Browsing by Author "Laubscher, Maritz"

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    Developing an antibiogram for empiric antibiotic prescribing for orthopaedic infections in adult patients at a South African tertiary orthopaedic unit
    (2023) Arakkal, Ashley; Laubscher, Maritz
    Background Empirical antibiotic strategies in the treatment of fracture related infections, chronic osteomyelitis, prosthetic joint infection, and septic arthritis should be based on local microbiological antibiograms. Aim To describe the microbiology and review the antibiogram profiles of bacterial isolates from patients undergoing surgical treatment for non-spinal orthopaedic infections, to identify the most appropriate empirical antibiotic strategy. Methods A retrospective review was performed of all cases of non-spinal orthopaedic infections treated surgically from 1 January 2018 to 31 December 2018. The National Health Laboratory Service microbiology database was used to identify all intra-operative microbiological specimens obtained from orthopaedic patients and data was correlated with the orthopaedic surgical database. Cases were divided into fracture related infections, chronic osteomyelitis, prosthetic joint infection, and septic arthritis. Antibiotic susceptibility data was used to predict the efficacy of different empirical antibiotic regimens. Results A total of 107 cases were included in the study; 184 organisms were cultured. Overall, the most common organism cultured was Staphylococcus aureus (25%) followed by Acinetobacter baumannii (9%), Enterococcus faecalis (7%) and Enterobacter cloacae (5%). Across all categories the oral antibiotic combination with the highest effectiveness (81%) would have been a combination of cotrimoxazole, ciprofloxacin and amoxicillin. The most effective intravenous antibiotic combination would have been either piperacillin-tazobactam, amikacin and vancomycin or meropenem and vancomycin; 90% of tested isolates were susceptible to either of these combinations. Conclusion Antibiogram profiles can serve to guide to empirical antibiotic choice in the management of different categories of non-spinal orthopaedic infections.
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    The influence of different connecting rod configurations on the stability of the Ilizarov Frame: A biomechanical study
    (2017) Thiart, Gerhard; Laubscher, Maritz
    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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    Intramedullary nailing of tibial non-unions using the suprapatellar approach: a case series
    (2021) Botma, Nicolaas; Laubscher, Maritz
    Background: A number of treatment options are available for diaphyseal non-unions of the tibia, including intramedullary (IM) nailing. An infrapatellar entry point with the knee in deep flexion can make this procedure challenging, especially with associated deformity or an obliterated canal. The suprapatellar approach allows nail insertion with the knee extended, which facilitates correction of malalignment in the sagittal and coronal planes. The aim of our study was to review the outcome of diaphyseal tibia non-unions, treated with an intramedullary nail, using the suprapatellar approach. Method: We retrospectively reviewed consecutive cases with non-union of the tibial shaft, treated with a suprapatellar entry nail between May 2016 and January 2018. Patients who were previously managed with a nail or who had active sepsis were excluded. The rate and time to union, as well as complications were assessed. Results: Thirteen cases were included and followed up until union at a mean of 5.8 months. All were performed percutaneously, without opening of the non-union site. Two patients developed complications, although bony union was still achieved. Conclusion: A suprapatellar entry tibial nail is an acceptable treatment option for tibial non-unions not previously treated with a nail.
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    Radiographic Union Score for Tibia (RUST) scoring system in adult diaphyseal femoral fractures treated with intramedullary nailing: an assessment of interobserver and intraobserver reliability
    (2022) Panchoo, Pravesh; Laubscher, Maritz
    Objectives The Radiographic Union Score for Tibia (RUST) scoring system has been validated in multiple studies assessing the healing of tibial fractures. Our objective was to assess the inter and intraobserver reliability for the RUST in diaphyseal femoral fractures treated with intramedullary (IM) nailing. Patients and Methods A total of 60 sets of anteroposterior (AP) and lateral radiographs of diaphyseal femoral fractures treated by reamed IM nailing were randomly selected from a prospectively collected database. The 60 sets of radiographs were then scored by three reviewers using the RUST system. Interobserver reliability was measured at initial scoring. The 60 sets of radiographs were scored again by the three reviewers to calculate the intraobserver reliability. Results The RUST scores ranged from 4 to 12 with a mean score of 11.3 ± 1.3. The interobserver intraclass correlation coefficient (ICC) was 0.87 (95% CI, 0.81-0.92) and the intraobserver ICC was 0.91 (95% CI, 0.88-0.94), which indicated excellent agreement. Conclusion This study demonstrated that the RUST system can be used reliably in the assessment of healing in diaphyseal femur fractures treated by reamed intramedullary nailing, with excellent interobserver and intraobserver reliability.
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    Soft tissue Reconstruction of Gustilo-Anderson Grade IIIB Open Extra-Articular Tibial Fractures at a Tertiary Hospital in Cape Town, South Africa: A Retrospective Case Series
    (2020) Barouni, Elyas; Laubscher, Maritz
    Introduction: Management of Gustilo-Anderson grade 3b tibia fractures are challenging due to the high rate of complications which includes infection, nonunion and possible amputation. Due to limited soft tissue coverage of the tibia antero-medially, open fractures remain a treatment challenge. Despite many advances, the ideal time delay to definitive soft tissue cover remains controversial. Aim: We aimed to investigate the management strategy and the outcome of soft tissue reconstruction of Gustilo-Anderson grade 3b tibia fractures at a tertiary hospital in Cape Town, South Africa. Methods: A retrospective study was conducted on 22 patients who underwent soft tissue reconstruction for grade 3b tibia fractures from January 2014 to July 2017. Patient demographics, comorbidities, injury characteristics and management practices such as time to debridement, relook time, Negative Pressure Wound Therapy (NPWT), soft tissue coverage and complications were recorded. Results: Most patients were males (n=18; 81.8%) with an average age of 39.3 years. Pedestrian vehicle accidents accounted for 45.4%(n=10), motor-vehicle accidents (n=6; 27.3%) and gunshot wounds (n=2; 9.1%). The commonest site of injury was the middle third of the tibia (n=13; 59.1%), distal third (n=7; 31.8%) and proximal third (n=2; 9.1%). Most patients (n=18; 81.8%) were debrided within 24 hours. The mean times for NPWT prior to cover was 12.5 days and for soft tissue cover 13.7 days (range 2-35), respectively. Fasciocutaneous flaps (n=11; 50%) were predominantly used as cover, then pedicled muscle flaps (n=8; 36.4%), free flaps (n=2) and skin graft(n=1). Most patients (n=13; 59.1%) received satisfactory outcomes. Seven (31.8%) required soft tissue revisions. Three patients (13.6%) suffered complications namely, complete flap loss resulting in amputation, partial skin graft loss and soft tissue infection, respectively. Patients who underwent debridement after 24 hours reported the least complications and there appeared to be better outcomes in the relooks beyond 48 hours. Conclusion: Despite achieving outcomes which concur with other published studies, the BOAST 4 guidelines were not fully reflected in our management strategy. We will require larger numbers in future studies to formulate a standardized management protocol going forward.
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    Subtotal capsulectomy for idiopathic chondrolysis of the hip : a clinical, radiological and histological study
    (2014) Laubscher, Maritz; Hoffman, EB
    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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    The Reuse of Circular External Fixator Components: An Assessment of Safety and Potential Savings
    (2022) Chironga, Kudzai; Laubscher, Maritz
    Purpose: Cost saving strategies are important especially in a resource constrained environment. One such strategy well supported in literature is the reuse of temporary monolateral external fixator components, a strategy we utilize at our institution. The aim of the study was to determine the safety and cost saving associated with the reuse of definitive circular external fixator components in a resource constrained environment. Method: We performed a retrospective review of all adult patients who were treated with either new or reused circular external fixators from a single manufacturer between January and December 2017. Reused circular external fixator components, excluding half pins and wires, were subjected to an in-house reprocessing protocol. Cost savings were calculated as the difference between the price of a completely new frame and the amount invoiced for new components only in a reused frame. Results: 33 patients were included in the study with an average age of 31.9 years. The mean duration of treatment with a circular external fixator was 5.8 months. No mechanical failure events were recorded during the study period. Our institution saved approximately 52% (R717 503.89) and 63 % (R136 568.19) of expected total cost for hexapod and Ilizarov frames respectively. Conclusion: The strategy of reusing circular external fixator components is unconventional and this study was conducted to evaluate the safety and potential savings in a resource constrained environment. We demonstrated this practice to be reasonably safe and to result in significant cost savings which might be relevant in low-and-middle income countries (LMICs).