January 2023
SA Orthopaedic Journal
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January 2023
SA Orthopaedic Journal
January 2022
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7 Reads
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1 Citation
The South African Orthopaedic Journal (SAOJ)
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
January 2021
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16 Reads
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2 Citations
The South African Orthopaedic Journal (SAOJ)
June 2019
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44 Reads
The South African Orthopaedic Journal (SAOJ)
BACKGROUND: Resection of aggressive benign or malignant tumours of the proximal fibula are difficult due to the high number of surrounding anatomical compartments and close association with many important neurovascular and functional structures. For the same reasons malignant tumours behave differently in this area. Before the 1980s results were poor. With the introduction of neoadjuvant chemotherapy and limb salvage surgery, Malawer described a technique of local en bloc resection. This study presents the oncological and functional results of a case series using this technique PATIENTS AND METHODS: A retrospective folder review of 14 patients was done. Six patients with a large active, an aggressive benign or a low-grade malignant tumour had a Malawer type I marginal resection, and eight patients with a stage IIB malignant sarcoma had a Malawer type II wide intracompartmental resection sacrificing the common peroneal nerve. The follow-up at a median of 38 months included the imaging, histology and a functional MSTS score. RESULTS: The median age of the type I resections was 42.5 years; giant cell tumour was the commonest tumour (50%); and the median functional MSTS score at follow-up was 29. The median age of the type II resections was 12 years; osteoblastic osteosarcoma was the commonest tumour (75%); and the median functional MSTS score was 26. All type II resections achieved clear margins at the initial surgery and there were no recurrences or metastases in either group. There were no wound complications and no vascular complications in spite of sacrificing the tibialis anterior artery in some type I and all type II resections, and the peroneal artery in type II resections. No patient complained of knee instability. The main functional impairment was due to loss of common peroneal function which required an AFO in some patients and a tibialis posterior tendon transfer in one patient CONCLUSIONS: Resection of benign and malignant tumours of the proximal fibula achieved good cure rates and functional results, despite the sacrifice of the common peroneal nerve Level of evidence: Level 4
March 2019
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49 Reads
The South African Orthopaedic Journal (SAOJ)
June 2017
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116 Reads
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15 Citations
The South African Orthopaedic Journal (SAOJ)
BACKGROUND: The reconstruction of complex pelvic trauma or developmental bone abnormalities is challenging as it involves in-depth understanding of a complex three-dimensional structure. Advances in medical imaging and rapid prototyping allow for detailed pre-operative planning and manufacture of planning models, custom jigs and prostheses to make this type of surgery manageable with good results. METHODS: We report the reconstruction of a hip and proximal femur using planning models, jigs and custom prostheses produced by rapid prototyping methods. These tools helped to solve a complex problem and produced a good functional result for the patient RESULTS: In this case report the patient underwent the reconstruction of her right hip joint. She was unable to mobilise well independently prior to the surgery. The surgery provided her with a stable and functional hip joint. This allows her to mobilise independently with an external prosthesis. One year down the line she has a Fair MSTS score (14 of 30) CONCLUSION: Advances in medical imagining and rapid prototyping have produced planning and operative tools with which surgeons are able to solve complex problems safely and with good result. This technology has widespread use not only in orthopaedics but other surgical disciplines, and with increasing availability and improved cost effectiveness will be used more frequently in the future. Level of evidence: Level V (case report)
March 2017
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123 Reads
The South African Orthopaedic Journal (SAOJ)
BACKGROUND: Purely ligamentous lesser arc, Mayfield grade 3 and 4, perilunate dislocations (PLDs) are uncommon. Current recommendations are for open reduction and repair of the interosseous ligaments to prevent the development of scapholunate dissociation and degeneration to a scapholunate advance collapse (SLAC) wrist. This study proposes a less invasive treatment method which includes closed reduction and pinning alone without repair of the scapholunate interosseous ligament. We propose that most patients will obtain good function and pain scores and the few that develop instability may still have a reconstruction performed through a naïve surgical field METHODS: Dislocations were reduced anatomically and held with buried K-wires which were removed at 6 weeks with no specific rehabilitation protocol observed. Subjective assessment included Mayo wrist scoring system, wrist range of movement, instability and grip strength testing. Radiological measurements included scapholunate distance, scapholunate angle, radiolunate angle and osteoarthritis RESULTS: Ten male patients, median age of 35 years, were followed up for a median of 22 months. Seven patients underwent a closed reduction and anatomical pinning while three underwent open reduction due to unachievable reduction by closed means. All of these patients presented at a median of 14 days after the injury occurred. None of the patients had their scapholunate ligaments repaired or reconstructed. Mayo scores included three excellent scores, two good scores and five fair scores. Instability was found clinically in one asymptomatic patient who had a positive Watson shift test. Radiological scores include a median scapholunate distance of 2 mm, a scapholunate angle of 70° and a radiolunate angle of 15°. Osteoarthritis was found in two patients, all of whom were asymptomatic DISCUSSION: Current recommendations in the literature are that PLDs should be reduced via an open surgical technique with repair of the scapholunate interosseous ligament (SLIL) and percutaneous pinning. However, the results of this treatment strategy are not optimal and do not confer uniformly good results. We propose a closed anatomical reduction and percutaneous pinning of the PLD. Our study shows that most patients will demonstrate good function and pain scores when managed this way. A smaller number of these injured wrists will go on to develop instability. However, the advantage of our method over the current recommendations is that when this happens the reconstruction of the SLIL will be made easier through a naïve surgical field CONCLUSION: We recommend the closed reduction and anatomical pinning of a purely ligamentous lesser arc injury. This treatment strategy yields good results at medium term follow-up and preserves the option for the reconstruction of the scapholunate interosseous ligament should instability develop
March 2017
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1,370 Reads
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13 Citations
The South African Orthopaedic Journal (SAOJ)
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 these injuries is an attractive treatment strategy. It provides stable internal fixation and limits further insult to the soft tissue envelope. It also allows complete access for wound management and early range of movement of the adjacent joints. This study aims to review the results of patients treated with IM nailing for gunshot wound (GSW) tibia fractures to assess whether this is a viable treatment option for this injury. METHODS: A retrospective folder review was performed of all adult patients who sustained a GSW tibia fracture treated with intramedullary nailing between January 2009 and December 2014. Parameters evaluated included time to theatre, time to wound closure, radiographic extent of fracture comminution, anatomical alignment, time to union and incidence of chronic osteomyelitis. RESULTS: Twenty-two patients were eligible for inclusion; however, nine were lost to follow-up. The remaining 13 patients achieved union over an average of 26 weeks. Three cases developed osteomyelitis, all of which had radiographic zones of comminution exceeding 120 mm. No cases of malunion were reported and no other significant trends noted. CONCLUSION: Treatment of tibial gunshot fractures must be individualised according to both the soft tissue injury and radiographic zone of comminution in order to achieve a favourable outcome. Intramedullary nailing is an effective treatment strategy for low Gustilo-Anderson grade injuries, with minimal complications.
June 2016
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98 Reads
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1 Citation
The South African Orthopaedic Journal (SAOJ)
BACKGROUND: Primary bone sarcomas that are associated with a pathological fracture are rare and as a group have a worse prognosis than their non-fractured counterparts. QUESTIONS/PURPOSES: Traditionally limb ablation was advised; however, recent evidence suggests that limb salvage is a safe and acceptable form of treatment for both surgeon and patient. PATIENTS AND METHODS: We present a retrospective review of a series of six patients referred to our unit with pathological fractures. These were treated by initial traction and neo-adjuvant chemotherapy where indicated with subsequent resection and endoprosthetic replacement. RESULTS: The age range of our series is from 20 to 81 years, with four males and two females. All had distal femur involvement with a 60% incidence of osteosarcoma and 40% chondrosarcoma. Three patients required total femur resection due to extensive tumour involvement. Our results show 100% of patients had clear margins at postoperative histology. Due to the aggressive nature of these types of tumours they carry a worse long-term prognosis and as such we had three deaths in our series. One patient died of a myocardial infarction post-operatively, and two patients developed lung metastases and died 2 years later. CONCLUSION: Our conclusion is that with careful planning, a safe margin can be achieved. Endoprosthetic replacement allows for rapid reconstruction and mobilisation in this group of patients facilitating further oncological management.
... Advancements in CT technology and additive manufacturing have enabled the production of 3D-printed custom prostheses, offering methods for viable defect reconstruction and prosthetic fixation into remaining bone, when standard implants like the cone cup will not suffice. 1,[34][35][36] The observational retrospective design and small patient cohort limit the accuracy of the data. A multicentred international study is needed to include larger numbers. ...
January 2022
The South African Orthopaedic Journal (SAOJ)
... Many clinicians in the country have long aimed to establish a registry for sarcomas. 6 A comprehensive oncology spectrum is currently available on the SAOR. ...
January 2021
The South African Orthopaedic Journal (SAOJ)
... To ensure the best fit for individual patients, doctors increasingly seek custom-made products manufactured for a specific patient [10]. Because of the unique geometry of models of anatomical structures, surgical templates, or implants, additive methods are often used in manufacturing [11,12]. However, such devices must be characterized by a certain accuracy of manufacture. ...
June 2017
The South African Orthopaedic Journal (SAOJ)
... In this study, participants had a 23.1% chance of having a poor radiological outcome. This was similar to a previous study that found that the rate of non-union after tibial shaft fractures treated with IMNs ranged from 5% to 33% (23). This means that a poor radiological outcome after tibial shaft fractures treated with IMN is a major concern as they largely afflict young FIGURE 3 Distribution of patients according to associated injury types among tibial shaft fracture patients treated with intramedullary nail fixation at the AaBET Hospital, Ethiopia, 2022. ...
March 2017
The South African Orthopaedic Journal (SAOJ)