Browsing by Author "Held, Michael"
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- ItemOpen AccessAnterior-posterior view by full-body digital X-ray to rule out severe spinal injuries in Polytraumatized patients(2021-03-05) Häckel, Sonja; Hofmann, Elena; Anwander, Helen; Albers, Christoph E; Basedow, Jasmin; Bigdon, Sebastian F.; Exadaktylos, Aristomenis K; Keel, Marius J B; Dunn, Robert N; Maqungo, Sithombo; Benneker, Lorin M; Held, Michael; Hoppe, SvenBackground Spinal injuries are present in 16–31% of polytraumatized patients. Rapid identification of spinal injuries requiring immobilization or operative treatment is essential. The Lodox-Statscan (LS) has evolved into a promising time-saving diagnostic tool to diagnose life-threatening injuries with an anterior-posterior (AP)-full-body digital X-ray. Methods We aimed to analyze the diagnostic accuracy and the interrater reliability of AP-LS to detect spinal injuries in polytraumatized patients. Therefore, within 3 years, AP-LS of polytraumatized patients (ISS ≥ 16) were retrospectively analyzed by three independent observers. The sensitivity and specificity of correct diagnosis with AP-LS compared to CT scan were calculated. The diagnostic accuracy was evaluated by using the area under the ROC (receiver operating characteristic curve) for sensitivity and specificity. Interrater reliability between the three observers was calculated using Fleiss’ Kappa. The sensitivity of AP-LS was further analyzed by the severity of spinal injuries. Results The study group included 320 patients (48.5 years ±19.5, 89 women). On CT scan, 207 patients presented with a spinal injury (65%, total of 332 injuries). AP-LS had a low sensitivity of 9% (31 of 332, range 0–24%) and high specificity of 99% (range 98–100%). The sensitivity was highest for thoracic spinal injuries (14%). The interrater reliability was slight (κ = 0.02; 95% CI: 0.00, 0.03). Potentially unstable spinal injuries were more likely to be detected than stable injuries (sensitivity 18 and 6%, respectively). Conclusion This study demonstrated high specificity with low sensitivity of AP-LS in detecting spinal injuries compared to CT scan. In polytraumatized patients, AP-LS, implemented in the Advanced Trauma Life Support-algorithm, is a helpful tool to diagnose life-threatening injuries. However, if spinal injuries are suspected, performing a full-body CT scan is necessary for correct diagnosis.
- ItemOpen AccessAwareness and Knowledge of the Female Athlete Triad and Relative Energy Deficiency in Sport (REDs) among Multi-Specialty Healthcare Professionals(2024) Visagie, Rowena; Laubscher, Maritz; Keay, Nicky; D'alton, Caroline; Held, MichaelBackground The female athlete triad (Triad) and Relative Energy Deficiency in Sport (REDs) are serious conditions with harmful health and athletic performance consequences. International research suggests that awareness and understanding of these terms and their associated repercussions among healthcare professionals is lacking. The awareness and knowledge of the Triad and REDs among healthcare providers in South Africa is unknown. Objective The aim of this study is to investigate the knowledge and awareness of the Triad and REDs, and the comfort of multi-specialty healthcare professionals in diagnosing, treating, and referring individuals with these and related conditions. Methodology An online expert-reviewed questionnaire was designed and distributed to healthcare professionals to assess awareness and knowledge. Results Of the 162 survey participants, 51% were aware of the Triad and 40% were familiar with the term REDs. Of those aware of the Triad, 46% were able to identify all 3 components. Among those familiar with REDs, 69% were able to recognise that low energy availability (LEA) is the main underlying cause, 80% had good knowledge of potential REDs consequences, and 60% were able to correctly identify potential symptoms of REDs. Investigatory practices regarding certain health manifestations including low bone mineral density and menstrual dysfunction were found to be lacking. Overall, 6%, 8% and 44% reported feeling very comfortable diagnosing, treating, and referring those with REDs respectively. Only 14% felt very comfortable diagnosing disordered eating and eating disorders. Conclusion Overall, healthcare professionals have generally poor awareness of the Triad and REDs, as well as low rates of comfort in diagnosing, treating, and referring those with REDs. Education strategies to address the gaps in awareness and knowledge among multi-specialty healthcare providers is warranted.
- ItemOpen AccessConversion of the Knee Osteoarthritis Outcome Score – Physical Shortform into a Video Format(2018) de Roos, Jordy Anterio; Held, Michael; Kruger, NeilIntroduction Patient Reported Outcome Measures (PROMs) are an integral part of evidence-based medicine and provide the necessary information for clinicians to make decisions in patient management. The Knee Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS) was developed to assess patients’ perception of their knee’s function. Yet, there are cultural and language barriers, when implementing PROMs in a setting for which it was not originally designed, particularly in low-middle income countries with low levels of education. To address these challenges, the study introduces a video version of the KOOS-PS with the aim to validate it in a local setting. Methods This is a validation study of a video version of the KOOS-PS against various other knee scores. The KOOS-PS was converted into videos and a Likert scale in form of icons was used as grading system. The videos were reviewed by a panel for acceptance and comprehensibility. Second, the video score was tested in a prospective study against other internationally accepted and validated knee PROMs. Patients were recruited from both the public and private sectors of healthcare. Descriptive statistics, Pearson’s correlation coefficient and Cronbach’s Alpha were used for psychometric testing. Results The mean time taken to complete the video score was 79 seconds. Internal consistency received an excellent Cronbach’s Alpha of 0.89. Reproducibility received a Pearson Correlation Coefficient of r=0.91 which illustrates there was no significant difference. Pearson Correlation coefficients between the converted video score and other validated scores indicated high correlation. Conclusion This is the first validation study that converts a written PROM into a video format. The results show that the video score is reliable, acceptable, and valid, and can therefore be used in clinical practice.
- ItemOpen AccessEvaluating basic knee arthroscopy skills in orthopaedic trainees in a limited resourse setting(2023) Berry, Kirsty; Held, MichaelBackground: Orthopaedic training in Southern Africa is largely focused on trauma, although elective procedures, such as knee arthroscopy are increasing. This is especially true in the private sector where most trainees will practice. The primary aim of this study was to assess the arthroscopic competency of orthopaedic trainees in a setting of limited resources. Methods: A prospective observational cohort study was carried out. Orthopaedic trainees of a Southern African university hospital performed basic arthroscopy on a knee model. Their surgical competency was assessed by two surgeons proficient in arthroscopy using the modified Basic Knee Arthroscopy Skill Scoring System (mBAKSSS). Results: A total of 16 trainees (12 male) were included (6 junior and 10 senior trainees). The median age of participants was 36 (34.8, 37). The median mBAKSSS was 28.0 (20.3, 32.5) but showed a large variability (12.0-42.5). The overall reliability was excellent with Cronbach's Alpha of 0.91 and interclass correlation of 0.91 [95% CI 0.75, 0.97]. Conclusions: The average knee arthroscopy proficiency of our trainees is comparable to those of international training programs, but there was great variability with inconsistent skills amongst the trainees. This calls for improved and reproducible arthroscopy training and skills transfer, exposure to procedures and ongoing assessment. Level of Evidence: II (Prospective observational cohort study)
- ItemOpen AccessEvaluation of diagnostic advances in Musculoskeletal Tuberculosis; the automated xpert MTB/RIF assay(2019) Held, Michael; Dunn, R; Zar, HeatherBackground Xpert MTB/RIF (Xpert) is a rapid, automated, onsite nucleic acid amplification test for tuberculosis (TB). It is effective for the diagnosis of pulmonary TB but there is limited evidence for its usefulness in extrapulmonary TB, particularly musculoskeletal TB. Aims and hypothesis 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. Methods Prospective studies of patients with suspected musculoskeletal TB, at the tertiary care hospitals Groote Schuur and Red Cross Children’s Hospital in Cape Town, South Africa, were undertaken from June 2013 to March 2015. The diagnostic accuracy of Xpert was compared to culture or histopathology. Findings 206 biopsies of 201 patients older than 13 years of age (23% HIV positive) were analysed. The sensitivity and specificity of Xpert was 92.3% and 99.1% respectively. Xpert detected 8 cases more than culture (p = 0.069) and positive results were available 17 days earlier (<0.001). The sensitivity of Xpert in HIV positive patients was 96.9% (31/32) versus 89.6% (43/48) in HIV negative patients (p=0.225). The sensitivity of Xpert for spinal biopsies was 93.8% (95% CI 86.0-97.9) with specificity of 97.6% (95% CI 87.4 – 99.9), compared to extraspinal biopsies with a sensitivity of 81.8% (95% CI 48.2 – 99.7, p=0.164) and specificity of 100% (95% CI 95.1 – 100%, p=0.186). 109 osteoarticular samples of children 12 years of age or younger, with a median age of 5.6 years (IQR 2.2 – 8.7) were analysed. Xpert provided a sensitivity of 73.9% (95% CI 51.6-89.8) with a specificity of 100% (95% CI 95.7 - 100) and was available at a mean of 0.8 days (0.46- 1.4) compared to 21 days (19 – 30) for culture (p< 0.001). All rifampicin resistant cases were correctly diagnosed. A trend towards higher sensitivity in spinal tissue as well as HIV infected patients was observed. This study also provides evidence that Xpert has a lower sensitivity in children than in adults, yet, still detects more cases of paediatric musculoskeletal TB and is faster than culture. Histology was a useful test for the diagnosis of musculoskeletal TB, especially in children, and should be used alongside Xpert to provide the highest yield possible to detect TB. Conclusion: These first large studies on the accuracy of Xpert for musculoskeletal TB provide evidence for the usefulness of Xpert in the diagnosis of spinal TB, extraspinal TB, in HIV positive patients, and in childhood musculoskeletal TB. Based on these results, Xpert should be recommended as the initial test for diagnosis as it is more sensitive and faster than the gold standard of liquid culture.
- ItemOpen AccessEvaluation of diagnostic advances in musculoskeletal tuberculosis; the automated xpert MTB/RIF assay(2016) Held, Michael; Zar, Heather; Dunn, RobertThe 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.
- ItemOpen AccessMinimally invasive CT-guiding excision of benign bone tumours(2018) Sluis-Cremer, Timothy Richard; HIlton, Thomas; Held, MichaelBackground: 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.
- ItemOpen AccessThe accuracy of clinical examination of rotational and sagittal laxity of the knee(University of Cape Town, 2020) Bezuidenhout, Carel Willem; Held, MichaelPurpose: 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.
- ItemOpen AccessThe Fc Orth(SA) final examination. How effective is the written component?(2019) Swanepoel, Stefan; Held, MichaelBackground: To determine the pass rate of the final exit examination of the College of Orthopaedic Surgeons of South Africa [FC Orth(SA)] and to assess the correlation between the written component with the clinical and oral component. Methods: Results of candidates who participated in the FC Orth(SA) final examination during a 12-year period from March 2005 through to November 2016 were assessed retrospectively. Pass rates and component averages were analysed using descriptive and inferential statistics. Spearman's rho test was used to determine the correlation between the components. Results: A total of 399 candidates made 541 attempts at the written component of the examination; 71.5% of attempts were successful and 387 candidates were invited to the clinical and oral component, of which 341 (88%) candidates were certified. The second-attempt pass rate for those candidates who wrote the written component again was 42%. The average annual increase in the number of certified candidates was 8.5%. The overall certifying rate increased by 1.5% for this period. Invited candidates who scored less than 54% for the written component were at significant risk of failing the clinical and oral component. The written component showed weak correlation with the clinical and oral component (r=O.48). Conclusion: While the written component was found to be an effective gatekeeper, as evidenced by a high eventual certifying rate, the results of this component of the FCOrth(SA) final examination did not correlate strongly with the performance in the clinical and oral component. This finding confirms the value of the written component as part of a comprehensive assessment for the quality of orthopaedic surgeons.
- ItemOpen AccessThe management of acute knee dislocations: a global survey of orthopaedic surgeons' strategies(2022) Venter, Santa-Marie; Held, MichaelPurpose: The aim of this study was to compare the management approach of acute knee dislocations (AKDs) by orthopaedic surgeons from nations with different economic status. Methods: A survey sent to members of the Societe Internationale de Chirurgie Orthopedique et de Traumatologie (SICOT) compared different management strategies for acute multiligament knee injuries (aMLKIs). These were compared after categorising surgeons into developed economic nations (DEN) and emerging markets and developing nations (EMDN) based on the gross domestic product (GDP) per capita. Results: 138 orthopaedic surgeons from 47 countries participated in this study. DEN surgeons had more years of experience and were older (p <0.05). Surgeons from EMDN preferred conservative management and delayed reconstruction with autograft (p<0.05) if surgery was necessary. Surgeons from DEN favoured early, single stage arthroscopic ligament reconstruction. Significantly more EMDN surgeons preferred clinical examination (p<0.05) and duplex doppler scanning (p<0.05) compared to DEN surgeons. More surgeons from EMDN did not have access to a physiotherapist for their patients. Conclusions: Treatment of aMLKIs varied significantly based on the economic status of the country. In EMDN, aMLKIs are often treated conservatively, ligament surgery is often delayed and staged, alternative vascular assessment methods are more commonly used, and access to physiotherapy is challenging. This calls for adjusted guidelines when treating patients in areas of low resource setting.
- ItemOpen AccessThe Oxford Shoulder Score: Cross-cultural adaption and translation validation into Afrikaans(2018) Kruger, Neil; Held, Michael; Roche, StevePurpose: 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.
- ItemOpen AccessUse of ChatGPT for student co-creation of open textbooks(Digital Open Textbooks for Development, 2024-02) Cox, Glenda; Willmers, Michelle; Held, Michael; Brown, RobynThis is a presentation by members of the Digital Open Textbooks for Development (DOT4D) initiave, Asso. Prof Glenda Cox and Michelle Willmers, and collaborators Dr Michael Held and Robyn Brown, as part of the Centre for Innovation in Learning and Teaching's (CILT) Brown Bag seminar series in February 2024.