Paediatric distal radius fractures: risk factors for redisplacement

The anatomy of the distal radius is unique. It is an area of rapid growth and remodelling, but is also vulnerable to fracture. Of all forearm fractures in children, approximately 30% occur at the wrist, and distal radius fractures account for 75% of these injuries. Despite the tremendous remodelling potential of the distal radius, controversy exists regarding the degree of angulation that is acceptable in the growing child. With increasing age, the degree of acceptable sagittal plane angulation decreases, with recommendations to accept up to 10–15° in children aged 9 to 13 years, and 5–10° in children aged 13 to 15 years. Other literature suggested that dorsal angulation deformities of up to 35° will remodel adequately in children that have at least five years of growth remaining. However, remodelling does not always occur as predicted, especially in children nearing skeletal maturity.

Coding guidelines for soft tissue knee procedures based on a national Delphi consensus study

Determining one’s value in orthopaedic private practice is daunting, especially for novice surgeons. Here we walk a fine line between altruistic social obligation to the patient and commercial self-interest regarding our practice and family. In South Africa, coding for procedures was introduced to allow standardisation of remuneration as legislated by Section 53(3) paragraph D of the Health Professions Act (56 of 1974). Since the introduction of this system, few changes have been made, which creates challenges to code in an evolving field. A Competition Commission ruling in 2004 prohibited collective negotiation on healthcare tariffs. Healthcare professionals must therefore negotiate tariffs with medical schemes individually. It was also stated that public sectors and representative associations are not permitted to negotiate tariffs on behalf of their members.

Diagnostic accuracy of preoperative clinical examination in zone V flexor injuries

The zone V flexor region is anatomically defined as the region from the proximal end of the carpal tunnel to the musculotendinous junction in the forearm. It is densely packed with 12 tendons (flexor carpi ulnaris [FCU], flexor carpi radialis [FCR], flexor pollicis longus [FPL], palmaris longus [PL], flexor digitorum superficialis [FDS] and flexor digitorum profundus [FDP] to the index, middle, ring and little fingers), three nerves (median nerve, ulnar nerve, superficial radial nerve) and two major arteries (ulnar and radial arteries) and their satellite veins. The tendons, nerves and arteries are vital to the meaningful function of the human wrist, fingers and the hand. The superficial location of the tendons and neurovascular structures in zone V flexor region with its widely exposed surface area makes it increasingly vulnerable for penetrating, accidental, homicidal and suicidal injuries.

Soft tissue reconstruction of Gustilo-Anderson grade 3B open tibia fractures at a tertiary hospital: a retrospective case series

Open tibia fractures typically represent high-energy trauma that results in significant damage to adjacent soft tissues and neurovascular structures. Falls from height, road-traffic accidents, direct blows and sporting injuries are common causes of open tibia fractures. These injuries tend to occur in males with a peak incidence in the fourth decade of life. The annual incidence of open long bone fractures has been estimated at 3.4–11.5% per 100 000 population, with 40% occurring in the lower limb, most commonly the tibia diaphysis. The subcutaneous nature of the anteromedial midshaft tibia both increases the likelihood of fractures in this area communicating with the outside environment and poses soft tissue treatment challenges. Although irrigation and surgical debridement is a critical step in managing these injuries, the relevance of the timing of this first surgery remains debateable. Historically, it was thought that open fractures should have their first debridement in theatre within six hours of injury for best results. However, studies show no statistically significant increase in infection rates after a Maimin D et al. SA Orthop J 2023;22(4) Page 193 delay to irrigation and surgical debridement of between 12 and 24 hours, provided that antibiotic treatment was initiated early.

Establishing the safety of the lateral femoral cutaneous nerve when using the Bridging Infix for anterior pelvic fixation

Pelvic ring injuries account for approximately 8% of injuries in trauma cases, and 0.3–6% of all fractures. Although the prevalence of pelvic ring injuries is lower in comparison to other fractures, these injuries are known to have both high morbidity and mortality rates. Surgical interventions for anterior pelvic fixation have been well established. Traditional subcutaneous internal fixation techniques have shown reduced wound complications, better quality of life and reduced pain. However, these techniques still have specific indications, contraindications and complications. The most significant known complication for these techniques is injury of the lateral femoral cutaneous nerve (LFCN).

The biochemical, microbiological and histological findings in native joint septic arthritis in adults

Septic arthritis (SA) 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. Staphylococcus aureus ( S. aureus) is the most common pathogen identified on culture of septic knee aspirate. The knee is the most commonly affected joint in adults and is associated with significant morbidity when not treated correctly and expeditiously. A combination of the host immune response and bacterial toxins and enzymes damage the intra-articular cartilage matrix within three hours and lead to its destruction and subchondral bone loss in as little as three days.

Fibrous dysplasia: a current concepts review

Fibrous dysplasia (FD) is an uncommon benign tumour-like condition caused by a Gsα protein mutation that leads to the production of fibro-osseous tissue in place of normal lamellar bone. The affected skeleton loses its structural integrity and becomes prone to fractures and deformity, causing pain and functional impairment. The disease occurs clinically in two forms: 1) monostotic FD, which is the most common form and is often asymptomatic; or 2) polyostotic FD, which may or may not be part of a syndrome. The associated syndromes include McCune- Albright syndrome (MAS) which is characterised by café-aulait skin markings, endocrinopathy and precocious puberty; or Mazabraud syndrome (MS) which is characterised by multiple soft tissue myxomas. Management of FD varies depending on the presentation but is principally holistic in nature, requiring input from various healthcare team members especially in patients with more extensive and syndromic involvement.


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South African Orthopaedic Journal - November 2023 Vol 22 No 4

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Level 2