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Lützner, Jörg, Stephan Kirschner, and Klaus-Peter Günther. "Möglichkeiten der navigationsgestützten Knie- und Hüftendoprothetik." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2008. http://nbn-resolving.de/urn:nbn:de:bsz:14-ds-1223729518905-08387.
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Die Knie- und Hüftendoprothetik hat sich zu einem Standardeingriff in der Orthopädie entwickelt. Der Erfolg einer endoprothetischen Versorgung hängt neben vielen anderen Faktoren auch von der möglichst korrekten Implantation des Kunstgelenkes ab. Sowohl in der Standardendoprothetik, aber insbesondere auch in schwierigen Situationen kann durch die zusätzliche Unterstützung eines Navigationssystems die Implantationsgenauigkeit verbessert und damit die Häufigkeit von Folgeproblemen minimiert werden. Besonders hilfreich ist diese Unterstützung, wenn eine normale Ausrichtung aufgrund von veränderten Knochenformen nicht möglich istTotal knee and hip arthroplasties have become a standard procedure in orthopaedic surgery. The success of total arthroplasties depends on a number of factors. One of these is the positioning of the implant. A computer-assisted navigation system is able to improve the accuracy of implant positioning in standard operations, and especially in difficult situations. Problems arising as a consequence of malpositioning can be minimised
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Tarazi, Kamal. "Computer assisted orthopaedic surgery." Thesis, Imperial College London, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.321608.
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Walenkamp, G. H. I. M. "Orthopaedie: blijft in beweging." Maastricht : Maastricht : Maastricht University ; University Library, Universiteit Maastricht [host], 2007. http://arno.unimaas.nl/show.cgi?fid=13131.
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Ashby, Elizabeth. "Morbidity following orthopaedic surgery." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10054431/.
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Morbidity following hip and knee arthroplasty has previously been poorly recorded. This is the first time the Post-Operative Morbidity Survey (POMS) has been used for this purpose. The POMS identifies clinically significant morbidity using indicators of organ system dysfunction rather than traditional diagnostic categories. The most common types of morbidity following hip and knee arthroplasty are infection and renal morbidity. Pulmonary, pain and gastro-intestinal morbidity are less common. Cardiovascular, wound, neurological and haematological morbidity are least common. Many arthroplasty patients remain in hospital without morbidity. The POMS identifies these patients and thus has potential as a prospective bed utilisation tool. To be used for this purpose, the POMS must identify all clinically significant morbidity. Mobility is an important factor for safe discharge of arthroplasty patients. Addition of a ‘mobility’ domain could improve the utility of POMS as a bed utilisation tool following orthopaedic surgery. This study showed no association between post-operative morbidity defined by the POMS and longer-term patient-reported outcome measures (PROMs). This study does not support the POMS as an early surrogate marker of long-term PROMs in orthopaedic patients. The wound domain of the POMS has a high specificity, reasonable sensitivity, high negative predictive value and low positive predictive value compared to the inpatient ASEPSIS (Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, inpatient Stay over 14 days) score. The wound domain of POMS could be replaced with a validated definition of wound infection such as ASEPSIS. On the same series of orthopaedic patients, surgical site infection (SSI) rate according to the Centres for Disease Control (CDC) definition was 15.45%, according to the Nosocomial Infection National Surveillance Scheme (NINSS) definition was 11.32% and according to the ASEPSIS definition was 8.79%. This highlights the need for a consistent definition of SSI.
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Johansson, Åke. "Experimental implant-associated orthopaedic infections /." Stockholm, 1999. http://diss.kib.ki.se/1999/91-628-3562-9/.
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Widman, Jan. "Blood saving in orthopaedic surgery /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-220-5.
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Di, Laura Anna. "Corrosion of metal orthopaedic implants." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10045267/.
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Tribocorrosion at the taper junctions of femoral components in total hip arthroplasty is a complex mechanism and a source of metal release in the body. Understanding the various modes and mechanisms of in-vivo corrosion and the pathogenesis of the body’s biological response that results in implant failure is of significant clinical importance. This thesis focused on the forensic analysis, using both metrology methods and synchrotron radiation, of a class of modular orthopaedic implants - dual-taper hip arthroplasty, retrieved from patients whose hip replacements were revised secondary to adverse reaction to metal debris (ARMD). Emphasis was placed on the forensic investigation of the neck/stem junction of contemporary designs and the recalled Rejuvenate modular femoral stem. All the retrieved implants in the CoCr/Ti combination group showed moderate to severe corrosive attack. The severity of taper degradation was found to increase with implant time in situ and to be associated with a greater Co to Cr ion ratio in the blood. Metal species identified in periprosthetic tissue from these corroded implants, were analysed for metal distribution and oxidation state by means of synchrotron radiation. For the first time, Ti was found in an amorphous dioxide form and Cr in Cr2O3. The metal species showed preferential affinity between each other and were often co-localized. This suggests that the complexity (in morphology and chemistry) of the debris may play an active role in eliciting a pathologic response in periprosthetic tissues. The findings from this body of research will inform future toxicological studies and may provide useful information helping to better design future pre-marketing tests of orthopaedic implants and more broadly the understanding of the metal/metal and metal/body interactions.
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Slocum, Alexander Henry Jr. "Rolling contact orthopaedic joint design." Thesis, Massachusetts Institute of Technology, 2013. http://hdl.handle.net/1721.1/81736.
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Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2013.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references.
Arthroplasty, the practice of rebuilding diseased biological joints using engineering materials, is often used to treat severe arthritis of the knee and hip. Prosthetic joints have been created in a "biomimetic" manner to reconstruct the shape of the biological joint. We are at a disadvantage, however, in that metals and polymers used to replace bone and articular cartilage often wear out too soon, leading to significant morbidity. This thesis explores the use of kinetic-mimicry, instead of bio-mimicry, to design prosthetic rolling contact joints, including knee braces, limb prosthetics, and joint prostheses, with the intent of reducing morbidity and complications associated with joint/tissue failure. A deterministic approach to joint design is taken to elucidating six functional requirements for a prosthetic tibiofemoral joint based on anatomical observations of human knee kinetics and kinematics. Current prostheses have a high slide/roll ratio, resulting in unnecessary wear. A rolling contact joint, however, has a negligible slide/roll ratio; rolling contact prostheses would therefore be more efficient. A well-established four-bar linkage knee model, in a sagittal plane that encapsulates with the knee's flexion/extension degree of freedom, is used to link human anatomy to the shape of rolling cam surfaces. The first embodiment of the design is a flexure coupling-based joint for knee braces. Failure mode analysis, followed by cyclic failure testing, has shown that the prototype joint is extremely robust and withstood half a million cycles during the first round of tests. Lubrication in the joint is also considered: micro- and nano-textured porous coatings are investigated for their potential to support the formation of favorable lubrication regimes. Hydrodynamic lubrication is optimal, as two surfaces are separated by a fluid gap, thus mitigating wear. Preliminary results have shown that shear stress is reduced by more than 60% when a coating is combined with a shear thinning lubricant like synovial fluid. These coatings could be incorporated into existing joint prostheses to help mitigate wear in current technology. This thesis seeks to describe improvements to the design of prosthetic joints, both existing and future, with the intent of increasing the overall quality of care delivered to the patient.
by Alexander Henry Slocum, Jr.
Ph.D.
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Wilkinson, Andrew James. "Biomimetic topography in orthopaedic ceramic." Thesis, University of Glasgow, 2016. http://theses.gla.ac.uk/7791/.
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The primary objective of this research was to perform an in vitro assessment of the ability of microscale topography to alter cell behaviour, with specific regard to producing favourable topography in an orthopaedic ceramic material suitable for implantation in the treatment of arthritis. Topography at microscale and nanoscale alters the bioactivity of the material. This has been used in orthopaedics for some time as seen with optimal pore size in uncemented hip and knee implants. This level of topography involves scale in hundreds of micrometres and allows for the ingrowth of tissue. Topography at smaller scale is possible thanks to progressive miniaturisation of technology. A topographic feature was created in a readily available clinically licensed polymer, Polycaprolcatone (PCL). The effect of this topography was assessed in vitro. The same topography was transferred to the latest generation composite orthopaedic ceramic, zirconia toughened alumina (ZTA). The fidelity of reproduction of the topography was examined using scanning electron microscopy (SEM) and atomic force microscopy (AFM). These investigations showed more accurate reproduction of the topography in PCL than ZTA with some material artefacts in the ZTA. Cell culture in vitro was performed on the patterned substrates. The response of osteoprogenitor cells was assessed using immunohistochemistry, real-time polymerase chain reaction and alizarin staining. These results showed a small effect on cell behaviour. Finally metabolic comparison was made of the effects created by the two different materials and the topography in each. The results have shown a reproducible topography in orthopaedic ceramics. This topography has demonstrated a positive osteogenic effect in both polycaprolactone and zirconia toughened alumina across multiple assessment modalities.
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Millar, Lindsay Jane. "Visual feedback in orthopaedic rehabilitation." Thesis, University of Strathclyde, 2016. http://digitool.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=27634.
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Currently, functional outcome following total knee arthroplasty (TKA) surgery is often not restored, with the majority of TKA patients exhibiting lower functional outcome scores than healthy counterparts. There is some controversy regarding the nature of rehabilitation delivery following TKA surgery which could contribute to sub-optimal outcomes. Visual feedback has had a positive effect in other patient populations, such as stroke survivors, and therefore may also improve the efficacy of TKA rehabilitation. Currently, the most effective way to deliver visual feedback is with motion analysis technology. However, current protocols are not suitable for routine clinical use as they are time consuming and complex. Therefore, the aims of this study were to develop a motion analysis protocol tailored for routine clinical use, use the protocol to implement real-time visual feedback to TKA patients and test the effectiveness of the feedback on patients’ functional outcome. A cluster based protocol was developed (Strathclyde Cluster Model; SCM) and compared to the current clinical gold standard (Vicon Plug in Gait; PiG) in terms of kinematic output and inter/intra-assessor reliability. SCM was used to implement 3 visual feedback scenarios during TKA rehabilitation. To test the effectiveness of visual feedback, functional outcome was compared for a group of patients who received feedback and a group of controls. Further, the acceptability and reliability of SCM was tested with clinicians who had no prior experience in motion analysis. Results demonstrated that SCM was generally as reliable and accurate as PiG. Further, visual feedback does appear to have a positive effect on TKA patients and when tested with clinicians who were inexperienced in motion analysis, SCM was generally acceptable and reliable. In conclusion, SCM is an appropriate protocol for routine clinical use to deliver visual feedback during TKA rehabilitation and visual feedback has a positive effect on outcome for TKA patients.
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Hughes, Gareth Martin. "Surface analysis of orthopaedic implants." Thesis, University of Bristol, 2003. http://hdl.handle.net/1983/03628cc5-0770-4017-97c4-7753d184e308.
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Okhiria, David. "Orthopaedic application of magnetic sensors." Thesis, Cardiff University, 2018. http://orca.cf.ac.uk/109877/.
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The purpose of this thesis is to propose a novel application of amorphous magnetic ribbons for use as knee force measurement sensors, without the need for secondary windings. This thesis demonstrates that the magnetic properties of amorphous ribbons are retained when embedded in Ultra-high molecular weight polyethylene (UHMWPE) tibial inserts, and these properties can be interrogated non-invasively. This is of importance, as it offers a viable solution for instrumented prosthesis which can be used for in-vivo monitoring. The research conducted also demonstrates that the tibiofemoral contact force on the instrumented tibial insert can be measured by observing the impedance changes in adjacent coils. Other conventional methods, though effective, require additional circuitry for non-invasive retrieval of measured data. The work contained herein eliminates this need, thereby reducing the structural modification of the implant required to accommodate the additional components. This research also shows that the variation in the coil impedance can be related to the permeability changes in the amorphous ribbons, and these can be quantified by tracking the resonant frequency of the coils. Amorphous ribbons have not been used in monitoring orthopaedic prosthesis before, and this work shows how the simplified measurement system can offer an alternative technique to knee implant monitoring.
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Yang, Jun. "Immune response to orthopaedic biomaterials." Case Western Reserve University School of Graduate Studies / OhioLINK, 1995. http://rave.ohiolink.edu/etdc/view?acc_num=case1058195837.
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Bick, Simon Millard. "Occipito-cervical fusion." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10142.
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The aim of this study is to review the different surgical indications, techniques and outcomes of occipito-cervical fusion, including C2 fixation methods, the influence on clinical outcome, patient scoring systems and complications.
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Sharifi, Husham. "Cost Effectiveness Analysis in Orthopaedic Surgery." Yale University, 2010. http://ymtdl.med.yale.edu/theses/available/etd-03302010-163307/.
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The purpose of this thesis was to explore the use of cost effectiveness for interventions in orthopaedics. This was done through three cost effectiveness articles that have been published by the author. In each of these articles, similar methodologies were used. Decision models were constructed for cost-effectiveness analyses of competing orthopaedic interventions. Outcome probabilities and effectiveness values were derived from the literature. Effectiveness was expressed in quality adjusted life years gained. Cost data were compiled and verified from either hospital cost data or from Medicare data. Costs and utilities were discounted in accord with the United States Panel on Cost Effectiveness in Health and Medicine. Principal outcome measures were average incremental costs, incremental effectiveness, incremental quality-adjusted life years, and, in the case of one article, net health benefits. In particular the articles compared the following: 1. Core decompression versus conservative management for osteonecrosis of the hip as a way to delay hip replacement; 2. Total knee arthroplasty versus unicompartmental knee arthroplasty; and 3. Periacetabular osteotomy versus total hip arthroplasty for a young adult with developmental dysplasia of the hip. The more cost effective intervention was identified in each case, along with implications of the results for clinical and operative decision-making. Cost effectiveness was found to be a useful tool in orthopaedic surgery under limited circumstances of either scarce data on new interventions or the need to use more resources to achieve greater effectiveness. It also can provide excellent insight into ways to direct future clinical research.
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Pitz, Mary Katlyn. "Compression-aided stability of orthopaedic devices." Thesis, Georgia Institute of Technology, 2011. http://hdl.handle.net/1853/39487.
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Repair and remodeling of bone during healing and fusion require a combination of bone resorption and formation to successfully restore the bone to its previous strength. The healing process is highly responsive to the mechanical conditions of the construct, where excessive loading can cause high strains that delay healing, but moderate loading can be beneficial. Maintaining compression at the site of fracture can benefit healing by maintaining bone congruency and increasing the stability of the bone-implant construct to prevent excessive shifting. For these reasons, compressive mechanisms are employed in many orthopaedic devices, including both intramedullary (IM) nails and external fixators for ankle arthrodesis applications. Tibiotalocalcaneal (TTC) arthrodesis is a salvage procedure that fuses both the ankle and the subtalar joints. It has become the standard of care in ankle degeneration, which can be brought on by posttraumatic arthritis, failed total ankle arthroplasty, or diabetic conditions such as Charcot arthropathy. While current devices are effective in many cases, TTC arthrodesis procedures still incur failure rates as high as 22%, where failure of the bones to successfully fuse can result in amputation. Because bone healing relies upon bone resorption, the initial compression applied to the implanted constructs can be quickly lost, which may sacrifice the stability of the structure and delay or inhibit further healing.
By employing a mechanism that can sustain compression during the bone healing process, it was possible to increase the stability of the construct even during bone resorption, minimizing the failures that still occur. The focus of this study was to determine the effects of compression on the mechanical stability of the implant-bone construct found in TTC arthrodesis. A comparison was made between the torsional stability of two currently marketed intramedullary devices, as well as a prototype IM device comprised of a nickel titanium core, designed to hold constant compression for up to 9mm of resorption. Additionally, the stability of each construct over time was evaluated by correlating bone resorption to a loss in compressive force.
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Lilley, Kevin James. "Novel cement formulations for orthopaedic applications." Thesis, University of Birmingham, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.442648.
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Evans, S. E. K. "Applied photogrammetry in orthopaedic implant manufacture." Thesis, University of Liverpool, 2018. http://livrepository.liverpool.ac.uk/3020338/.
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Song, Xiaodong. "Titanium vaulted structures for orthopaedic applications." Thesis, University of Liverpool, 2013. http://livrepository.liverpool.ac.uk/13335/.
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Medical devices are used to recreate damaged or diseased joints and also to restore pain reduced mobility to patients. Devices such as hip and knee implants are fixed to the host bone by use of acrylic bone cement or by a press-fit interference technique. The surface of the press fit implants may be roughened, but non-porous, which allows new bone to form on the surface, or they may be porous to encourage bone growth into the structure. Traditionally implants are produced by machining, casting or forging, before applying any coatings that are required. More recently Additive Manufacturing (AM) techniques such as Electron Beam Manufacturing (EBM) and Selective Laser Melting (SLM) have attracted interest as they may be able to create the whole device in one operation. This thesis describes the research carried out to produce “Vaulted Structure (VS)” as a method for creating specific porosity with increased strength in porous medical devices. Unit cell structures (Wire frames) are inherently weak because of the struts. It was proposed that VSs, constructed of platelets, would have a higher specific strength and therefore extend the range of available properties while still maintaining a structure that resembles cancellous bone, a structure preferred by surgeons. The creation of a VS begins with a computer model of the object to be created. This is then surrounded by an axis aligned bounding box, a box that has edges parallel to the x, y and z directions and just encloses the object. The bounding box is then voxelised, so it consists of many smaller cubic boxes, these boxes being the size of the required structure. The VS is then constructed by creating holed platelets on some of the surfaces of the smaller boxes, with these platelets being randomly deformed if required. The structure within the bounding box is then trimmed to the boundary of the required structure, this being accomplished using a rapid technique developed during this project. To allow manufacture of the components, the structure is sliced to create a suitable format for the SLM. By using SLM in combination with these new novel structures, a wide range of possible properties and morphologies can be generated, these being controlled by the cell size, hole size, thickness of the platelet and the level of randomisation. ii A range of structures with different morphologies were produced and mechanically tested in compression. It was found that a percentage randomisation of more than 60% and a cell aspect ratio of 1:1:2, produced isotropic mechanical behaviour, while other structures produced very different behaviour. It was also observed that the failure mode in compression could be controlled by the degree of randomisation and this is discussed in the thesis. A property that is important in the medical device industry is the look of the component as this affects up take by surgeons. The preferred structures are ones that look like cancellous bone and the new structures created here match both the look and mechanical properties of this material, but with the added advantage that it is possible, by modifying the control variables, to match the structure to cancellous bone from different aged patients. The research presented in this thesis considers the inter-relationship between the process parameters, architecture, properties of the structures and why these inter relationships occur. The research presented here extends knowledge of how to create these novel material/structure combinations, how to tailor them to a given purpose and by predicting behaviour in software produce the most suitable properties for a given medical device without extensive testing.
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Held, Michael. "Evaluation of diagnostic advances in musculoskeletal tuberculosis; the automated xpert MTB/RIF assay." Doctoral thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20495.
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The aim of this thesis was to investigate the diagnostic accuracy of Xpert for musculoskeletal TB and for rifampicin resistance against a gold standard of culture or histology. Site of disease, HIV status, and age of patients, and accuracy in spinal compared to extraspinal TB were investigated as secondary objectives. The overarching hypothesis was that Xpert is more accurate and would provide results faster than the gold standard for musculoskeletal TB, and that it would have a higher yield in HIV infected patients, adult patients, and patients with spinal disease.
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Roussot, Mark. "Amputation rate following tibia fractures with associated popliteal artery injuries." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25507.
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Objectives: 1. Determine the amputation rate; and 2. identify risk factors in patients with tibia fractures and associated popliteal artery injuries. Intervention: Amputation or limb salvage. Design: Retrospective case-control study. Setting: Level 1 trauma center. Patients: Thirty popliteal artery injuries with ipsilateral tibial fractures. Outcome measures: Primary and delayed amputation rates were determined. Risk factors tested for significance (Fischer's Exact) included: mechanism of injury, signs of threatened viability, compartment syndrome, fracture pattern, surgical sequence, and time delay from injury or presentation to revascularization. Results: The study group consisted of 22 males and 8 females, with a mean age of 31 years. Motor vehicle accidents and gunshot wounds constituted the mechanism in 17 and 11 patients respectively. Twenty-one were polytrauma victims. Intra/extra16 articular metaphyseal fractures (OTA 41 A-C) were recorded in 19 and diaphyseal (OTA 42 A-C) in 7 patients. Primary amputation was performed in 7 and delayed in 10 patients (overall rate 57%). No individual risk factors were predictive of amputation; however, the "miserable triad" of a proximal tibia fracture (OTA 41) with signs of threatened viability, and delay to revascularization ≥ 6 hours from injury or ≥ 2 hours from presentation was predictive of amputation (p = 0,036 and p = 0,018 respectively). Conclusions: We should aim to intervene within 6 hours following injury or 2 hours following presentation to reduce the risk of amputation. This provides a target for trauma teams even with uncertain time of injury. Level of Evidence: III.
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Kauta, Ntambue. "The management of fragility fractures of the hip: a quality assessment project." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25067.
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Introduction: Fragility fractures of the hip (FFH) constitute the most serious complication of osteoporosis carrying a mortality rate of up to 20 – 30% in the first year after injury and are associated with post injury decay in patient's level of activity in more than 50% of the cases. It is also a predictor of future osteoporosis related fractures. Surgical fixation of the hip fracture within 48 of admission, multimodal pain management, deep vein thrombo-prophylaxis, early physical therapy, appropriate assessment and management of osteoporosis and frailty in a multidisciplinary approach are the standard of care for FFH to keep the mortality and morbidity rate as low as possible and prevent future fragility fractures. Aim: To assess the standard of care of FFH at our institution and determine areas of care which need more attention and improvement. Methods: Retrospective review of clinical and radiographic records of all patients admitted at our level 1 trauma unit for fragility fracture of the hip from 1st January 2014 to 31st December 2014. The waiting time from admission to surgical fixation of the hip fracture, pain control and thrombo-prophylaxis strategies, the rate of geriatric referrals and the extent of osteoporosis management were assessed. Results: We admitted 113 fragility fractures of the hip from 1st January to 31st December 2014. Ninety- eight clinical records and 98 pelvis radiographs were included in the study. The other 15 clinical records were incomplete and were therefore excluded. The average waiting time from admission to surgery was 49 hours (range 9 -120). Low dose morphine, paracetamol and tramadol were the only perioperative pain control medication used for all patients. All patients had low molecular weight heparin and compression stockings prescribed for thrombo-prophylaxis. Only 2 (2, 04%) of patients had some osteoporosis investigations ordered. There were no geriatric referrals made and no formal osteoporosis management in all reviewed records. Conclusion: While the waiting time from admission to surgery was largely within the recommended time frame, there were no signs of a multidisciplinary approach to the management of fragility fractures of the hip at our institution leaving osteoporosis and frailty largely untreated.
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HIlton, Thomas. "Clinical outcomes following reduction and pinning of lesser arc injuries without repair of the scapholunate interosseous ligament." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20373.
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Study Rationale: Purely ligamentous lesser arc, Mayfield grade 3 and 4, perilunate dislocations (PLD's) 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 the majority of 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: 10 male patients, median age of 35, were followed-up for a median of 22 months. 7 patients underwent a closed reduction and anatomical pinning while 3 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, 3 excellent scores, 2 good scores and 5 fair scores. Instability was found clinically in 1 asymptomatic patient who had a positive Watson shift test. Radiological scores include a median scapholunate distance of 2mm, a scapholunate angle of 70° and a radiolunate angle of 15°. Osteoarthritis was found in 2 patients, all of whom were asymptomatic. Discussion: Current recommendations in the literature are that PLD's should be reduced via an open surgical technique with repair of the 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 the majority of 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.
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Marais, Christoff de Villiers. "Functional outcomes and patient satisfaction after fasciotomy performed for chronic exertional compartment syndrome." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25068.
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Study Rationale: Chronic exertional compartment syndrome often forces patients to change their sporting activities or reduce their level of participation. Many undergo surgery with the aim to return to their activities symptom free. The aim of the study was to determine if fasciotomies for chronic exertional compartment syndrome are a reliable treatment option with a predictable outcome to allow patients to return to the same level of activities. Objective: The evaluation of the functional outcomes and patient satisfaction in an active population who had surgery, namely fasciotomies, for chronic exertional compartment syndrome (CECS) of the lower leg. Design: A retrospective descriptive cohort study with a telephonic follow-up interview. Patients: A consecutive series of 41 patients that were surgically treated for CECS by a single orthopaedic surgeon from July 2005 to October 2013. Main Outcome Measures: Patient records were reviewed to determine their presenting symptoms, diagnostic investigations and surgical procedures performed. A questionnaire was completed by each participant to assess pain and level of activity before and after surgery, level of improvement after surgery and patient satisfaction with surgical outcomes. Results: Twenty-one of the 41 patients that were included in the study were categorized as active sportsmen, participating at a competitive or a non-competitive level. The remaining 20 were experiencing symptoms during leisure activities. The majority of all the patients (63%) had to stop their activity due to their symptoms. After surgery 95% were able to return to participate in the same level of activities as before surgery. Ninety percent of the active sportsmen were able to return to participation at a competitive or non-competitive level, with 45% reporting an increase in the level of intensity that they could maintain. Overall satisfaction was reported by 80% of participants although only 46% were completely pain free. Conclusions: Fasciotomies are a viable surgical treatment option for chronic exertional compartment syndrome in active patients, including athletes. There is an 87% return rate to previous activities within 6 months and an 80% satisfaction rate reported by patients post-surgery. We do acknowledge that some of the data collected regarding symptomology is subject to recall bias due to the interval between surgery and completion of the questionnaire.
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Kruger, Neil. "The Oxford Shoulder Score: Cross-cultural adaption and translation validation into Afrikaans." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29797.
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Purpose: The Oxford Shoulder Score (OSS) is a robust and universally utilised shoulder score that has been translated for use in Western and Asian countries. This study aimed to translate, cross-culturally adapt and psychometrically validate the Afrikaans version of the OSS for use in Africa. Methods: Translation and cross-cultural adaptation was performed in accordance with guidelines in the literature. 108 consecutive patients with either degenerative or inflammatory pain of the shoulder were prospectively enrolled. Patients were evaluated by completing the Afrikaans OSS, Constant-Murley, quickDASH, and the Subjective Shoulder Value (SSV) scores. Comprehensibility and acceptance, as well as any floor or ceiling effects, were calculated. Reliability was assessed through reproducibility. Internal consistency was assessed using Cronbach’s alpha. Validity was determined using a Pearson Correlation Co-efficient between the Afrikaans OSS and the other validated shoulder scores. Results: Comprehensibility and acceptance were excellent, and no floor or ceiling effects were observed. Reproducibility (r = 0.99) and internal consistency (Cronbach’s alpha = 0.93) were both excellent. Correlation of the Afrikaans OSS with the Constant-Murley and quickDASH was excellent (r = 0.84; r = 0.81 respectively), and very good with the SSV and VAS pain score (r = 0.73; r = 0.66). Conclusion: The Afrikaans OSS proved understandable, acceptable, reliable and valid. It is an appropriate instrument for use in Afrikaans speaking patients with shoulder pain from degenerative or inflammatory origin.
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Louw, Frederik Marthinus. "Neurovascular complications in displaced extension-type supracondylar fractures in children : outcome of conservative management." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/12517.
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Includes bibliographical referencesThe aim of our study was to review our conservative management of neurovascular complications in displaced extension-type supracond ylar fractures of the humerus in children. We critically analysed the outcomes. Our results shall aim to clarify the management of this contentious issue.
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Fleming, Mark Alexander. "How does pre-reduction MRI affect surgeon's behaviour when reducing Distraction-Flexion injuries of the cervical spine?" Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/2840.
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Sluis-Cremer, Timothy Richard. "Minimally invasive CT-guiding excision of benign bone tumours." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29681.
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Background: The management of osteoid osteoma (OO) and other small primary benign lesions of bone has evolved over the past 50 years from open surgery with wide resection margins to less invasive surgical techniques such as image guided intralesional excision and percutaneous radiofrequency ablation. We aim to evaluate the outcomes of patients treated with computerised tomography (CT guided) intralesional excision and bone grafting of small benign lesions of bone. Method: A retrospective folder review of patients treated in a large academic hospital in Cape Town, South Africa, between March 2012 and May 2016 was performed. Patient demographics, details of presentation, clinical information and outcome following treatment were analysed descriptively. Pre-operative diagnosis based on radiological examination was compared with histological diagnosis. Result: Eleven patients (5 male) with a median age of 16 years (range 5-33) were included. Pain was the most common presenting feature. A histological diagnosis of OO was confirmed in 5 of 9 patients with a suspected diagnosis of OO preoperatively. Of the 4 patients whose diagnosis changed after the procedure the diagnoses included a benign spindle cell lesion, a benign fibrous histiocytoma, subacute osteitis and an osteochondral defect with geode cyst formation. Of the 2 patients where OO was not suspected preoperatively, chondroblastoma was confirmed in one while a benign spindle cell lesion was reported in the other. Overall histological yield was thus 100%. There were no complications or repeat procedures at a median follow up of 42 months (range 30-52 months). Conclusion: CT guided intralesional curettage is a safe and minimally invasive technique. This is especially useful in less accessible regions of the skeleton as it provides a means of accurately locating the lesion with minimal risk of complications and morbidity to the patient. We consider this to be the optimal method of treatment in our setting as it provides high success rates, few complications and a histological diagnosis without the need for any additional and expensive equipment.
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Koller, Ian M. "Locking plates for distal femur fractures does an increased working length improve healing?" Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/2844.
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Includes abstract.Includes bibliographical references.
Distal femur locking plates have become a very popular means of internal fixation because of their ability to provide stable distal periarticular fixation. In spite of this enthusiasm however several studies have reported significant problems with healing. In the distal femur it is recognized that locking plate fixation may be too rigid if used in certain configurations that limit the essential micro movement required for biological healing. Implant failure may arise from rigid configurations that cause excessive hardware stress concentrations. In an attempt to address these problems longer plates and an increased working length have been proposed to reduce construct rigidity. The purpose of our study is to investigate whether an increased working length translates into improved healing.
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Naude, Petrus Hendrik. "Prospective study to compare the difference in cerebral perfusion in patients undergoing shoulder surgery with the standard beach chair position compared to 30˚ inclination." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20785.
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There have been devastating reports of patients suffering permanent neurological damage following surgery in the beach chair position. Recent literature have shown that placing a patient under general anaesthesia in the beach chair position may place patients at risk of complications. There is no set angle of inclination used by all orthopaedic surgeons. Previous research have used angles of 70˚-90˚. At these angles patients suffered a significant number of cerebral desaturation events that may lead to ischaemic neurological events. This angle is far more upright than what is used in our practice. We postulated that decreasing the angle of inclination may be protective of cerebral perfusion. We performed a prospective randomised single blind study. 45 consecutive patients presenting for shoulder surgery were randomised to 2 groups. The control group patients were placed in the normal position used by the surgeon for the procedure and this angle was measured. The patients in the trial group were all placed at 30˚. Patients with known cerebrovascular disease, younger than 18 years, ASA grade 4 and 5, allergy to local anaesthetic, pre-existing coagulopathies or a failed interscalene block were excluded. Cerebral oxygenation were measured with the INVOS system along with the other standard observations in theatre. The 2 most important parameters measured were mean arterial pressure and cerebral oxygenation levels.
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Dunn, Robert. "Posterior segmental spinal fixation in Scoliosis surgery." Master's thesis, University of Cape Town, 2001. http://hdl.handle.net/11427/2839.
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Includes bibliographical references.Spinal deformity was recognised in the ancient works for philosophy, religion, myths, and fairy tales dating back as far as 3500BC[1,6]. Scoliosis was first described in the 5th century BC by Hippocrates. He recommended treatment with axial distraction on an extension apparatus (figure 1).
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Dachs, Robert. "An assessment of undergraduate musculoskeletal training at Medical Schools in South Africa." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/2837.
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Jordaan, Pieter Willem. "Surface replacement of proximal interphalangeal joint (SR-PIPJ) arthroplasty - A case series." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20858.
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Surface replacement (SR) proximal interphalangeal joint replacement consists of a cobalt-chrome alloy component articulating with an ultra-high molecular weight polyethylene component. After experiencing a high rate of subsidence and complications with a pyrocarbon implant, our unit has changed to the cemented SR system in the hope of decreasing these complications. The main aim of this study was to determine whether this change in practice has led to a decrease in subsidence and complications. A retrospective chart review was performed including 43 joints in 28 patients. Subsidence was noted in 26% of the joints and complications in 31% of the joints. Even though subsidence remains a problem, the change in implant has led to a decrease in subsidence and other complications.
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Maqungo, Sithombo. "Tuberculosis of the foot and ankle in children." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10763.
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The purpose of our retrospective study is to critically assess the long-term outcome of tuberculosis of the foot and ankle in children and to define an initial classification system that would relate to prognosis.
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Charilaou, Johan. "Quantitative fit analysis of acromion fracture plating systems using three-dimensional anatomical modelling." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31486.
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Background
Displaced acromial fractures are challenging to treat. Complex bony anatomy, variable fracture morphology and limitations of available implants present challenges in achieving favourable surgical outcomes. We determined to what extent currently available scapular and clavicular plating systems are able to provide adequate fixation options.
Methods
Patients presenting to an urban trauma centre with acromial fractures sustained from blunt trauma between 2012 and 2016 were identified (n = 15, 14M / 1F). The fracture patterns were categorized according to location (Type I = 13%, Type II = 27%, Type III = 60%). Computed Tomography (CT) scans were reconstructed to produce three-dimensional (3D) printed anatomical models on which a quantitative fit analysis was performed. Measurements were performed twice, by five separate observers, with fit graded as anatomical fit (< 2mm), intermediate fit (> 2mm) or no-fit.
Results
The anterior clavicle 6 hole plate fitted best in 45.7% of cases. Acromial plates only achieved 27.3%. The acromion short plate together with the lateral clavicle short plates performed the best in Type II fractures. An inter-observer intraclass correlation coefficient (ICC) agreement of 0.974 was obtained.
Conclusion
The available commercial acromial plating system fails to provide adequate congruency and fit for fixation. Clavicular plates were superior alternative implants. 3D printed anatomical models can be used effectively to assist in templating implants preoperatively.
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Nortje, Marc Boydell. "Single pin versus multiple pin fixation in the management of slipped upper femoral epiphysis." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/2846.
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Thiart, Gerhard. "The influence of different connecting rod configurations on the stability of the Ilizarov Frame: A biomechanical study." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27557.
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Background: The Ilizarov external fixator (IEF) is frequently used in trauma and elective orthopaedics. Many of its biomechanical variables (ring size; wire diameter; wire number; half pins versus wires; etc.) and their influence on stability and stiffness have been investigated. There is however a paucity in the literature regarding the influence of the connecting rod numbers and configurations between the rings on IEF stability. Objectives: Primarily to compare the stability between four and three rod IEF configurations. Secondarily to assess the difference in stability between symmetrical and asymmetrical spacing of the IEF rods. Methods: A custom jig was designed to facilitate mounting of a basic two ring IEF in a hydraulic press. Controlled centre and off centre (thus simulated bending) axial loading was then applied across the frame. The configurations were loaded up to 4000 Newtons. The frame deformation was plotted and the data was then analysed and interpreted. Results: Negligible differences were observed between different four and three rod configurations as long as the applied force at the loading point (LP) was within the area of support (AOS) created by the rods. The different four rod constructs were always more stable than the three rod constructs during bending. Conclusions: There is comparable stiffness between a four rod and a three rod IEF construct as long as the loading point (LP) is within the area of support (AOS) created by the rods. A four rod IEF is stiffer than a three rod IEF in bending.
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Dix-Peek, Stewart. "Pelvic osteotomies for exstrophy : a review of techniques and outcomes at Red Cross Children's Hospital." Master's thesis, University of Cape Town, 2007. http://hdl.handle.net/11427/2838.
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Grey, Barend Christiaan. "Humeral stem loosening following reverse shoulder arthroplasty - systematic review and meta-analysis." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24990.
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Background: Aseptic stem loosening following reverse shoulder arthroplasty (RSA) is an uncommon complication. The majority of literature on RSA consists of case series with short follow-up periods. It remains unknown which factors contribute to aseptic stem loosening in RSA. Our analysis aimed to compare the incidence of aseptic stem loosening, humeral radiolucent lines (RLL) and revision for stem loosening between: 1) cemented and uncemented stems, and 2) different etiological subgroups Methods: In a systematic review 75 articles were included after assessment of study methodology and a meta-analysis of 1660 cemented and 805 uncemented stems was performed. We compared the incidence of aseptic stem loosening, humeral RLL, and revision for stem loosening between: 1) cemented and uncemented stems from cohorts with short (< 5 years) mean follow-up periods, long (≥ 5 years) mean follow-up periods, and all cohorts combined; and 2) different etiological subgroups. Results: The overall incidence of aseptic stem loosening was 1%. When comparing cemented to uncemented stems, there was no significant difference in the incidence of aseptic stem loosening or of revision for stem loosening in both the short and long term follow-up groups. Humeral RLL were more common with cemented stems (15.9% versus 9.5%, p = 0.002). The highest incidence of aseptic stem loosening occurred in the tumor subgroup (10.81%), followed by RSA as revision for failed arthroplasty (3.66%). No stem loosening was seen in the acute fracture or fracture sequelae groups. Conclusion: Aseptic stem loosening occurred more commonly in cohorts with long follow-up times (2% vs 0.8%, p = 0.01). There was no difference in the incidence of aseptic stem loosening or revision for stem loosening between cemented and uncemented stems. Humeral RLL occurred more frequently when cemented stems were used. Patients treated with RSA following excision of proximal humerus tumors and RSA as revision for failed arthroplasty were at greater risk of aseptic stem loosening.
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Michael, Held. "Reliability of shoulder symptom recall after one year in a retrospective application of the oxford shoulder score." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/2842.
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Mcguire, Duncan Thomas. "Pyrocarbon proximal interphalangeal joint arthroplasty." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11636.
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Arthritis of the proximal interphalangeal joint of the hand can be debilitating disease resulting in pain and stiffness. Treatment is initially conservative but with diseasse progression surgical treatment often becomes necessary. Arthroplasty is one of the surgical options available.
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Garrett, Benjamin R. "Knee pain, swelling and stiffness after total knee replacement : a survey of South African knee surgeons." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/2841.
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Maree, Michelle Nerine. "An alternative treatment for type B Ulnar Polydactyly." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/2845.
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Includes summary.Includes bibliographical references (leaves 47-50).
Rudimentary ulnar polydactyly is one of the most common congenital hand anomalies. These are conventionally treated by suture ligation in the neonatal period or by formal excision, when the child is one year of age. For the last three years, the Congenital Hand Unit at Red Cross Children’s Hospital has used vascular clip ligation as an alternative method of treatment for rudimentary ulnar polydactyly, based on the same principle as suture ligation, but with less associated complications. A study was performed at the unit, where two hundred and nineteen supernumerary digits were treated over a two-year period. The digits were ligated using a vascular clip, as an outpatient procedure.
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McCollum, Graham. "An investigation into the intramedullary pressure rise during femoral nailing: does the level and type of fracture determine peak pressures during the procedure?" Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/12605.
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Includes bibliographical references.First introduced by Kuntshner, femoral nailing has become the 'Gold Standard' of treatment for femur fractures. The efficacy and benefit of early osteosynthesis by this technique is well established. Some of the acute complications of intramedullary manipulation and nailing are fat embolism syndrome, pulmonary dysfunction and Adult Respiratory Distress Syndrome (ARDS). One of the causes of fat embolism is a raised intramedullary pressure. Investigators have shown the direct correlation of intramedullary pressure with fat intravesation and embolism in both animal and human studies. Fat embolism syndrome is unpredictable and the true incidence is unknown. Mortality from fat embolism syndrome ranges from 10-35%. The incidence is increased with associated pulmonary trauma and in the multiply injured patient. The aim of our study was to investigate the intramedullary pressure rise during reamed prograde femoral nailing and determine whether fracture level and complexity affect the peak pressures. The relevance is that certain fracture types or levels that result in the highest pressures can be identified before the operation. Measures could be taken to reduce the intramedullary pressure during the procedure, particularly in those patients at greatest risk of pulmonary complications from fat embolism. We hypothesised that more proximal, simple fractures generate higher pressures during nailing because there is a long 'closed tube' distal to the fracture. Pressure proximal to the fracture does not reach the same high levels because the intra-medullary content is able to decompress through the fracture as the reamer moves distally. With proximal fractures there is a greater volume of medullary content distal to the fracture which can enter the venous system and embolize. Fracture comminution and complexity should lead to lower intramedullary pressures because there is a greater length of the femur through which the intramedullary content can decompress. The study sought to answer the question of whether fracture level makes a difference with respect to the intramedullary pressure rise during reamed prograde nailing. The results of this study have not been submitted for publication at the time of submission of these results for the thesis.
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White, Clive David. "Late-onset Blount's disease." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11634.
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Includes bibliographical references.In 1937 WP Blount published a review of tibia vara or osteochondrosis deformans of the proximal tibia. Late-onset Blount's disease is varus deformity of the proximal tibia that occurs at or after 6 years old (excluding late presenting infantile Blount's) and has an associated femoral varus.
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Chivers, David Andrew. "Long term follow up of rotator cuff Magnetic resonance imaging changes in patients who underwent acromioplasty without repair of full thickness supraspinatus tendon tears." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16535.
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Includes bibliographical referencesAim: To assess the MRI pathoanatomical changes 10 years after unrepaired full thickness supraspinatus tears in a population of patients that had acromioplasty done for symptomatic impingement with a rotator cuff tear.
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Horn, Anria. "The effect of a change in plastering technique on the rate of Major Surgery in Congenital Talipes Equinovarus(CTEV)." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/21745.
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The Ponseti technique of manipulation and casting is reported to have almost eliminated the need for extensive soft tissue release in the treatment of idiopathic clubfoot. This technique of treatment has however not been universally adopted and results of treatment vary significantly between treatment centres. Furthermore, surgical decision making in the treatment of clubfoot is currently largely based on clinical findings as opposed to radiographic parameters. The Ponseti method of manipulation and casting was introduced at our institution in 2002, prior to which we used the Kite method. Both prior to, and following the introduction of Ponseti casting, surgical decision making was based on pre-operative radiology, and intra-operative clinical assessment. We propose to determine the impact on this change of plastering technique on the rate of major surgery performed primarily in our patients with idiopathic clubfoot. We also aim to determine whether or not pre- operative radiographs have any bearing on the surgery performed on these patients.
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Bezuidenhout, Carel Willem. "The accuracy of clinical examination of rotational and sagittal laxity of the knee." Master's thesis, University of Cape Town, 2020. http://hdl.handle.net/11427/32462.
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Purpose: This study evaluates the accuracy and reliability of clinical examination for knee laxity in degrees and millimetres when compared to movement measured by computer-assisted navigation. Methods: A cadaver lower limb was connected to a computer assisted knee surgery system (CAS) and calibrated through a mini medial parapatellar arthrotomy. Examiners estimated millimetres of sagittal and degrees of rotational laxity of the knee at 30º and 90º of knee flexion. This examination was done in the ligamentous intact knee and again after sequential release of the anterior cruciate ligament (ACL) and anterolateral ligament (ALL). The clinical assessments were compared with measurements produced by CAS. Intraclass correlation coefficient (ICC), correlation coefficient (CC) and Bland Altman plots were used to compare and summarize the data. Results: At least 21 participants assessed the knee after each sequence of ligament sectioning. The reliability of clinical examination when correlated with the CAS measurements was poor for all examination groups. The ICC was poor for sagittal laxity at 30º (R=0.02; p=0.04), rotational laxity at 30º and 90º (R=0.17; p=0.04) (R=0.3; p=0.04) respectively and sagittal laxity at 90º(R=0.47; p=0.04). The correlation coefficients were very weak for sagittal laxity at 30º (R=0.09; p=0.46), weak for rotational laxity at 30º (R=0.24; p=0.06) and 90º (R=0.3; p=0.01) and moderately weak for sagittal laxity at 90º(R=0.4; p=0.001). Clinical examination was only accurate in the detection of sagittal laxity greater than 11.6mm at 30°, and greater than 9.4mm at 90°. Clinical examination for rotational laxity was only accurate for rotational instability greater than 27.7° at 30°flexion, and 28.9° rotation at 90°. Conclusions: There was poor reliability and weak correlation between clinician estimated sagittal and rotational laxity and measurements produced by CAS. This study showed that participants could not accurately estimate laxity in degrees and millimetres and supports the need for accurate objective knee laxity measurements.
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Laubscher, Maritz. "Subtotal capsulectomy for idiopathic chondrolysis of the hip : a clinical, radiological and histological study." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13251.
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Includes bibliographical references.The purpose of this study will be to review the outcome of a subtotal capsulectomy of the hip for idiopathic chondrolysis. Idiopathic chondrolysis of the hip is a very rare condition. It is characterized by cartilage necrosis of the hip joint not associated with trauma, SUFE, infections or other demonstrable causes. It was first described in 1971 by Jones from the Princess Alice Orthopaedic Hospital in Cape Town. It occurs mainly in adolescent girls. The outcome in South Africa has been reported as a progressive downhill course resulting in a painful, stiff hip. The aetiology of the disease remains unknown. Theories suggested are mechanical (decreased movement with loss of synovial nutrition; increased joint pressure) and an auto-immune response in genetically predisposed individuals. The differential diagnosis includes atrophic-type tuberculosis of the hip. Suggested treatment ranges from NSAIDs and range of motion exercises alone to early aggressive surgical treatment. Our experience with continuous passive motion (CPM) and NSAID treatment have been disappointing.
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Wever, Stefan. "The Management of acute lateral ankle sprains: A survey of South African Surgeons and best evidence available." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33083.
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Introduction: Ankle sprains remain the single most frequent injury in modern sports with increasing evidence that it is not as innocuous as previously thought. Conservative treatment options include various forms of immobilization such as casts, moonboots and stirrup braces, followed by a rehabilitation period involving different modalities. Despite clinical evidence there seems to be a divergence between research and practice with an increase in acute surgical repair especially with regards to professional athletes. Design: Descriptive cross-sectional survey analysis Aim of the study: To assess the approach on management of acute ankle sprains by orthopaedic surgeons in South Africa. Methods: A two part study. Firstly, a questionnaire was emailed to participating orthopaedic surgeons, consisting of eight treatment options for a grade 3 lateral ankle sprain in a non-professional athlete. Secondly, a literature review to establish the current best practice concerning ankle sprain management. Results: The total number of respones where 129 out of 719 that were sent out. Surgical repair was offered in 24 (19%). Conservative treatment including either cast or moonboot for a period of 6 weeks was chosen by 49 (38%) and 2 to 4 weeks by 55 (43%) as their preferred treatment. Only 39 (30%) of responding SAOA members chose a short period of immobilization followed by functional rehabilitation in accordance with the current best evidence available, based on the literature review done. Conclusion: Despite good clinical evidence there seem to be a lack of consensus in the management of grade 3 lateral ankle sprains.