bluuebunny/crossref_metadata_2025_split huggingface dataset:
CLINICAL AND RADIOLOGICAL OUTCOME OF LENKE V ADOLESCENT IDIOPATHIC SCOLIOSIS VIA THE ANTERIOR APPROACH
Authors: Arnolds Delroy , Marie-Hardy Laura , Dunn Robert 
Published: November 2023

Adolescent idiopathic scoliosis is a three-dimensional deformity of the spine, affecting 1–3% of the population.Most cases are treated conservatively. Curves exceeding 45° in the thoracic spine and 40° in the lumbar spine may require correction and fusion surgery, to limit the progression of the curve and prevent restrictive pulmonary insufficiency (curves above 70°). When fusion is required, it may be performed either by posterior or anterior approaches. Posterior is useful for thoracic (Lenke I) curves, notably to correct the thoracic hypokyphosis frequently observed in AIS. Anterior approaches by thoraco-lombotomies allow an effective correction of thoraco-lumbar and lumbar curves (Lenke V and VI), with fewer levels fused than with posterior approaches. However, the approach requires diaphragm splitting and one may be concerned about the long-term pulmonary consequences. The literature provides conflicting insight regarding the consequences of the approach in anterior scoliosis correction, the interpretation of the results being difficult knowing that the correction of the scoliosis itself may improve pulmonary function.This is a retrospective observational study done at a Tertiary Institution. The HRQOL scores have been collected as a prospective cohort. Clinical and radiographic data was collected from patients charts and analysed by two senior surgeonsA cohort of 64 patients were operated in the given time period. 50 patients met the inclusion criteria. No major complications were reported. The Union rate was 100% and no post operative complications were noted. Pre and post SRS scores improved in all patients.The Anterior approach for Lenke V AIS gives great surgical exposure and allows for excellent correction of Cobb angle with minimal risk to the patient.
AN INTERPOPULATION COMPARISON AND CORRELATION OF 3D MORPHOMETRIC MEASUREMENTS OF THE SCAPULA
Authors: Rachuene Pududu Archie , Dey Roopam , Motchon Yawovi Dodzi , Sivarasu Sudesh , Stephen Roche 
Published: November 2023

In patients with shoulder arthritis, the ability to accurately determine glenoid morphological alterations affects the outcomes of shoulder arthroplasty surgery significantly. This study was conducted to determine whether there is a correlation between scapular and glenoid morphometric components. Existence of such a correlation may help surgeons accurately estimate glenoid bone loss during pre-operative planning.The dimensions and geometric relationships of the scapula, scapula apophysis and glenoid were assessed using CT scan images of 37 South African and 40 Chinese cadavers. Various anatomical landmarks were marked on the 77 scapulae and a custom script was developed to perform the measurements. Intra-cohort correlation and inter-cohort differences were statistically analysed using IBM SPSS v28. The condition for statistical significance was p<0.05.The glenoid width and height were found to be significantly (p<0.05) correlated with superior glenoid to acromion tip distance, scapula height, acromion tip to acromion angle distance, acromion width, scapula width, and coracoid width, in both the cohorts. While anterior glenoid to coracoid tip distance was found to be significantly correlated to glenoid height and width in the South African cohort, it was only significantly correlated to glenoid height in the Chinese cohort. Significant (p<0.05) inter-cohort differences were observed for coracoid height, coracoid width, glenoid width, scapula width, superior glenoid to acromion tip distance, and anterior glenoid to coracoid tip distance.This study found correlations between the scapula apophyseal and glenoid measurements in the population groups studied. These morphometric correlations can be used to estimate the quantity of bone loss in shoulder arthroplasty patients.
THE OFFICIAL TRANSLATION OF THE DASH SCORING SYSTEM TO ISIZULU FOR USE IN SOUTH AFRICA
Authors: Rankin Mario , Majola Samkelwe 
Published: November 2023

The Disability of Arm Shoulder and Hand (DASH) score questionnaire is a common self-administered tool to assess symptom severity and function in patients with injuries or pathology of the upper limb. However, having such a pertinent tool only in English is limiting in multi-cultural and multilingual populations where English is not always the first language, such as our South African context. IsiZulu is the most widely spoken language in South Africa (approximately 25% of the population). There are certain instances in research, particularly in international studies, where non-English speaking individuals need to be excluded based on translator reliability. This puts our institutions at a disadvantage by not being able to contribute to research.As per the international Institute of Work and Health (IWH), we followed the 5 stage guidelines to achieve the most appropriate linguistic and cultural adapted translation for our setting. (1) Two independent translations from English to isiZulu. (2) A synthesis of the 2 initial translations. (3) Two independent back-translations from the synthesized isiZulu version into English. (4) Expert panel (consisting of university lecturers and official translators) to review all versions and re-create an optimized synthesized version. (5) Pre-testing of the final optimized synthesized version in a pilot study. This rigorous process allowed for a concise and more culturally relevant translation for use in our population. The fourth stage in the process was integral in synthesizing the tool while considering the colloquial and semantic differences and resolving them with appropriate equivalents.The IWH guidelines aids in the cross-cultural adaptation of the DASH score while remaining valid and comparable to the original English version. This is beneficial in multi-national research projects and allows for the standardization of health outcome measures.
TRANSCORACOID DRILLING FOR CORACOCLAVICULAR LIGAMENT RECONSTRUCTIONS IN PATIENTS WITH ACROMIOCLAVICULAR JOINT DISLOCATIONS RESULT IN ECCENTRIC TUNNELS
Authors: Molepo Maketo , Hohmann Erik , Oduoye Sinmiloluwa , Myburgh Jolandie , van Zyl Reinette , Keough Natalie 
Published: November 2023

This study aimed to describe the morphology of the coracoid process and determine the frequency of commonly observed patterns. The second purpose was to determine the location of inferior tunnel exit with superior based tunnel drilling and the superior tunnel exit with inferior based tunnel drilling.A sample of 100 dry scapulae for the morphology aspect and 52 cadaveric embalmed shoulders for tunnel drilling were used. The coracoid process was described qualitatively and categorized into 6 different shapes. A transcoracoid tunnel was drilled at the centre of the base. Twenty-six shoulders were used for the superior-inferior tunnel drilling approach and 26 for the inferior-superior tunnel drilling approach. The distances to the margins of the coracoid process, from both the entry and exit points of the tunnel, were measured.Eight coracoid processes were of convex shape, 31 of hooked shape, 18 of irregular shape, 18 of narrow shape, 25 of straight shape, and 13 of wide shape. The mean difference for the distances between superior entry and inferior exit from the apex was Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation 3.65+3.51mm (p=0.002); 1.57+2.27mm for the lateral border (p=0.40) and 5.53+3.45mm for the medial border (p=0.001). The mean difference for the distances between inferior entry and superior exit from the apex was 16.95+3.11mm (p=0.0001); 6.51+3.2mm for the lateral border (p=0.40) and 1.03+2.32 mm for the medial border (p=0.045).The most common coracoid process shape observed was a hooked pattern. Both superior to inferior and inferior to superior tunnel drilling directed the tunnel from a more anterior and medial entry to a posterior-lateral exit. Superior to inferior drilling resulted in a more posteriorly angled tunnel. With inferior to superior tunnel drilling cortical breaks were observed at the inferior and medial margin of the tunnel.
EPIDEMIOLOGICAL DATA REVIEW OF PRIMARY REVERSE TOTAL SHOULDER ARTHROPLASTY AT A SINGLE TERTIARY ACADEMIC HOSPITAL IN SOUTH AFRICA: A FOUR-YEAR RETROSPECTIVE REVIEW
Authors: Swartbooi Sarah 
Published: November 2023

Reverse Total shoulder arthroplasty (RTSA) was initially introduced to treat rotator cuff arthropathy. With proven successful long-term outcomes, it has gained a noteworthy surge in popularity with its indications consequently being extended to treating various traumatic glenohumeral diseases.Several countries holding national registries remain a guide to the use the prosthesis, however a notable lack of epidemiological data still exists. More so in South Africa where the spectrum of joint disease related to communicable diseases such as HIV and tuberculosis may influence indications and patient demographics. By analysing the epidemiology of patients who underwent RTSA at our institution, we aimed to outline the local disease spectrum, the patients afflicted and indications for surgery.A retrospective review of all patients operated within the sports unit between 1 January 2019 and 31 December 2022 was conducted. An analysis of the epidemiological data pertaining to patient demographics, diagnosis, indications for surgery and complications were recorded.Included in the review were 58 patients who underwent primary RTSA over the 4-year period. There were 41 females and 17 male patients, age <55 years (n= 14) >55 years (n=44). The indications included 23 rotator cuff arthropathy (40%), 12 primary glenohumeral osteoarthritis (OA) (20%), 10 avascular necrosis (AVN) humeral head (17%), 7 inflammatory OA (12%), 4 chronic shoulder dislocation (7%) and 2 sequalae of proximal humerus fractures (4%).The study revealed RTSA being performed in patients older than 55 years of age, the main pathologies included rotator cuff arthropathy and primary OA, however AVN and shoulder dislocations secondary to trauma contributed significantly to the total tally of surgeries undertaken. This highlights the disease burden of developing countries contributing to patients presenting for RTSA
EXTENDED GRAM-NEGATIVE COVER ANTIBIOTIC PROPHYLAXIS IN ORTHOPAEDIC TRAUMA SURGERY: IS IT TIME TO RECONSIDER CURRENT PRACTICE?
Authors: Tsang Jerry , Ferreira Nando , van Rensburg Adrian Jansen , Venter Rudolph , Epstein Gadi 
Published: November 2023

Gram-negative organisms are increasingly seen as causative pathogens in orthopaedic fracture surgery, which might necessitate a change in antibiotic prophylaxis protocols.A single-centre retrospective review of antibiogram results from all patients treated for fracture-related infection (FRI) was conducted. Subgroup analysis was undertaken to identify any host, injury or treatment variables predisposed to Gram-negative infection.The bacteriological results of 267 patients who underwent surgical treatment for FRI were analysed. Pathogens were isolated in 216 cases (81%), of which 118 (55%) were Gram-negative infections. Fractures involving the tibia and femur (p=0.007), the presence of soft tissue defect (p=0.003) and bone defects (p=0.001) were associated with an increased risk of developing a Gram- negative FRI.Gram-negative fracture-related infections were associated with injuries experiencing bone loss and those requiring soft tissue reconstruction. It is, therefore, prudent to consider extended Gram-negative directed antimicrobial prophylaxis in these cases to prevent the development of fracture-related infection
MICROBIOLOGICAL EPIDEMIOLOGY AT CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL: POLYMICROBIAL OSTEOMYELITIS ANALYSIS
Authors: Hlapolosa Tiego , Kgagudi Paul , Jingo Maxwell 
Published: November 2023

Most patients treated at our clinical setting present during chronic osteomyelitis stage, which is anecdotally likely to be poly-microbial. Adults with poly-microbial infection have a predilection for gram-negative bacteria and anaerobes, a scenario that hypothetically leads to a higher morbidity of poly-microbial osteomyelitis following trauma. Our study looks into the epidemiology of poly-microbial osteomyelitis treated at our Tumour and Infection unit.Retrospective study of patients treated for osteomyelitis from 2016 to 2020. Records of eligible patients were retrieved for examination. Demographics such as age, sex and race were recorded. Clinical presentation, organisms cultured, including their anti-microbial sensitivities were documented.There were 63 participants in the study. 31 (49.21%) had mono-microbial osteomyelitis with 32 (50.79%) having poly-microbial osteomyelitis. Majority of the poly-microbial patients presented with a sinus (68.75%) mostly located in the tibia (50%).Multiple mixed pathogens (both gam-positive and gram-negative) were cultured in our patients and this comprised 71.21% of the total bacteria cultured. Staphylococcus Aureus was the commonest bacteria (30%) isolated, followed by Enterococcus faecalis (12%). The commonest gram-negative bacteriae cultured was Enterococcus cloacae (10%) followed by Acinetobacter baumannii (7%). Most enterobacteriacae species were sensitive to Ertapenem and Ceftazidime.A slightly higher incidence of poly-microbial osteomyelitis was found in our study than that reported in literature. Furthermore, our study demonstrated a wide variety of organisms found in poly-microbial osteomyelitis, with a large contribution made by gram-negative anaerobic rod-shaped bacteria
SHORT-TERM CELECOXIB PROMOTES BONE FORMATION WITHOUT COMPROMISING ANTIBIOTIC EFFICACY IN EARLY ORTHOPAEDIC DEVICE-RELATED INFECTION: EVIDENCE FROM A RAT MODEL
Authors: Mdingi Vuyisa , Marais Leonard , Gens Lena , Mys Karen , Zeiter Stephan , Richards Geoff , Moriarty Fintan , Chittò Marco 
Published: November 2023

We investigated the effects of non-steroidal anti-inflammatory drugs (NSAIDs) with different cyclooxygenase (COX) selectivity on orthopaedic device-related infections (ODRIs) in a rat model. We aimed to measure the impact of NSAID therapy on bone changes, bacterial load, and cytokine levels after treatment with antibiotics. We also compared the effects of long vs short-term celecoxib (a COX-2 inhibitor) treatment on the same outcomes.Skeletally mature female Wistar rats were implanted with Staphylococcus epidermidis- contaminated polyetheretherketone (PEEK) screws in the proximal right tibia and monitored for 7 days. All animals received subcutaneous antibiotics (rifampicin plus cefazolin) for two weeks from day 7 to 21. In phase I of the study, rats were randomly assigned to receive 28 days of oral treatment with acetylsalicylic acid, ibuprofen, celecoxib, or vehicle control. In phase II, an additional group received seven days of celecoxib treatment from day 0 to 7. Bone changes were monitored using in vivo micro-CT and histology. Quantitative bacteriology was performed at euthanasia. Plasma samples were collected to measure cytokine levels on days 0, 6, 20, and 28.Combination antibiotic therapy resulted in treatment success in 85.71% of cases, while the addition of long-term celecoxib treatment reduced it to 45.45%. Long-term celecoxib treatment significantly reduced bone loss (33.85% mean difference [95% CI 14.12–53.58], p=0.0004 on day 6 bone fraction) and periosteal reaction (0.2760 μm mean difference [95% CI 0.2073–0.3448], p<0.0001 on day 14 periosteal thickness) during early infection compared to the control group. Short- term celecoxib treatment showed similar radiological results without a reduction in treatment success (88.9%). No differences in the inflammatory markers were observed.Our findings highlight the potential benefits of short-term use of celecoxib in improving bone fraction during the early post-infection period without impairing the efficacy of antibiotic therapy
IMPROVING THE DIAGNOSIS OF SPINAL TUBERCULOSIS AND OUR UNDERSTANDING OF ITS PATHOPHYSIOLOGY AND INTERACTION WITH HIV-1 CO-INFECTION
Authors: Waters Robyn , Held Michael , Dunn Robert , Laubscher Maritz , Adikary Nawaal , Coussens Anna 
Published: November 2023

Specific and rapid detection methods for spinal tuberculosis, with sufficient sensitivity in HIV-1 co-infected individuals, are needed, to ensure early initiation of appropriate treatment to prevent physical disability and neurological fallout. In addition, understanding the systemic and local pathophysiology of spinal tuberculosis, and its interaction with HIV-1 infection, is crucial to guide future therapeutic interventions.We prospectively enrolled adult patients presenting with signs and symptoms of suspected spinal tuberculosis, at Groote Schuur Hospital, between November 2020 and December 2021. TB diagnostic testing was performed on open and CT-guided spinal biopsies using Xpert MTB/RIF Ultra compared to gold standards TB culture and histology. A highly sensitive droplet digital PCR assay for detecting and quantifying Mycobacterium tuberculosis complex (MTBC) and HIV-1 DNA was tested. Plasma inflammatory proteins were measured to assess systemic inflammation.Xpert Ultra had a high sensitivity of 94.7% and specificity of 100% for STB against TB culture and histology in both open and CT-guided biopsy samples. The ddPCR assay confirmed TB detection in 94% of patients with positive Xpert Ultra results. Four patients with negative TB diagnostic results had MTBC DNA detected by ddPCR. HIV-1 DNA was detected in the spinal tissues from all HIV-1-infected patients. MTBC DNA levels were significantly higher in HIV-1-co-infected spinal tissue samples (p< 0.01). We identified four biomarkers significantly associated with higher bacterial burden at the disease site (p< 0.01).Xpert Ultra and MTBC ddPCR improve the detection of STB. DdPCR can be utilized as an additional, highly sensitive tool for detecting and quantifying Mtb, in pathological samples that may be paucibacillary. These findings provide novel diagnostic and pathophysiologic insight into STB, in the context of HIV-1 infection, and provide rationale to include these tests in hospital and research settings for patients from communities burdened by TB and HIV-1.
IS MALNUTRITION CONTRIBUTING TO THE SEVERITY OF SUPRACONDYLAR FRACTURES IN CHILDREN? A RETROSPECTIVE REVIEW
Authors: Ragunandan Shiksha , Goller Ruan 
Published: November 2023

The aims of this study was to determine the incidence of malnutrition in children with supracondylar fractures. It was hypothesised that the presence of malnutrition will increase the severity type of fractures.The study was a retrospective, cross-sectional study at a single institution. Children between 0 years and 12 years of age, who sustained documented supracondylar fracture treated surgically as a result of low velocity trauma were included in the study. Patients who sustained high velocity trauma, who had known bone disorders or had incomplete chart data, were excluded from the study Data was captured from children's’ notes who have been treated surgically for supracondylar fractures from casualty, theatre and the clinic notes. The nutritional status of children and fracture grade were identified and the two sets of data were compared against each other to try to identify a possible relation between fracture severity and malnutrition. Data was analysed in STATA and 5% level of significance was used to signify statistically significant associations.150 patients were identified and included in the study. The majority of patients reviewed were in the normal nutritional range according to their z-scores. The severity of the fracture was not only associated with a poorer nutritional status however children with high and low z-scores (over weight as well as undernourished children) had the more severe fracture patterns, while children with normal z-scores had a fracture patterns of varying severity.Children who were malnourished were more likely to sustain more severe fracture types. The results highlighted the need for all children to have a good nutritional status as this may play a role in preventing more complex fractures.
DELAYED DISCHARGE OF PATIENTS WITH SUSPECTED NON-ACCIDENTAL INJURY
Authors: Simmons Dina , Robertson Anthony , Milner Brenda 
Published: November 2023

Child abuse is an essential discussion within society and poses many challenges. The international literature describes patient and family based risk factors and suspicious injuries. We have created a protocol for the identification and investigation of children with suspected non-accidental injuries. The paediatric orthopaedic ward experiences many children being delayed in the ward once fit for discharge. This study aimed to quanitify those delayed discharges and describe the demographics and risk factors for abuse within the local population.After obtaining ethics clearance, we conducted a retrospective review of records from the Teddy Bear Clinic, as well as admission records. The study examined demographic characteristics, family, injury characteristics and referral to Child Welfare. The delay of discharge from hospital was quantified and was compared to those characteristics.Records were collected from 1 January 2015 to 31 December 2021. Seventy-nine complete records were included. There were 40 males and 39 females with an average age of 20 months. 75.9% were under 36 months old. 94.1% of the cases sustained lower limb fractures. Fifty-two cases had a delayed discharge. The delay ranged from 1 to 233 days. There was an association between an age less than 36 months and delayed discharge. There were no significant correlations between caregiver characteristics and delayed discharge. The later the completion of investigations, the more likely there would be a delay. There was also a significant correlation between referral to Child Welfare and delayed discharge.Children under 36 months on this remain at highest risk for non-accidental injury. Delayed discharge was associated with age less than 36 months, upper limb fractures and referral to Child Welfare.Despite the delayed discharge, most children returned to the same home environments
THE FASSIER TECHNIQUE FOR CORRECTION OF PROXIMAL FEMORAL DEFORMITY IN CHILDREN WITH OSTEOGENESIS IMPERFECTA
Authors: Mwelase Sandile , Maré Pieter , Marais Leonard , Thompson David 
Published: November 2023

Children with osteogenesis imperfecta (OI) frequently present with coxa vara (CV). Skeletal fragility, severe deformity and limited fixation options make this a challenging condition to correct surgically. Our study aimed to determine the efficacy of the Fassier technique to correct CV and determine the complication rate.Retrospective, descriptive case series from a tertiary hospital. We retrospectively reviewed records of a cohort of eight children (four females, 12 hips) with OI (6/8 Sillence type III, 2/8 type IV) who had surgical treatment with Fassier technique for CV between 2014 and 2020.Inclusion Criteria: All patients with CV secondary to OI treated surgically with Fassier technique.Exclusion Criteria: Patients older than 18 years; Patients with CV treated non-operatively or by surgical technique different to Fassier technique.Data relating to the following parameters was collected and analyzed: demographic data, pre- and postoperative neck shaft angle (NSA), complications and NSA at final follow-up.The mean age at operation was 5.8 years (range 2–10). The mean NSA was corrected from 96.8° preoperatively to 137º postoperatively. At a mean follow-up of 38.6 months, the mean NSA was maintained at 133°, and 83% (10/12) of hips had an NSA that remained greater than 120°. There was a 42% (5/12) complication rate: three Fassier–Duval rods failed to expand after distal epiphyseal fixation was lost during growth; one Rush rod migrated through the lateral proximal femur cortex with recurrent coxa vara; and one Rush rod migrated proximally and required rod revision.The Fassier technique effectively corrected CV in children with moderate and progressively deforming OI. The deformity correction was maintained in the short term. The complication rate was high, but mainly related to the failed expansion of the Fassier–Duval rods.