Research Articles (Orthopaedic Surgery)

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Assessment and management of shoulder pain at primary care level
(AOSIS, 2021-03) Kauta, Ntambue; De Vries, Elma; Du Plessis, Jean-Pierre; Grey, Ben; Anley, Cameron; Vrettos, Basil; Dachs, Robert; Roche, Stephen
Most patients with shoulder pain will initially visit their community health centre, private general practitioner or family physician, with various levels of experience in the assessment and management of shoulder conditions. Shoulder conditions will range from early, simple ailments that can be treated in the primary care setting, to post-traumatic injuries and complex pathologies requiring the expertise of an orthopaedic surgeon or a fellowship-trained shoulder surgeon. Correct assessment of the patient’s shoulder condition at the index consultation is a prerequisite for appropriate management. This article sets out straightforward guidelines to help general practitioners confidently identify the patient’s source of shoulder pain and initiate an appropriate management plan at primary care level. Criteria for urgent and elective referral for specialist care are also outlined.
Quantitative fit analysis of acromion fracture plating systems using three-dimensional reconstructed scapula fractures – a multi-observer study
(EDP Sciences, 2021) Charilaou, Johan; Dey, Roopam; Burger, Marilize; Sivarasu, Sudesh; Van Staden, Ruan; Roche, Stephen
Introduction: Surgical treatment of displaced acromial and scapula spine fractures may be challenging due to the bony anatomy and variable fracture patterns. This difficulty is accentuated by the limitations of the available scapular plates for fracture fixation. This study compares the quantitative fitting of anatomic scapular plates and clavicle plates, using three-dimensional (3D) printed fractured scapulae. Methods: Fourteen scapulae with acromion and spine fractures were used for this study. Computerized tomographic (CT) scans of the fractured scapulae were obtained from the Philips picture archiving and communication system (PACS) database of patients admitted to a tertiary teaching hospital in Cape Town, South Africa between 2012 and 2016. The reconstructed scapulae were 3D printed and the anatomical acromion and clavicle plates were templated about the fracture regions. The fit assessment was performed by five observers who classified the plates as no-fit, intermediate fit, and anatomical fit according to the surgical guidelines. Results: The 6-hole anterior clavicle plate performed better than any of the scapular plates as they were able to fit 45.7% of the fractured acromion, including the spine. Among the pre-contoured anatomical scapula plates, both the short and the long acromion plates could fit only 27.3% of the fractured acromion. The intraclass correlation coefficient was 0.965 suggesting excellent consensus among the five observers. Conclusion: Clavicle plates were found to be better suited to fit around a scapula fracture in its acromion and spine region.
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.
Mentorship : a two-way street
(Medpharm Publications, 2021-11-18) Anley, Cameron M.
Throughout our orthopaedic training and subsequent careers, we interact with many teachers and colleagues who help us develop our surgical skills and orthopaedic knowledge. Some may become personal role models, from whom we learn more than the basics of orthopaedics. They help to mould our orthopaedic ‘character’, influencing among other aspects, our bedside manner, compassion towards patients and their families, how we interact with colleagues and how we maintain a healthy work–family balance. Mulcahey et al. clarified these concepts by highlighting that a teacher shares knowledge with a learner while a role model demonstrates behaviour patterns in a passive manner and without conscious effort.1 Although the ability to teach and set a positive example as a role model are considered crucial characteristics of a mentor, these roles should not be confused with mentorship.
Do anatomical contoured plates address scapula body, neck and glenoid fractures? A multi-observer consensus study
(Medpharm Publications, 2021-11) De Wet, Japie; Dey, Roopam; Vrettos, Basil; Du Plessis, Jean-Pierre; Anley, Cameron; Rachuene, Pududu A.; Haworth, Leanne C.; Yimam, Habtamu M.; Sivarasu, Sudesh; Roche, Stephen J. L.
Background: The surgical management of scapula body, neck and glenoid fractures remains a challenge. This study focuses on templating an available anatomical pre-contoured plating system using three-dimensional (3D)-printed scapulae to assess the ability of these plates to address the aforementioned fractures and to determine consensus on classifying scapula body, neck and glenoid fractures. Methods: We used a cohort of 22 3D-printed scapulae prototypes and an available anatomical precontoured plating system to determine anatomical congruency and fit. Nine investigators templated the scapulae using four pre-contoured plates, and the investigators classified the 22 scapulae using the Ideberg and AO/OTA classification systems. Results: Eleven out of 22 fractures were found to be fixable using the plates under study. The long lateral plate addressed 83% of fractures involving the lateral border, while the glenoid plate was unable to adequately address any glenoid fractures. We observed good to excellent (p ≤ 0.001) interobserver reliability for three of the four plates. The interobserver reliability was moderate (ICC = 0.74) for the AO/OTA classification and good (ICC = 0.88) for the Ideberg classification. Conclusion: We believe that the anatomical pre-contoured plating system does not address all the fracture patterns encountered in clinical practice and further development in plate design is required. There is good to moderate interobserver reliability using the Ideberg fracture classification for intra-articular fractures and the AO/OTA classification for extra-articular fractures involving the body.

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