulnar joint dislocation. Compression plating was performed via the Thompson approach and closed reduction of the proximal radio-ulnar joint (PRUJ) was attained. At one-year follow-up he had united fully and regained full use of his arm. Clinic...

Hypothesis: We reviewed the outcome of angular stable plates in addressing displaced lateral-third clavicle fractures. We investigated union, shoulder function, request for implant removal, and return to sport. Our hypothesis was that these implants provide predictable union and return to sports without the negative consequence of leaving plates i...

The association of sarcoidosis with multiple myeloma is not well known. Including this case report, 12 cases of patients with both sarcoidosis and multiple myeloma have been reported in the literature. The skeletal lesions of both conditions have many clinical and radiological similarities, and unless clinicians are aware of the association and the...

To compare the free-hand technique (FH) of placing interlocking screws to a commercially available Electromagnetic targeting system (EM)in terms of operating time, radiation dose and accuracy of screw placement. Between September 2011 and July 2012 we prospectively randomised 100 consecutive femur shaft fractures in 99 patients requiring intramedul...

We reviewed 28 patients in order to assess the outcome of tuberculosis of the foot and ankle in children and to describe a classification that would relate to prognosis. The median age was 3 years (1 to 12.5 years). The ankle was involved in 13 (46.4%) patients, the midfoot in nine (32.1%), the subtalar joint in five (17.9%) and the calcaneus in on...

We report on a rare case of pelvic ring injury with an overlapping pubic symphysis dislocation in a patient who was a pedestrian involved in a motor vehicle accident. She sustained a lateral compression pelvic ring injury with an overlapping pubic symphysis dislocation and a mildly displaced zone 2 sacral fracture. She was treated with open reducti...