Browsing by Author "Ferreira, Nando"

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    Common mistakes when writing the conclusion of a research manuscript
    (South African Orthopaedic Association, 2018) Ferreira, Nando
    ENGLISH ABSTRACT: The last couple of years have seen a tremendous change in mindset towards research in South Africa. This was in part due to new Health Professions Council of South Africa (HPCSA) requirements to register as a specialist, resulting in an increased output of research from predominantly academic training centres. This renewed focus on conducting research was, however, not always reciprocated by support with the analysis and reporting of research findings.
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    A computer tomography-based anthropomorphic study of forearm osteology : implications for prosthetic design
    (Medpharm Publications, 2021-08-31) Pretorius, Henry S.; Ferreira, Nando; Burger, Marilize C.
    Background: The aim of this study was to accurately establish the variability in the anatomy of the radius and ulna in the context of the design of an intramedullary nail for both bones. Methods: Forearm computed tomography scans were used to measure the specific internal and external anatomy of the radius and ulna in adult patients. Patients with fractures or dislocations involving either the radius and/or ulna were excluded. Results: A total of 97 scans, comprising 84% male and 16% female patients, were included. The mean radius length was 238.43±18.38 mm (95% CI 234.60–241.74 mm). The mean curvature was an arc with a radius of 561.43±93.49 mm (95% CI 543.09–580.78 mm). The smallest measurement of the canal width was 5.17 mm (95% CI 4.87–5.47 mm). The ulna showed a mean length of 259.90±19.88 mm (95% CI 255.89–263.91 mm). The smallest measurement of the canal width was 4.80±1.30 mm (95% CI 4.53–5.87 mm). The mean proximal shaft angle was 11.39±3.30° (95% CI 10.76–12.82°). Conclusion: This computed tomography scan-based anthropomorphic study has identified novel anatomical features and associations of human forearm bones. This information will be used in the design and manufacture of anatomic intramedullary devices to better manage radius and ulna fractures or pathology.
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    Defining the anatomic axis joint center distance and anatomic axis joint center ratio of the distal femur in the coronal plane
    (Wolters Kluwer - Medknow, 2020-12) Ferreira, Nando; Cornelissen, Andries Johannes; Burger, Marilize; Saini, Aaron Kumar
    Background: The aim of this radiographic study was to define the anatomic axis joint center distance (aJCD) and anatomic axis joint center ratio (aJCR) of the distal femur in the coronal plane for skeletally mature individuals. Methods: A cross‑sectional radiographic study was conducted to calculate the horizontal distances between the anatomical axis and the center of the knee at the level of the intercondylar notch and the joint line. Ratios relating these points to the width of the femur were then calculated. Results: A total of 164 radiographs were included: 91 male (55.5%) and 73 female patients (44.5%) with a mean age of 44.9 ± 18.1 years, with 79 right (48.2%) and 85 left (51.8%). The mean intercondylar width was 75.6 ± 6.6 mm, the mean aJCD at the notch was 3.6 ± 1.8 mm, the mean aJCD at the joint line was 4.9 ± 1.8 mm, the mean aJCR at the notch was 45.2 ± 2.4, and the mean aJCR at the joint line was 43.5 ± 2.4. The intercondylar width was significantly different (P < 0.001) between males (79.5 ± 4.8 mm) and females (70.6 ± 5.0 mm). A significant difference between the aJCR at the notch (P = 0.004) and the aJCR at the joint line (P = 0.003) was observed in males and females. No differences between the aJCD at the notch and/or aJCD at the joint line were observed between males versus females, left versus right, and those younger versus those older than 65 years. Conclusion: This is the first objective description of the aJCR of the distal femur in the coronal plane. This ratio can be used to aid the planning and execution of distal femoral deformity correction, retrograde femoral nailing, and total knee arthroplasty. Level of Evidence: IV
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    Evaluating the accuracy of the SMART Taylor spatial frame software – comparison with manual radiographic analysis methods
    (Wolters Kluwer - Medknow, 2021-06-30) Ferreira, Nando; Arkell, Christopher; Fortuin, Franklin; Saini, Aaron Kumar
    Background: The accuracy of hexapod circular external fixator deformity correction is contingent on the precision of radiographic analysis during the planning stage. The aim of this study was to compare the SMART Taylor spatial frame (TSF) in suite radiographic analysis methods with the traditional manual deformity analysis methods in terms of accuracy of correction. Methods: Sawbones models were used to simulate two commonly encountered clinical scenarios. Traditional manual radiographic analysis and digital SMART TSF analysis methods were used to correct the simulated deformities. Results: The final outcomes of all six analysis methods across both simulated scenarios were satisfactory. Any differences in residual deformity between the analysis methods are unlikely to be clinically relevant. All three SMART TSF digital analyses were faster to complete than manual radiographic analyses. Conclusion: With experience and a good understanding of the software, manual radiographic analysis can be extremely accurate and remains the gold standard for deformity analysis. In suite SMART TSF radiographic analysis is fast and precise to within clinically relevant parameters. Surgeons can with confidence trust the SMART TSF software to provide analysis and corrections that are clinically acceptable.
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    Limb reconstruction in a resource-limited environment
    (EDP Sciences, 2021) Ferreira, Nando; Sabharwal, Sanjeev; Hosny, Gamal Ahmed; Sharma, Hemant; Johari, Ashok; Nandalan, Vasudevan P.; Vivas, Mauro; Parihar, Mangal; Nayagam, Selvadurai; Ferguson, David; Rolfing, Jan Duedal
    Introduction: Limb salvage and reconstruction are often challenging and even more so in the limited resource setting. The purpose of this narrative review is to explore the strategies for addressing the unique obstacles and opportunities of limb reconstructive surgery in resource-limited environments globally. Methods: We review (1) the global burden and dimension of the problem, (2) the relevance of orthopedic forums and communication, (3) free and open-access software for deformity analysis and correction, (4) bidirectional learning opportunities, and the value of fellowships and mentoring between resource-rich and resource-limited countries, and (5) how societies like SICOT can help to tackle the problem. Finally, case examples are presented to demonstrate the choice of surgical implants, their availability in regions with limited resources, and how the universal principles of limb reconstruction can be applied, irrespective of resource availability. Results: Limb reconstruction can often be life-changing surgery with the goals of limb salvage, improved function, and ambulation. The contradiction of relatively few severe limb deformities in high-income countries (HICs) with abundant resources and the considerable burden of limb deformities in resource-limited countries is striking. Free, open access to education and software planning tools are of paramount importance to achieve this goal of limb reconstruction. Bidirectional learning, i.e., knowledge exchange between individual surgeons and societies with limited and abundant resources, can be reached via fellowships and mentoring. The presented cases highlight (1) fixator-assisted wound closure obliviating the need for plastic surgery, (2) open bone transport, and (3) hinged Ilizarov frames for correction of severe deformities. These cases underline that optimal clinical outcome can be achieved with low-cost and readily available implants when the principles of limb reconstruction are skillfully applied. Discussion: Limb lengthening and reconstruction are based on universally applicable principles. These have to be applied regardless of the planning tool or surgical implant availability to achieve the goals of limb salvage and improved quality of life.
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    Nonunion – consensus from the 4th annual meeting of the Danish Orthopaedic Trauma Society
    (Bioscientifica, 2020-01) Schmal, Hagen; Brix, Michael; Bue, Mats; Ekman, Anna; Ferreira, Nando; Gottlieb, Hans; Kold, Soren; Taylor, Andrew; Tengberg, Peter Toft; Ban, Ilija; Danish Orthopaedic Trauma Society
    Nonunions are a relevant economic burden affecting about 1.9% of all fractures. Rather than specifying a certain time frame, a nonunion is better defined as a fracture that will not heal without further intervention. Successful fracture healing depends on local biology, biomechanics and a variety of systemic factors. All components can principally be decisive and determine the classification of atrophic, oligotrophic or hypertrophic nonunions. Treatment prioritizes mechanics before biology. The degree of motion between fracture parts is the key for healing and is described by strain theory. If the change of length at a given load is > 10%, fibrous tissue and not bone is formed. Therefore, simple fractures require absolute and complex fractures relative stability. The main characteristics of a nonunion are pain while weight bearing, and persistent fracture lines on X-ray. Treatment concepts such as ‘mechanobiology’ or the ‘diamond concept’ determine the applied osteosynthesis considering soft tissue, local biology and stability. Fine wire circular external fixation is considered the only form of true biologic fixation due to its ability to eliminate parasitic motions while maintaining load-dependent axial stiffness. Nailing provides intramedullary stability and biology via reaming. Plates are successful when complex fractures turn into simple nonunions demanding absolute stability. Despite available alternatives, autograft is the gold standard for providing osteoinductive and osteoconductive stimuli. The infected nonunion remains a challenge. Bacteria, especially staphylococcus species, have developed mechanisms to survive such as biofilm formation, inactive forms and internalization. Therefore, radical debridement and specific antibiotics are necessary prior to reconstruction.