Introduction

The impact of the Covid-19 lockdown restrictions on orthopaedic trauma admissions in a central academic hospital in Johannesburg

Worldwide, the impact of lockdown levels on orthopaedic trauma admissions has been widely documented (Table I). Waseem et al. reviewed over 665 studies noting a decrease in trauma admission rates ranging from 20.3% up to 84.6%. Many studies from Europe, Asia, Australasia and the United States of America have all shown varying degrees of a decrease in orthopaedic trauma admissions (Table I). The aim of this study is to determine the impact of lockdown restrictions and subsequent alcohol prohibition imposed in response to the Covid-19 pandemic on orthopaedic trauma admissions at a central academic hospital in Johannesburg, compared to the preceding two years.

Comparing outcomes between enhanced recovery after surgery and traditional protocols in total knee arthroplasty: a retrospective cohort study

Osteoarthritis is the leading cause of disability around the globe. It is a major source of morbidity and an economic burden for the health system. For end-stage disease, not responsive to conservative treatment, joint replacement is the best option. It has proven to be a reliable option for return of function and effectively improves health-related quality of life scores. The primary total knee arthroplasty demand is estimated to grow by 673% from 2008 to 2030 in the United States. Enhanced recovery after surgery (ERAS) protocols have been shown to be more cost effective and resource sensitive than traditional protocols. The future burden of disease worldwide emphasises the need for validating ERAS in countries such as South Africa as well as contributing to research in this field. Recent treatment protocols favour shorter hospital stays with accelerated recovery. With ERAS, emphasis is placed on pre-, intra- and postoperative interventions specifically to decrease length of stay (LOS), but we should be cognisant of the possible negative effects it can have on morbidity and mortality. The efficacy and safety of the ERAS protocol has been proven by studies done in developed world health systems. They speed up the recovery process, improve patient satisfaction and save medical resources without compromising patient safety or increasing the readmission rate.

Splints and immobilisation approaches used for second to fifth metacarpal fractures: a systematic review

Metacarpal fractures account for 10% of bony injuries and are one of the most prevalent upper limb injuries among adults Among all hand fractures identified in the United States (US), metacarpal fractures have an incidence rate of 13.6 per 100 000 persons per year and a prevalence of 33%.2 Fifth metacarpal neck fractures or boxer’s fractures account for 10% of all hand fractures that have left individuals with functional deficits, including weakened grip strength and decreased metacarpal joint range of motion (ROM). The concern is the residual deficits that impact the young and working adult population as they seem to sustain metacarpal fractures more often. The potential functional implications of sustaining a second to fifth metacarpal fracture can impact the individual in all components of the International Classification of Functioning, Disability and Health (ICF) framework, namely body functions and structures, activity and participation.

Orthopaedic research in Zimbabwe: a seminal bibliometric analysis

Musculoskeletal pathology accounts for an increasing proportionof deaths in sub Saharan low- and middle-income countries (LMICs) as other leading causes of death such as communicable diseases have been effectively targeted. Musculoskeletal pathology, specifically due to road traffic injuries (high-energy trauma), has also experienced an absolute increase in incidence due to increased motorised vehicle use in an environment of limited infrastructure and lax traffic law enforcement. Trauma and other musculoskeletal pathology, which require orthopaedic surgery for definitive management, are particularly concerning as already limited surgical capacity has not grown at the same rate to face the increased incidence of the orthopaedic trauma.

Modular prosthetic reconstruction for primary bone tumours of the distal tibia in ten patients

Limb-sparing surgery for primary bone tumours of the distal tibia is fraught with difficulties due to the paucity of soft tissue coverage and difficulties in creating a durable fixation of the prosthetic components. Wide surgical margins and acceptable function of the ankle joint can seldom be achieved. Therefore, belowknee amputation (BKA) is the surgical method of choice. While oncologically safe, it also provides excellent function with the everimproving external prosthetics. In selected cases where a wide surgical margin is possible and amputation unacceptable to the patient, limb salvage may be attempted. With the advent of additive manufacturing and improvements in polyethylene components and manufacturing, distal tibial replacement (DTR) design has provided solutions to previous problems and reduced implant cost by creating an ‘off-the-shelf’ prosthesis rather than an expensive and time-consuming custom prosthesis.

Current concepts on the assessment of a patient with a traumatic anterior shoulder dislocation

Anterior shoulder dislocation is the most common joint dislocation. Following nonoperative management of the initial episode, the recurrence rate varies from 70% to more than 90% in the adolescent population group. Recurrent instability has been reported in up to 30% of surgically treated adolescent traumatic anterior shoulder dislocation. Two-thirds of patients with recurrent dislocation will develop instability arthropathy within 25 years of the initial dislocation episode. There is, therefore, a need to identify patients who are likely to recur and who may need surgical stabilisation. An understanding of factors that predispose to recurrent anterior instability, a thorough clinical examination to define the instability characteristics and an analysis of bone loss pattern through imaging are the steppingstones to an appropriate treatment algorithm.

Mega-OATS of the knee without specialised instrumentation: a low-cost option for large cartilage defects in a resource-restrained environment

Osteochondral lesions present a challenge in young patients when arthroplasty is not considered a reasonable treatment option. Most joint-preserving treatment modalities for large cartilage defects are associated with considerable cost and often require intricate supply chains, subspecialist surgical skill sets, and an advanced theatre setup. Therefore, complex cartilage surgery is often not feasible with limited resources. The use of autologous chondrocyte implantation (ACI) is limited due to the high cost, and osteochondral allograft (OCA) depends on a reliable tissue bank that can guarantee good quality and infection-free fresh allograft. These techniques are therefore unavailable in a limited-resource environment. An option that is available is a large osteochondral autograft transplantation system (Mega-OATS) where an ipsilateral posterior femoral condyle is harvested and transplanted. It must be highlighted that this is a salvage procedure and should not be used as a first-line option for all cases. This technique has been well described and excellent outcomes have been shown up to 5.5 years postoperatively. Mega-OATS relies on autograft, and therefore does not require access to chondrocyte culture or a tissue bank. However, in the described techniques, an expensive workstation to handle and shape the autograft is needed.

Accreditation

Health Professions Council of South Africa

MDB015/137/01/2022

3 Clinical 

Certification

Attempts allowed: 2

70% pass rate





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South African Orthopaedic Journal - May 2022 Vol 21 No 2