Communicate, collaborate and document: the pillars to avoid and manage complaints

It is an unfortunate sign of the times that complaints and litigation against the medical profession are increasing, even going as far as doctors being accused of assault and culpable homicide. Orthopaedic surgery is not exempt from this, and the SAOA has received a number of complaints from patients over the last year regarding surgeons. In other cases, patients have gone directly down the legal route and/or to the HPCSA. Complaints can result in extreme stress, affecting the mental health of the surgeon, and cases can take years to resolve. An example is a case in the last few years which went to court 11 years after the initial complaint. The surgeon endured extreme stress for all those years and in the end, the case was dismissed in court.

Low dislocation rate one year after total hip arthroplasty at a tertiary hospital in South Africa

Total hip arthroplasty (THA) is widely considered to be one of the most successful surgical procedures in orthopaedics and the most successful surgery of the 20th century. It is associated with high satisfaction rates in relieving pain and restoring function. According to the Australian Arthroplasty Registry, there was an increase of 109% in the number of THAs performed between 2003 and 2016 and an increase of 170% internationally by 2030 is projected. Despite a registry-proven 93% 13-year survivorship rate for THA and more than 20-year survivorship of implants, complications can arise with THA.

Functional outcome of free fibula grafting in benign non-reconstructable bone tumours involving the hand

Bone tumours involving hands are usually benign but can be locally aggressive. Of all the bone tumours, only 6% occur in the hand. Several treatments have been described. Usual modalities of treatment include curettage and bone grafting. Cytotoxic adjuvant agents such as liquid nitrogen, phenol and hydrogen peroxide can be used in conjunction with curettage to enhance the area of tumour kill, although their efficacy is still controversial. In some cases, local sclerosant injections are advocated. All such methods require contained lesions.

A survey on the educational value of an mHealth referral app for orthopaedics in South Africa

The burden of trauma and injury is significantly higher in low- and middle-income countries, yet access to timely and quality injury care is limited. This is partly due to the shortage and maldistribution of surgical care providers, especially those with orthopaedic training. mHealth, defined as the provision of healthcare services using mobile devices, is increasingly being used to bridge access gaps by improving communication between providers and enabling virtual patient consultations.

Enhancing healthcare services in an orthopaedic department utilising a system dynamics and participatory action research perspective to optimise patient flow

This paper seeks to address how the potential use of system dynamics theory can enhance a quantitative patient flow perspective of healthcare to develop dialogue around the activity of resource allocation between the many stages of the patient flow process.

Healthcare is a large, complex adaptive system that does not naturally lend itself to simplistic evaluation and operational design. Contributing reasons include the dynamic components which interact with each other creating large-scaled complexity and several diversified multilayered output variables.

Factors associated with dissemination and complications of acute bone and joint infections in children

Paediatric bone and joint infections are a major burden in lowand middle-income countries (LMICs). Acute haematogenous osteomyelitis (AHOM) has been shown to have an incidence of 8 to 10 per 100 000 in high-income countries while in LMIC countries the incidence is reported to be much higher at 80 per 100 000.

Intertrochanteric femur fractures: a current concepts review

The intertrochanteric region is defined as the extracapsular portion of the proximal femur between the intertrochanteric line and a horizontal line at the lower end of the lesser trochanter. The fractures occur due to high or low energy trauma, the latter being common in patients with osteoporotic bone. With the use of computed tomography (CT) scans, understanding of intertrochanteric fracture patterns and management thereof has improved. In this paper we review the current knowledge on this injury, its management options and outcomes, and relate these to the South African context.

A subungual glomus tumour of the finger with five reappearances: a rare case report

A subungual glomus tumour is a rare benign neoplasm that develops in the distal portion of the finger from the glomus body. They account for 1–6% of all soft tissue tumours in the upper limb, particularly the hand (50–75%). The aetiology of the tumour is unknown. Because of its rarity, there is usually a significant period between the beginning of symptoms and the diagnosis. Sefeane et al. reported up to 16 years delay in diagnosis in 2013.

The management of postoperative pain after musculoskeletal surgery – a narrative review

The healthcare environment functions on cost-effective care, and the rapidly rising cost of medical services is fast becoming a major consideration in patient management. The implementation of a standardised multimodal analgesia plan can streamline planned patient care since all role players know what to expect after a surgical procedure. This review will focus on strategies for use in the management of postoperative pain following musculoskeletal surgery.

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South African Orthopaedic Journal - March 2023 Vol 22 No 1