Browsing by Author "Kruger, Nicholas"

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    Adherence to Standard Operating Procedure for patients with Acute Cervical Spine Dislocated Injuries: A case of a teaching central referral hospital in South Africa
    (2022) Ayik, Goud; Kruger, Nicholas
    1.1.1 Aims: To analyse the impact that the adoption of our institutional standard operating procedure (SOP) for cervical spine dislocations had on the timing of closed reduction at our hospital. 1.1.2 Patients and methods: The study was a retrospective review of patients who presented to our institution with cervical dislocation injuries and were managed with closed reduction. The patient records of acute cervical spine dislocations from 2015 to 2018, Data from the Acute Spinal Cord Injury database along with patient's demographic information were gathered and compared. Participants within the study time frame were diagnosed with a cervical facet dislocation based on clinical examination findings and radiological confirmation. Patients who had reduction performed at other referring hospitals were excluded from the study. 1.1.3 Results: The practice within all tertiary hospitals in the Western Cape is to perform closed reduction of cervical fracture dislocations as soon as possible after injury. In this study the time between injury and closed reduction before introducing the SOP was13 h 13 min and after introducing the SOP, the time increased to an average of 14 h 28 min. The main cause of delay was the transfer time from the site of injury to emergency ward. Other reasons for the delay include missed diagnosis, orthopaedic registrar unavailability, and incomplete reduction bed. 1.1.4 Conclusion: This study found that the time taken for orthopaedic management of cervical dislocations increased by an hour after introduction of the SOP. Additionally, the overall time to reduction also increased This was due to delays in transfer to the emergency ward and referral to Orthopaedics. We recommend that in our setting, reduction could be initiated within an hour of patient arrival, if emergency ward doctors rapidly identified the problem and commenced cervical traction when the orthopaedic team was not immediately available. Our impression was that there was poor adherence to the new SOP guidelines on time management by the trauma team, and possibly transport delays prior to hospital admission. A further study to investigate the bottlenecks of the referral system is advisable.
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    Design and Development of a Traction Device for Semi-Automated Closed Cervical Spine Reduction Procedures
    (2021) De Villiers, Tertius; Sivarasu, Sudesh; Kruger, Nicholas
    Cervical facet dislocations are traumatic injuries which can cause severe compression to the spinal cord. This can lead to extreme adverse outcomes such as full body paralysis or loss of life. Treatment involves a closed reduction (CR) of the dislocated cervical facet joints and alignment of the spinal canal as the first step. This is the most rapid mechanism of decompressing the spinal cord and improving the neurological outcomes. This kind of injury is infrequent, with many clinicians seldom becoming well practiced in CRs, but when they do occur, these injuries require immediate urgent treatment. In addition to this, the existing equipment can be awkward to use and lacks an intuitive framework for operation. This led to the development of the collaTract, a device taking the form of a single item of equipment, able to guide a user through the performance of a CR procedure while avoiding cumbersome and heavy equipment. It is wedge shaped, with an articulating arm, connecting to a patient's skull via commonly used traction callipers. It was designed to apply force to, and alter the angle of the patient's neck allowing it to perform all operations required for a CR. The device was tested for functionality on a single cadaver, after which, a usability study was performed with ten clinicians of varying skill and experience comparing the traditional equipment of weights and a pulley to the collaTract. The device was able to perform all operations involved in a CR including, at any point, returning the neck to a neutral angle and removing the applied tension as would be the case when aborting a procedure. After the usability test, the participants rated the device excellent from a usability standpoint. Of the returned feedback all participants rated the collaTract easier to use than the current equipment and they viewed the collaTract as an improvement over the current equipment. It is important to state that the cadavers in this study had intact cervical spines with no dislocation; therefore, future studies must look into validating the collaTract device with real world spine dislocation models. In conclusion, the collaTract device can perform the functions necessary for a closed cervical reduction procedure. The device was rated by ten different clinicians of varying skill levels as excellent in terms of its usability and can be seen as a new state of the art device in treatment of cervical spine dislocations.
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    An investigation into the intramedullary pressure rise during femoral nailing: does the level and type of fracture determine peak pressures during the procedure?
    (2010) McCollum, Graham; Kruger, Nicholas
    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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    MBChB 5th year student response To E-Learning within orthopaedic surgery during Covid-19
    (2024) Gamieldien, Hammaad; Kruger, Nicholas
    Background. With the onset of the COVID-19 pandemic and the subsequent country-wide lockdown, South African (SA) universities were forced to quickly adapt to teaching that minimised or eliminated in-person contact. The pandemic period necessitated rapid changes to the way in which learning occurs and resulted in significant shifts in the academic environment. There is limited evidence in the literature to support e-learning in undergraduate orthopaedic training. This is the first study of its kind evaluating e-learning in orthopaedic surgery in a middle-to-low- income country. Objectives. To identify the University of Cape Town fifth-year MB ChB cohort's attitudes towards the e-learning component of blended learning during the COVID-19 pandemic. It also aimed to investigate whether e-learning facilitates comparable levels of confidence and results among students and face-to-face methods. Methods. Multi-year cross-sectional survey analysis was completed by retrospectively analysing the students' end-of-block evaluations and end-of-block marks. Responses from the cohorts between 2016 and 2020 were compared. Results. Regarding course definition, workload, course organisation, intended preparation and course presentation, the 2020 cohort's responses were similar to those of previous years. The 2020 cohort agreed that the e-learning material was relevant; this response was higher than in previous years. They also agreed that the online practical sessions were useful and that the course stimulated more interest. Significantly, they also strongly agreed that the online course was easier to attend and participate in than in previous years. The 2020 cohort perceived the end-of-block assessment to be somewhat unreasonable; however, this cohort yielded similar grades compared with previous cohorts. Subjectively, the students' responses to e-learning were positive, as many of them welcomed the usefulness and stimulation of online media as a study tool. Students felt that more time should be made available to work through online material and that there was incongruity between the content taught and the content of the endof-block assessments. Conclusion. Subjectively, the students' responses to e-learning were positive, as many of them welcomed the usefulness and stimulation of online media. With comparable outcomes in terms of student confidence and final marks (compared with traditional teaching only), it further encouraged a move towards formulating a novel blended learning curriculum. With these positive findings, we were able to explore the possibilities of developing an e-learning course curriculum incorporating international blended learning practices, using locally sourced SA evidence-based literature to provide orthopaedic teaching relevant to our unique setting.