Browsing by Author "Roche, Stephan"

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    Open Access
    Do anatomical contoured plates address scapula body, neck, and glenoid fractures and can these fractures be classified? – A multi-observer consensus study
    (2022) De Wet, Johannes Jacobus; Roche, Stephan
    Background: The surgical management of scapula body, neck and glenoid fractures remains a challenge. This study focusses on templating an available anatomical pre-contoured plating system using 3D printed scapulae to assess the ability of these plates to address the aforementioned fractures and to determine consensus on classifying scapula body, neck and glenoid fractures. Methods: We used a cohort of twenty-two 3D printed fractured scapulae prototypes and an available anatomical pre-contoured plating system to determine anatomical congruency and fit. Nine investigators templated the scapula fractures using four pre-contoured plates and the investigators classified the twenty-two fractured scapulae using the Ideberg and AO/OTA classification system. Results: Eleven out of twenty-two fractures were found to be fixable using the plates under study. The long lateral plate addressed 83.3% of fractures involving the lateral border, while the glenoid plate was unable to adequately address any glenoid fractures. We observed good to excellent (p ≤ 0.001) inter-observer reliability for three of the four plates. The inter-observer reliability was moderate (ICC = 0.74) for the AO/OTA classification and good (ICC = 0.88) for the Ideberg classification. Conclusion: We believe that the anatomical pre-contoured plating system does not address all the fracture patterns encountered in clinical practice and further development in plate design is required. Good to moderate interobserver reliability were observed using the Ideberg fracture classification for intra-articular fractures and the AO/OTA classification for extraarticular fractures involving the body.
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    Evaluation and design of an adapted endobutton fixation system to be used in conjunction with suture and endobutton techniques for the treatment of coronoid process fractures
    (2025) Mason, Nicola; Sivarasu, Sudesh; Roche, Stephan
    Introduction: The coronoid process is a critical anatomical structure of the elbow, playing a fundamental role in the joint's stability. Fractures of the coronoid, typically resulting from high-energy impact, can disrupt this stability and compromise the elbow joint posing a significant challenge to the Orthopaedic surgeon. 3D imaging and fracture mapping are becoming the standard practice for visualising the fractured area and a means of planning surgical treatment. Although there is an ongoing debate about the ideal method of treating coronoid fractures, there are several recommended surgical fixation options. One of the available fixation devices is the Endobutton. This dissertation's primary aim is to design an adapted Endobutton using fracture mapping and Q3DCT techniques. The secondary aim is to evaluate the existing Endobutton to establish criteria for comparison and assessment of the newly designed device. Methods and Materials: Sixty-three upper limb computer tomography (CT) scans depicting coronoid fractures were acquired from Groote Schuur Hospital. Q3DCT techniques were used to generate fracture maps from multiple views. This involved editing CT scans to render 3D models of fractures and subsequent in-silico reduction and mapping. These were complimented by the generation of heat maps depicting the fracture line density. Templating and a qualitative assessment, performed by three Orthopaedic surgeons, evaluated the currently used Endobutton, leading to the establishment of evaluation criteria. This was followed by an iterative conceptual and detailed design process that was used to develop the adapted Endobutton. The designed device was verified through rapid prototyping, templating, and comparative qualitative assessment. Subsequent validation of the design was done using simulated surgeries in cadaver limbs, followed by the same comparative qualitative assessment. Results & Discussion: The 3D fracture and heat maps enable comprehensive inspection of the coronoid fractures from multiple views, thus facilitating the identification of the recurring patterns on the anterior surface of the bone. Fracture type specific critical fracture patterns and weak points of the bone's structure are identified. These insights inform the design of an adapted Endobutton. The templating and assessment of the commercially available Endobutton underscore its inefficacy in addressing coronoid fractures, highlighting the limitations that the designed adapted Endobutton aims to mitigate. Verification results indicate that the adapted Endobutton design yields improved qualitative user data, which suggests its enhanced performance as a fixation method compared to the commercially available Endobutton. The validation results reinforce the improved qualitative outcomes for Type 2 and Type 3 coronoid fractures, however the outcomes for Type 1 favour the commercially available device. Overall observations note that a spiked and curved asymmetrical design offer a more congruent fit to the bone, as well as effectively fitting over the majority of the fracture fragments. Conclusion: The commercially available Endobutton leads to unfavourable reduction and fixation qualitative parameters when compared to the newly designed adapted Endobutton. The new design demonstrates promising potential as an effective approach to coronoid fracture fixation as evidence by its effective application to the 3D-printed fractures and cadaver specimens.
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    Quantitative fit analysis of acromion fracture plating systems using three-dimensional anatomical modelling
    (2019) Charilaou, Johan; Roche, Stephan
    Background Displaced acromial fractures are challenging to treat. Complex bony anatomy, variable fracture morphology and limitations of available implants present challenges in achieving favourable surgical outcomes. We determined to what extent currently available scapular and clavicular plating systems are able to provide adequate fixation options. Methods Patients presenting to an urban trauma centre with acromial fractures sustained from blunt trauma between 2012 and 2016 were identified (n = 15, 14M / 1F). The fracture patterns were categorized according to location (Type I = 13%, Type II = 27%, Type III = 60%). Computed Tomography (CT) scans were reconstructed to produce three-dimensional (3D) printed anatomical models on which a quantitative fit analysis was performed. Measurements were performed twice, by five separate observers, with fit graded as anatomical fit (< 2mm), intermediate fit (> 2mm) or no-fit. Results The anterior clavicle 6 hole plate fitted best in 45.7% of cases. Acromial plates only achieved 27.3%. The acromion short plate together with the lateral clavicle short plates performed the best in Type II fractures. An inter-observer intraclass correlation coefficient (ICC) agreement of 0.974 was obtained. Conclusion The available commercial acromial plating system fails to provide adequate congruency and fit for fixation. Clavicular plates were superior alternative implants. 3D printed anatomical models can be used effectively to assist in templating implants preoperatively.
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    Throwing performance and shoulder injury risk in adolescent male water polo players in South Africa: exploring anthropometric and musculoskeletal parameters and evaluating the impact of a four week in-season conditioning program
    (2024) Mackenzie, Kelly Candice; Gray, Janine; Roche, Stephan
    using only one hand to interact with the ball at any given time. Consequently, catching and passing predominantly rely on the dominant arm whilst treading water. Although shoulder injuries are common, limited research exists regarding the specific factors that contribute to both sub-acute and chronic shoulder pain. Additionally, there is a dearth of evidence on the effectiveness of injury prevention interventions; programs designed to decrease the likelihood of injury and enhance performance. This novel research therefore aims to both; identify and understand the relationship between musculoskeletal parameters in adolescent water polo players and throwing performance and to investigate the effectiveness of a conditioning programme on musculoskeletal parameters associated with injury risk and throwing performance in adolescent water polo players. The thesis includes one literature review and two original research papers. The literature review highlights that; shoulder injuries are pervasive in water polo acros