Browsing by Author "McCollum, Graham"

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    Open Access
    Forefoot deformity surgical reconstruction outcomes in people living with rheumatoid arthritis in South Africa
    (2021) Mukabeta, Takura Darlington Maumbe; McCollum, Graham
    Introduction: Involvement of the forefoot is common among patients with Rheumatoid Arthritis. It results in severe deformities with significant disabilities. Aim: The aim of this study was to compare and assess in patients with Rheumatoid Arthritis in a South African population the outcomes of severe forefoot deformity reconstruction surgery in the short- to medium-term and in particular focusing on radiological, clinical, and functional outcomes. Patients and Methods: A retrospective review of 19 patients who received reconstructive forefoot surgery for forefoot deformities resulting from Rheumatoid Arthritis was undertaken. They all underwent Modified Hoffman Surgical Reconstruction (first MTPJ fusion and lesser toe resection arthroplasty). The patient records between 2013 and 2016 were reviewed. Pre-operative and post-operative outcome scores were collected. Final postoperative radiographs were analyzed. Patients completed Short Form 36 and AOFAS forefoot scores. Post-operative scores were collected 6 months post-op. Results: There were 19 patients in the study with a minimum 6 months follow up. Of the 19 patients 17 (89.5%) were females and 2 (10.5%) males. The mean age was 54.9 ± 9.6 years (range: 34 – 69 years). Most patient outcomes (SF36, AOS alignment, VAS Pain percentage, and VAS Disability percentage) significantly improved with a p value < 0.05, when comparing the pre-operative versus post-operative variable scores. However, only AOS Alignments showed no significant difference between pre-operative and post-operative scores (p>0.05). Conclusion: Reconstructive forefoot surgery with the Modified Hoffman Surgical Reconstruction provides marked radiological correction, with significant improvements in the quality of life of the cohort of patients.
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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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    The Management of acute lateral ankle sprains: A survey of South African Surgeons and best evidence available
    (2020) Wever, Stefan; McCollum, Graham
    Introduction: Ankle sprains remain the single most frequent injury in modern sports with increasing evidence that it is not as innocuous as previously thought. Conservative treatment options include various forms of immobilization such as casts, moonboots and stirrup braces, followed by a rehabilitation period involving different modalities. Despite clinical evidence there seems to be a divergence between research and practice with an increase in acute surgical repair especially with regards to professional athletes. Design: Descriptive cross-sectional survey analysis Aim of the study: To assess the approach on management of acute ankle sprains by orthopaedic surgeons in South Africa. Methods: A two part study. Firstly, a questionnaire was emailed to participating orthopaedic surgeons, consisting of eight treatment options for a grade 3 lateral ankle sprain in a non-professional athlete. Secondly, a literature review to establish the current best practice concerning ankle sprain management. Results: The total number of respones where 129 out of 719 that were sent out. Surgical repair was offered in 24 (19%). Conservative treatment including either cast or moonboot for a period of 6 weeks was chosen by 49 (38%) and 2 to 4 weeks by 55 (43%) as their preferred treatment. Only 39 (30%) of responding SAOA members chose a short period of immobilization followed by functional rehabilitation in accordance with the current best evidence available, based on the literature review done. Conclusion: Despite good clinical evidence there seem to be a lack of consensus in the management of grade 3 lateral ankle sprains.
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    Total Talar replacements, short-medium term case series, South Africa, 2019
    (2022) Abramson, Michael James; McCollum, Graham
    Background: There are few surgical options available to manage complex talar pathology that result in predictably acceptable functional and patient satisfaction scores. Recently, the total talar replacement has gained popularity as a viable option. This study presents the clinical outcomes of the first case series of total talar replacements in South Africa. Methodology: A retrospective review of prospectively collected data of eight consecutive patients who underwent a total talus replacement between July 2014 and August 2018 was performed. The American Orthopaedic Foot and Ankle Hindfoot Score (AOFAS) was used to assess clinical functional outcome and the Short Form36 satisfaction index (SF-36) was used to assess patient satisfaction. Patient demographics as well as data on pathology, range of motion, gait analysis and radiological outcomes were included. Results: The average age was 46 years (range, 23 to 71). Pathologies included trauma, avascular necrosis and tumours. Average followup time was 23 months (range, 12 to 49). The mean AOFAS score was 79.25 (range, 69 to 88) and the mean SF36 was 83.25. (range, 60 to 93). No complications or revision surgeries have been performed to date. Seven patients demonstrated a mildly abnormal gait pattern with one in the moderate category. One patient showed radiological changes of minor tibial wear, however this was the patient with the longest followup time (49 months) and he remained symptom free. Conclusion: Total talar replacements are a viable surgical option in appropriately selected patients with end stage talar pathology in the short to medium term, without compromising future salvage options.