bluuebunny/crossref_metadata_2025_split huggingface dataset:
GENETIC TESTING IN THE ORTHOPAEDIC CLINIC
Authors: Moosa Shahida 
Published: November 2023

Medical Genetics is a transversal discipline with the potential to impact on every specialty and subspecialty in medicine and the allied health sciences. The completion of the human genome project resulted in technical advancements in genomics, genomic testing and our understanding of genetic disorders in general. These advancements have greatly enhanced our understanding of the role of genetics in Orthopaedic practice, with respect to both monogenic and complex disorders. Tygerberg Hospital is currently the only state hospital in South Africa to support genetic testing in the form of gene panels as part of routine care. This is complemented by more comprehensive research testing in the form of exome and genome sequencing as part of the Undiagnosed Disease Programme.We audit the genetic and genomic testing done on patients referred from the Orthopaedic clinic over a period of 3 years (2020–2022) and review diagnostic rates and interesting results.The largest group of patients referred (n=50) had a clinical diagnosis of osteogenesis imperfecta (OI). A 100% diagnostic yield was achieved for these patients with the identification of recurring variants (FKBP10, COL1A2). Further families (n=20) with much rarer conditions are presented with important implications on the orthopaedic and medical management, prognosis, and genetic counselling for the families.We highlight the impact of genomic testing in the Orthopaedic clinic. Management changes and precision orthopaedic intervention were only possible due to a genetic diagnosis. We motivate for increased access to testing, especially for younger patients presenting with complex orthopaedic phenotypes.
AETIOLOGY OF CEREBRAL PALSY IN PATIENTS UNDERGOING ORTHOPAEDIC SURGERY FOR MUSCULOSKELETAL DEFORMITIES
Authors: Gamieldien Hammaad , Horn Anria , Mentz A. , Maimin D. , Van Heerden T. , Thomas M. 
Published: November 2023

Cerebral Palsy (CP) is a group of disorders that affect movement and posture caused by injury to the developing brain. While prematurity and low birth weight are common causes in developed countries, birth asphyxia, kernicterus, and infections have been identified as predominant aetiologies in Africa. There is, however, very little information on the aetiology of CP in South Africa. The purpose of this study was to determine the aetiology, severity, and topographical distribution of CP in children undergoing orthopaedic surgery at our tertiary paediatric unit.A retrospective folder review was performed for patients with CP that underwent orthopaedic surgery from July 2018 to June 2022. Data was collected on perinatal circumstances, aetiology or risk factors for developing CP, severity of disability as classified by the Gross Motor Function Classification Scale (GMFCS) and topographical distribution. Descriptive analysis was performed.Two-hundred-and-thirty-four patients were included in the analysis. No specific aetiology could be identified in 51 (21.9%) patients. Hypoxic ischaemic encephalopathy (HIE) accounted for 23.6% of patients and was the most common aetiology across the different categories except for patients graded as GMFCS 2, in whom prematurity was the most common aetiology. Congenital brain malformations (10.5%) and cerebral infections, including HIV encephalopathy (11.4%) were the next most frequent aetiologies, followed by prematurity (7.6%), ischaemic stroke (6.8%) and intraventricular haemorrhage (6.3%). Fifty-two percent of patients were classified as GMFCS 4 or 5. There was a predominance of quadriplegic patients (37%) compared to hemiplegics (29%), diplegics (30%) and monoplegics (4%).Most patients undergoing orthopaedic surgery for musculoskeletal sequelae of CP were severely disabled quadriplegic patients in whom HIE was the predominant cause of CP. This emphasises the need for intervention at a primary care level to decrease the incidence of this frequently preventable condition.
OPERATIVE VERSUS NONOPERATIVE MANAGEMENT OF DISTAL RADIUS FRACTURES IN ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS WITH AN ELDERLY SUBGROUP ANALYSIS
Authors: Bell Katrina , Oliver William , White Timothy , Molyneux Samuel , Clement Nicholas , Duckworth Andrew 
Published: November 2023

This systematic review and meta-analysis aimed to compare the outcome of operative and non-operative management in adults with distal radius fractures, with an additional elderly subgroup analysis. The main outcome was 12-month PRWE score. Secondary outcomes included DASH score, grip strength, complications and radiographic parameters.Randomised controlled trials of patients aged ≥18yrs with a dorsally displaced distal radius fractures were included. Studies compared operative intervention with non-operative management. Operative management included open reduction and internal fixation, Kirschner-wiring or external fixation. Non-operative management was cast/splint immobilisation with/without closed reduction. Version 2 of the Cochrane risk-of-bias tool was used.After screening 1258 studies, 16 trials with 1947 patients (mean age 66yrs, 76% female) were included in the meta-analysis. Eight studies reported PRWE score and there was no clinically significant difference at 12 weeks (MD 0.16, 95% confidence interval [CI] −0.75 to 1.07, p=0.73) or 12 months (mean difference [MD] 3.30, 95% CI −5.66 to −0.94, p=0.006). Four studies reported on scores in the elderly and there was no clinically significant difference at 12 weeks (MD 0.59, 95% CI −0.35 to 1.53, p=0.22) or 12 months (MD 2.60, 95% CI −5.51 to 0.30, p=0.08). There was a no clinically significant difference in DASH score at 12 weeks (MD 10.18, 95% CI −14.98 to −5.38, p<0.0001) or 12 months (MD 3.49, 95% CI −5.69 to −1.29, p=0.002). Two studies featured only elderly patients, with no clinically important difference at 12 weeks (MD 7.07, 95% CI −11.77 to −2.37, p=0.003) or 12 months (MD 3.32, 95% CI −7.03 to 0.38, p=0.08).There was no clinically significant difference in patient-reported outcome according to PRWE or DASH at either timepoint in the adult group as a whole or in the elderly subgroup.
A REVIEW OF CALCANEAL FRACTURES PRESENTING TO A SOUTH AFRICAN TERTIARY INSTITUTION
Authors: Nyalungu Mzwandile , Gqamana Loyiso 
Published: November 2023

To identify the demographics, mechanisms of injury and treatment modalities of patients presenting at CHBAH with calcaneal fractures.A retrospective study of all admitted patients with calcaneal fractures from 01 January 2018 to 31 December 2022. The data collected includes age, gender, side of injury, mechanism of injury, isolated injury versus polytrauma, open and close fractures, different treatment modalities and time to surgery. The descriptive data will be analysed, with results presented as frequency charts, histograms, and percentages.A total of 98 patients showed a male predominance of 90.8% compared to 9.2% of females. The median age was 38 years, the commonest mechanism was from falls from height, accounting for 67.3% with gunshot injuries accounting for 5%. Bilateral fractures were observed in 5 patients, with similar total numbers between those isolated to the left (47) as compared to the injuries isolated to the right side (46). Calcaneus fractures associated with other injuries in polytrauma cases were observed in 17.4%, and open fractures were observed in 7 patients with 5 having occurred post gunshot injury.A total of 48 patient required surgical treatment with the average time to surgery found to be 15 days. The surgical management varied, with open reduction and internal fixation with plate and screws in 68.7%, followed by 16.7% of patients who were treated with open reduction and internal screw fixation.Calcaneal fractures occurred frequently amongst male patients secondary to fall from height. Half of the total patient number admitted had require a surgical intervention to treat the fracture, with open reduction and internal fixation with plate and screws being the frequent mode of fixation in this population group.
ESTABLISHING A CONSENSUS ON RESEARCH PRIORITIES IN ORTHOPAEDIC TRAUMA WITHIN SOUTH AFRICA
Authors: Render Luke , Maqungo Sithombo , Held Michael , Laubscher Maritz , Graham Simon M , Ferreira Nando , Marais Leonard Charles 
Published: November 2023

Musculoskeletal (MSK) injuries are one of the leading causes of disability worldwide. Despite improvements in trauma-related morbidity and mortality in high-income countries over recent years, outcomes following MSK injuries in low and middle-income countries, such as South Africa (SA), have not. Despite governmental recognition that this is required, funding and research into this significant health burden are limited within SA.This study aims to identify research priorities within MSK trauma care using a consensus-based approach amongst MSK health care practitioners within SA.Members from the Orthopaedic Research Collaborative (ORCA), based in SA, collaborated using a two round modified Delphi technique to form a consensus on research priorities within orthopaedic trauma care. Members involved in the process were orthopaedic healthcare practitioners within SA.Participants from the ORCA network, working within SA, scored research priorities across two Delphi rounds from low to high priority. We have published the overall top 10 research priorities for this Delphi process. Questions were focused on two broad groups - clinical effectiveness in trauma care and general trauma public health care. Both groups were represented by the top two priorities, with the highest ranked question regarding the overall impact of trauma in SA and the second regarding the clinical treatment of open fractures.This study has defined research priorities within orthopaedic trauma in South Africa. Our vision is that by establishing consensus on these research priorities, policy and research funding will be directed into these areas. This should ultimately improve musculoskeletal trauma care across South Africa and its significant health and socioeconomic impacts.
THE TREATMENT, MANAGEMENT, DEMOGRAPHICS, AND ECONOMIC COSTS OF ORTHOPAEDIC INJURIES SUSTAINED IN MOTORCYCLE ACCIDENTS IN DELIVERY DRIVERS IN SOUTH AFRICA
Authors: Ward Joshua , Louw Frederick , Klopper Schalk , Schmieschek Maximilian 
Published: November 2023

Motorcycle accident-related traffic accidents contribute significantly to the burden of orthopaedic injuries seen in the South African Healthcare system. Subsequent to the Covid-19 pandemic, there has been an increase in the number of delivery drivers on the roads of South Africa. Many of these delivery drivers have no formal employment contracts. We aim to describe the demographics and injury patterns in motorcyclists involved in time dependent delivery work in South Africa; and to quantify the cost to the state of their orthopaedic surgeries.We performed a consecutive case series study at all of the hospitals draining the study region over the period of one year. Epidemiological, clinical and cost to hospital data was collected from medical records, digital radiographs, theatre invoices and a dedicated patient questionnaire.ProvisionalSo far 41 delivery drivers were captured by the study over a period of 11 months. All drivers were male and the vast majority foreign nationals. 11 patients were polytraumatised and 5 required admission to an intensive care unit. The most common injury patterns were closed femur fractures (17) followed by tibial shaft fractures (13). The average cost of surgery was R35 049 and average cost of ward stay R44 882 at an average of 10 days admission in a general ward. Overall, an estimated total of R 3.1 million rand was spent on these injuries.Informally employed “app users” performing delivery work on motorcycles in South Africa have added a significant burden to the cost of state healthcare since 2020. The vast majority of these patients are foreign nationals who do not hold South African licences or health insurance. They are sustaining high energy injuries typical of motorcycle-car accidents and many of them are left with lifelong loss of function.
NUMBER OF DISTAL RADIAL FRACTURES IN THE ELDERLY WILL INCREASE BY MORE THAN HALF BY 2040: PREDICTION MODELLING USING NATIONAL DATA
Authors: Bell Katrina , Yapp Liam , White Timothy , Molyneux Samuel , Clement Nicholas , Duckworth Andrew 
Published: November 2023

The aim was to predict the number and incidence of distal radius fractures in Scotland over the next two decades according to age group, categorised into under 65yrs(<65) and 65yrs and older (≥65), and estimate the potential increased operative burden of this.The number of distal radius fracture in Scotland was isolated from the Global Burden of Disease database and this was used, in addition to historic population data and population estimates, to create a multivariable model allowing incorporation of age group, sex and time. A Negative Binomial distribution was used to predict incidence in 2030 and 2040 and calculate projected number of fractures according to the population at risk. A 20.4% operative intervention rate was assumed in the ≥65 group (local data).In terms of number of fractures, there was a projected 61% rise in the ≥65 group with an overall increase of 2099 fractures per year from 3417 in 2020 (95% confidence interval (CI) 2960 – 3463) to 5516 in 2040 (95% CI 4155–5675). This was associated with 428 additional operative interventions per year for those ≥65yrs. The projected increase between 2020 and 2040 was similar in both sexes (60% in females, 63% in males), however the absolute increase in fracture number was higher in females (2256 in 2020 [95% CI 1954–2287] to 3620 in 2040 [95% CI 2727–3721]) compared to males (1160 [95% CI 1005–1176] to 1895 [95% CI 1427–1950]). There was a 4% projected fall in the number of fractures in those <65.Incidence of distal radius fractures is expected to considerably increase over the next two decades due to a projected increase in the number of fractures in the elderly. This has implications for the associated morbidity and healthcare resource use.
REASONS FOR TOTAL KNEE ARTHROPLASTY REVISIONS: A RETROSPECTIVE COHORT STUDY
Authors: Arakkal Ashley , Daoub Mohammad , Nortje Marc , Hilton Thomas , Le Roux Johan , Held Michael 
Published: November 2023

The aim of this retrospective cohort study was to investigate the reasons for total knee arthroplasty (TKA) revisions at a tertiary hospital over a four-year period. The study aimed to identify the primary causes of TKA revisions and shed light on the implications for patient care and outcomes.The study included 31 patients who underwent revisions after primary knee arthroplasty between January 2017 and December 2020. A retrospective approach was employed, utilizing medical records and radiological findings to identify the reasons for TKA revisions. The study excluded oncology patients to focus on non-oncologic indications for revision surgeries. Patient demographics, including age and gender, were recorded. Data analysis involved categorizing the reasons for revision based on clinical assessments and radiological evidence.Among the 31 patients included in the study, 9 were males and 22 were females. The age of the patients ranged from 43 to 81, with a median age of 65 and an interquartile range of 18.5. The primary reasons for TKA revisions were identified as aseptic loosening (10 cases) and prosthetic joint infection (PJI) (13 cases). Additional reasons included revision from surgitech hemicap (1 case), patella osteoarthritis (1 case), stiffness (2 cases), patella maltracking (2 cases), periprosthetic fracture (1 case), and patella resurfacing (1 case). The findings of this retrospective cohort study highlight aseptic loosening and PJI as the leading causes of TKA revisions in the examined patient population.These results emphasize the importance of optimizing surgical techniques, implant selection, and infection control measures to reduce the incidence of TKA revisions. Future research efforts should focus on preventive strategies to enhance patient outcomes and mitigate the need for revision surgeries in TKA procedures.
DETERMINING THE SAFETY AND ACCESSIBILITY OF DIRECT POSTERIOR PORTALS INTO THE KNEE WITH RESPECT TO THE NEUROVASCULAR STRUCTURES: A CADAVERIC STUDY
Authors: Greenwood Kelsi , Molepo Maketo , Mogale Nkhensani , Keough Natalie , Hohmann Erik 
Published: November 2023

The posterior compartments of the knee are currently accessed arthroscopically through anterior, posteromedial or posterolateral portals. A direct posterior portal to access the posterior compartments has been overlooked due to a perceived high-risk of injury to the popliteal neurovascular structures. Therefore, this study aimed to investigate the safety and accessibility of a direct posterior portal into the knee.This cross-sectional study comprised a sample of 95 formalin-embalmed cadaveric knees and 9 fresh-frozen knees. Cannulas were inserted into the knees, 16mm from the vertical plane between the medial epicondyle of the femur and medial condyle of the tibia and 8 and 14mm (females and males respectively) from the vertical plane connecting the lateral femoral epicondyle and lateral tibial condyle. Landmarks were identified in full extension and cannula insertion was completed with the formalin-embalmed knees in full extension and the fresh-frozen in 90-degree flexion. Posterior aspects of the knees were dissected from superficial to deep, to assess potential damage caused by cannula insertion. Incidence of neurovascular damage was 9.6% (n=10); 0.96% medial cannula and 8.7% lateral cannula. The medial cannula damaged one small saphenous vein (SSV) in a male specimen. The lateral cannula damaged one SSV, 7 common fibular nerves (CFN) and both CFN and lateral cutaneous sural nerve in one specimen. All incidences of damage occurred in formalin-embalmed knees. The posterior horns of the menisci were accessible in all specimens.A medial-lying direct posterior portal into the knee is safe in 99% of occurrences. The lateral-lying direct posterior portal is of high risk to the CFN.
Efficiency of octenidine dihydrochloride alcohol combination compared to ethanol based skin antiseptics for preoperative skin preparation in dogs
Authors: Eigner Fabian , Keller Stefanie , Schmitt Sarah , Corti Sabrina , Nolff Mirja C. 
Published: November 2023

ObjectiveTo quantify the bacterial burden after skin disinfection using an alcohol octenidine dihydrochloride combination (Octenisept®) compared to an 74.1% ethanol 10% 2-propanol combination (Softasept N®).Study designProspective randomized clinical trial.Material & methods61 dogs undergoing clean or clean-contaminated surgeries (excluding surgeries on the gastrointestinal tract) were randomly assigned to group O (skin disinfection with alcohol and octenidine dihydrochloride after washing with octenidine containing soap) or to control group C (skin disinfection using the ethanol-2-propanol combination after washing with a neutral soap without antiseptic ingredients). Samples were then taken from 8 different locations within the surgical field at four different stages: after clipping, after washing, after disinfection and one hour later. At each stage, two different sampling techniques (wet-dry swab technique (WDS) and contact plates (CP)) were used for quantitative analysis of bacterial counts.ResultsWDS detected about 100-fold more bacteria compared to CP sampling in cases with high bacterial burden, but was not accurate enough to detect small numbers. CP sampling was therefore used for comparison of treatment protocols. 30 dogs were assigned to group O and 31 to group C. A relative reduction of 69% in group O and 77 percent in group C was observed after the soap wash. No significant differences were detected between both groups. Washing and disinfection resulted in a reduction of bacterial counts of 99.99% in group O versus 99.7% in group C (p = 0.018). Bacterial reduction one hour after washing and disinfection was significantly higher in group O (99.9%) than in group C (98.5%, p = 0.001).ConclusionAdditional octenidine dihydrochloride provided a slightly better decontamination effect after disinfection, particularly one hour after, which means it may only be indicated in longer surgeries. WDS is more sensitive but less specific to detect bacteria on the skin than the CP sampling.
The World Has Forgotten Us: Sinjar and the Islamic State’s Genocide of the Yezidis, Thomas Schmidinger (2022)
Authors: Torbett David 
Published: November 2023

Review of: The World has Forgotten US: Sinjar and the Islamic State’s Genocide of the Yezidis, Thomas Schmidinger (2022)
London: Pluto Press, 257 pp.,
ISBN 978-0-74534-605-2, p/bk, £19.99
Risk of anxiety, depression, and ADHD in pediatric patients with inflammatory bowel disease: A population-based cohort study
Authors: Kappel Rebecca Kristine , Bisgaard Tania Hviid , Poulsen Gry , Jess Tine 
Published: November 2023

Abstract

Introduction:
Inflammatory bowel disease (IBD) is associated with depression and anxiety in adults, but data is scarce on risk of psychiatric diseases in children with IBD. We aimed to estimate the risk of anxiety, depression, or attention-deficit/hyperactivity disorder in patients with pediatric-onset IBD.

Methods:
We performed a nationwide, register-based cohort study including all patients with pediatric-onset IBD diagnosed in Denmark in the period 1998-2018, resulting in 3,559 patients matched 1:5 on age, sex, municipality of residence, and time period, resulting in 17,795 reference individuals. We used Cox regression to calculate hazard ratios for each outcome following a diagnosis with IBD.

Results:
Patients with pediatric-onset IBD had an increased risk of depression (hazard ratio [HR] 1.50, 95% confidence interval [CI] 1.26-1.80) and of using antidepressants (HR 1.54, 95% CI 1.39-1.71), and surprisingly a reduced risk of using methylphenidate (HR 0.75, 95% CI 0.58-0.98). Patients with both IBD subtypes (Crohn’s diseases [CD] and ulcerative colitis [UC]) had an increased risk of using antidepressants and developing depression, which was particularly high in patients with CD (HR 1.73, 95% CI 1.35-2.22). Patients with UC had reduced risk of using methylphenidate (HR 0.63, 95% CI 0.43-0.93) and a reduced – though not statistically significant – risk of being diagnosed with ADHD compared with the background population.

Discussion:
Patients with pediatric-onset IBD have a 50% increased risk of developing depression, which is important for health care providers to be aware of and manage. Remarkably, we found a reduced risk of receiving methylphenidate and being diagnosed with ADHD, which merits further investigation.
Participación ciudadana y presupuesto participativo en los gobiernos locales en Chile: el innovador caso de la comuna de Pudahuel
Authors: Cienfuegos Ignacio , Huerta Soledad 
Published: November 2023

La alcaldicia de la comuna de Pudahuel, se propuso implementar un nuevo modelo de gestión presupuestaria, deliberativa y vinculante, sumando a la comunidad como actor en la priorización de la inversión y el gasto del presupuesto municipal 2023. De esta manera, se desarrolló una estrategia de participación virtual, abierta a la comunidad en su conjunto y, una estrategia dedicada a grupos de especial protección. Con más de 1.200 participantes y sobre 150 iniciativas de proyectos, el presente artículo, analiza esta experiencia piloto, contrastándola luego con la literatura especializada discutida en esta misma investigación, explorando a su vez, posibles factores que explicarían las limitaciones de dicho proceso y sus resultados. El caso estudiado, se presenta como una experiencia innovadora de presupuesto participativo para el contexto Chileno, en cuanto a que no se observarían en los casos reportados con anterioridad para ese país, criterios de inversión de prioridades, lo que cambiaría la escala de la decisión; desde una votación directa sobre una acotada porción de los recursos financieros de una entidad pública (eligiendo ejecutar determinados proyectos), a la priorización de los grandes lineamientos de inversión y gasto del total del presupuesto estimado anual.