Masters Degrees (Orthopaedic Surgery)

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Continuous irrigation as dead space management for fracture related type 1 intramedullary chronic osteomyelitis
(Stellenbosch : Stellenbosch University, 2022) Grey, Jan-Petrus; Ferreira, Nando; Burger, Marilize Cornelle; Faculty of Medicine and Health Sciences. Dept. of Surgical Sciences. Orthopaedic Surgery.
ENGLISH ABSTRACT: 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 osteomyelitis by means of continuous irrigation (modified Lautenbach system) as dead space management following intramedullary reaming. Material and Method: A consecutive series of thirty patients with Cierny and Mader type 1 chronic osteomyelitis, treated between May 2016 and September 2019, were evaluated retrospectively. Patient history and clinical information, including imaging and laboratory results, were reviewed. Treatment procedures and antibiotic profiles were also recorded. Results: The initial cohort included 30 cases with 18 tibias, 11 femurs and one humerus. Seven patients were excluded; three patients did not return for follow up and four patients had less than six months follow up. Of the remaining 23 patients, 91% (21/23) achieved resolution of infection over a median follow up period of 16 months (Interquartile range, IQR 7-21 months). Infecting organisms where isolated in 65% (15/23). The median duration of hospital stay was 6 days (IQR 4-7 days). Post-operative complications were noted in two cases and involved a tibial and femoral refracture, respectively. Both patients however achieved union without recurrence of infection following surgical intervention. Conclusion: Continuous irrigation is a cost-effective single-stage surgical option for dead space management during the treatment of intramedullary chronic osteomyelitis. It provides the advantage of instilling high dose intramedullary antibiotics and negates the need for a second surgical procedure while achieving similar outcomes than other dead space management techniques.
Radiolographic assessment of lower limb alignment in South African children
(Stellenbosch : Stellenbosch University, 2022-07) Foxcroft, William Donnavan; Du Toit, Jacques; Burger, Marilize Cornelle; Ferreira, Nando; Faculty of Medicine and Health Sciences. Dept. of Surgical Sciences. Orthopaedic Surgery.
ENGLISH ABSTRACT: Background: Radiographic measurements on full length standing lower limb views are the standard for lower limb deformity analysis. Published measurements of Paley et al. on lower limb alignment is the gold standard but was derived from small adult samples. There are no radiographic measurements reported exclusively of children of South African descent. The study aimed to establish normal values of lower limb alignment and joint orientation angles in South African children between 5 and 18 years old, at specific age intervals and to compare these measurements to the values as derived from Paley et al. Methods: A cross-sectional radiographic study including all 5-18 year old children who underwent full-length anteroposterior radiographs between 2012 and 2020 was conducted. Radiographic measurements were done as described by Paley. Differences in measurements obtained and those reported by Paley et al.1 were investigated using a T-test for a single mean against a reference constant, using an alpha level of 0.05. Results: A total of 190 patients (110 male; 80 female) with a mean age of 10.0 ± 3.3 years were included. The medial neck-shaft angle (MNSA), mechanical and anatomical lateral distal femoral angle (LDFA) and lateral distal tibia angle (LDTA) remained consistent throughout the age groups. Significant differences between Paley’s published values and our cohort were observed for the median mechanical axis deviation (MAD), MNSA and medial proximal tibia angle (MPTA). The median MAD across age groups was -2.2 mm (IQR -6.4 – 1.5) with all subgroups showing a lateral MAD (valgus alignment), compared to the median MAD of +9.7mm (varus alignment) from Paley et al.1 The MNSA had a mean of 135.7°, compared to 129.7° from Paley. The mean MPTA was 89.7°, compared to Paley’s 87.2°. The MPTA had minimal change throughout the age groups. Conclusion: Significant differences were seen in the mean/median of our MAD, MNSA and MPTA compared to Paley’s work. Our MAD have a sustained valgus tibio-femoral angulation throughout our population. Our MNSA have more pronounced valgus with minimal change throughout growth. The increasing MPTA leads to a more valgus joint line when compared to other studies. Other measured values are comparable with previously published adult and paediatric populations. We were able to develop set values that could be the norm for paediatric joint orientation angles in the South African population.
The Radiological Assessment to determine whether the use of assistive devices improve Syndesmotic screw placement during surgical fixation of ankle fractures
(Stellenbosch : Stellenbosch University, 2022-07) Kriel, Renier; Ferreira, Nando; Burger, Marilize Cornelle; Faculty of Medicine and Health Sciences. Dept. of Surgical Sciences. Orthopaedic Surgery.
ENGLISH ABSTRACT: Background: Ankle fractures are common injuries, and syndesmotic instability can pose a challenge to the inexperienced surgeon. This study aimed to investigate whether the aid of an assistive device as part of the standard of practice, namely the adapted technique, improves the accuracy of syndesmotic screw placement and reduction of the syndesmosis, compared to the traditional free-hand technique during the operative management of ankle fractures. Methods: This post-operative radiological assessment serves as a retrospective comparative series. Standard anterior-posterior radiographs were used to measure the height of the screw from the ankle joint line, and axial computed tomography slices at the level of the syndesmosis screw were used to measure the trajectory of screw placement against that of the ideal syndesmotic line, as well as the anterior and posterior syndesmotic spaces. Results: A total of 67 post-operative ankles were included (n=56 in the free-hand group vs n=11 in the adapted technique group). A difference between the height of screw placement was observed when comparing the historical free-hand technique to the adapted technique (p=0.002). No significant difference for the angle deviation or anterior- and posterior syndesmotic spaces was observed between the two groups. A trend (p=0.074) was observed with the free-hand technique associated with a larger deviation from the intended screw trajectory. Conclusion: Simple assistive devices may improve the accuracy of syndesmotic screw placement in terms of height and trajectory during the operative management of ankle fractures.
Anatomy of the clavicle and its medullary canal - a computer tomography study
(Stellenbosch Univeristy, 2014-12) King, Paul Reginald; Ikram, Ajmal; Lamberts, Robert Patrick; Stellenbosch University. Faculty of Health Sciences. Dept. of Surgical Sciences: Orthopaedic Surgery.
ENGLISH ABSTRACT: Background With recent literature indicating certain clavicle shaft fracture types are best treated surgically; there is renewed interest in the anatomy of the clavicle. lntramedullary fixation of clavicle shaft fractures requires an adequate medullary canal to accommodate the fixation device used. This computer tomography anatomical study of the clavicle and its medullary canal describes its general anatomy and determines the suitability of its medullary canal to intramedullary fixation. Description of methods Four hundred and eighteen clavicles in 209 patients were examined using computer tomography imaging. The length and curvatures as well as the height and width of the clavicle and its canal at various pre-determined points were measured. ln addition the start and end of the medullary canal from the sternal and acromial ends of the clavicle were determined. The data was grouped according to age, gender and lateralization. Summary of results The average length of the clavicle was 151.15 mm with the average stemal and acromial curvature being 146 and 133 respectively. The medullary canal starts on average 6.59 mm from the sternal end and ends 19.56 mm from the acromial end with the average height and width of the canal at the middle third being 5.61 mm and 6.63 mm respectively. Conclusion The medullary canal of the clavicle is large enough to accommodate commonly used intramedullary devices in the nraprity of cases. The medullary canal extends far enough medially and laterally for an intramedullary device to adequatet'y bridge most middte third clavicle fractures. An alternative surgical option should be avalable in theatre when treating females as the medullary canal is too small to pass an intranedullary device past the fracture site on rare occasions.
Submuscular bridge plating of length-unstable paediatric femoral shaft fractures in children between the ages of 6 and 13
(Stellenbosch : Stellenbosch University, 2014-12) Salkinder, Rael; Du Toit, J.; Lamberts, R. P.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Surgical Sciences. Orthopaedic Surgery
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