Browsing by Subject "Orthopaedics"

Now showing 1 - 4 of 4
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    Orthopaedic implications of physeal arrest following meningococcal septicaemia
    (2010) Du Plessis, Jean-Pierre; Hoffman, EB
    Thirteen patients seen at Red Cross Children's and Maitland Cottage hospitals have under gone complex treatment for the significant deformities caused by meningococcal septicaemia. These patients underwent 62 surgical procedures between them. These procedures were directed at the treatment of sequelae of growth arrest alone and excluded amputations, contracture releases, skin grafts and flaps. The extent of the surgical problems caused by this disease brought about the realisation that a thorough review of the literature and follow up of these patients was required. This would hopefully be of use in assessing the outcomes of various surgical treatment options employed and in developing guidelines for the future management of physeal arrest in these patients.
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    Physeal Bar resection for partial growth plate arrest
    (2009) Hobbs, Hayden Ronald; Hoffman, EB
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    Surgeon directed transcranial motor evoked potential spinal cord monitoring in spinal deformity surgery: A review of viability, safety and efficacy
    (2020) Magampa, Ramanare; Dunn, Robert
    Aims Spinal deformity surgery carries the risk of neurological injury. Neurophysiological monitoring allows early identification of intraoperative cord injury facilitating early intervention which has a better prognosis. Although multimodal monitoring is the ideal, resource constraints make surgeon directed intra-operative transcranial motor evoked potential (TcMEP) monitoring a useful compromise. Our experience using surgeon directed TcMEP is presented in terms of viability, safety and efficacy. Methods A retrospective review was performed on a single surgeon's prospectively maintained database from 2010 to 2017 where TcMEP monitoring was utilised. The upper limbs were used as the control. A true alert was recorded when there was a 50% or more loss of amplitude of the lower limbs with maintained upper limb signals. Patients with true alerts were identified and their case history analysed. Results Of the 299 cases were reviewed, 279 (93.3%) had acceptable traces throughout and awoke with normal clinical neurological function. No case with normal traces had a post-operative clinical neurological deficit. True alerts occurred in 20 (6.7%) cases. The alert group diagnoses included adolescent idiopathic scoliosis 9 (45%) and congenital scoliosis 6 (30%). The incidence of deterioration based on diagnosis AIS was 9/153 (6%), congenital 6/30 (20%) and TB spine 2/16 (12.5%). Deterioration in congenital is much more common (p=0.02) when compared to AIS. 65% of alerts occurred during rod instrumentation and 15% during decompression of the internal apex in vertebral column resection surgery. 4 (20%) alert cases awoke with clinically detectable neurological compromise Conclusion Surgeon directed TcMEP monitoring has a 100% negative predictive value and allows early identification of physiological cord distress and immediate intervention. In resource constrained environments, surgeon directed TcMEP is a viable and effective method of intra-operative spinal cord monitoring. Clinical relevance • Surgeon directed TcMEP monitoring has a 100% negative predictive value. • In resource constrained environments, surgeon directed TcMEP is viable and effective • Level 3 evidence
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    Traumatic posterior fracture-dislocation of the hip joint in adults
    (2000) Selvey, David M; Siboto, Gordon M
    During the period July 1994 to September 1998 surgery was carried out on seventy-six hips in seventy-five patients that sustained posterior fracture-dislocation of their hip joints. During my training I was personally involved in thirteen of these cases and was the primary surgeon in seven cases. Because of my personal interest in these patients Dr Siboto provided me the records of all seventy-five patients for my scrutiny. While he has carried out the surgery on all but the seven cases which I operated on, the literature review, the correlating of the data and all of the interpretation is my own personal work. At surgery prospective records were kept of the degree of comminution of the fracture, the presence of marginal impacting and the presence of fragments in the joint. Fractures were then classified according to Thompson and Epstein (1951). The surgical time was recorded as well as the nature of the associated acetabular floor fracture when it occurred. Anatomical reconstruction was always attempted including elevation of marginal impaction and bone grafting where appropriate. Fragments were only discarded when too small and unattached to permit their inclusion in the reconstruction. All patients had neurological assessment preoperatively and their Sciatic nerves were explored and the state of the nerve recorded at surgery. The process of formulating this dissertation took place over a two-year period from September of 1997 until June of 1999. As a result, the number of patients examined in relationship to a specific subject is not constant but alters according to the group under scrutiny at that particular point in time. An initial review of sixty cases in September 1997 was carried out and then an additional fifteen patients up until September 1998 were included where relevant. The aim of carrying out this study was to gain a better understanding of this injury so that we could formulate a management protocol for our patients in Groote Schuur Hospital. First of all, I reviewed the literature to discover exactly what has been written about this pathology. In the process I hoped to gain a better understanding of the problem and attempt to define a more concise approach to the injury by consolidating the broad array of articles written on this subject. Then by reviewing our findings in our large series of patients I aimed to discover whether we were encountering similar problems to the surgeons who had preceded us and whether we had made any new discoveries that might positively contribute to the future management of these patients.