The effect of a change in plastering technique on the rate of Major Surgery in Congenital Talipes Equinovarus(CTEV)

The Ponseti technique of manipulation and casting is reported to have almost eliminated the need for extensive soft tissue release in the treatment of idiopathic clubfoot. This technique of treatment has however not been universally adopted and results of treatment vary significantly between treatment centres. Furthermore, surgical decision making in the treatment of clubfoot is currently largely based on clinical findings as opposed to radiographic parameters. The Ponseti method of manipulation and casting was introduced at our institution in 2002, prior to which we used the Kite method. Both prior to, and following the introduction of Ponseti casting, surgical decision making was based on pre-operative radiology, and intra-operative clinical assessment. We propose to determine the impact on this change of plastering technique on the rate of major surgery performed primarily in our patients with idiopathic clubfoot. We also aim to determine whether or not pre- operative radiographs have any bearing on the surgery performed on these patients

The orthopaedic management of myelomeningocele

Despite improvement in antenatal care and screening, myelomeningocele remains the most common congenital birth defect, with a reported incidence of 1 - 2.5/1 000 patients in the Western Cape, South Africa. The multidisciplinary team involved in the Spinal Defects Clinic at Red Cross War Memorial Children's Hoapital, Cape Town, South Africa consists of neurosurgeons, urologists, orthopaedic surgeons, stomatherapists and orthotists.  Orthopaedic surgeons have a protean involvement in the management of myelomeningocele

Distal interlocking screw placement in the femur: free-hand versus electromagnetic assisted technique (sureshot).

OBJECTIVES To compare the free-hand (FH) technique of placing interlocking screws to a commercially available electromagnetic (EM) targeting system in terms of operating time, radiation dose, and accuracy of screw placement. METHODS Between September 2011 and July 2012, we prospectively randomized 100 consecutive femur shaft fractures in 99 patients requiring intramedullary nails to either FH using fluoroscopy (n = 43) or EM targeting (n = 38; Sureshot). SETTING Single Level 1 University Hospital Trauma Center. MAIN OUTCOME MEASUREMENTS The 2 groups were assessed for distal locking with respect to time, radiation, and accuracy. RESULTS Eight-one fractures had data accurately recorded (38 EM/43 FH). The average total operative time was 50 minutes (range, 25-88 minutes; SD, 13.9 minutes) for the FH group and 57 minutes (range, 40-103 minutes; SD, 16.12 minutes) for the EM group. The average time for distal locking was 10 minutes (range, 4-16 minutes; SD, 3.56 minutes) with FH and 11 minutes (range, 6-28 minutes; SD, 10.24 minutes) with EM. Average radiation dose for distal locking was significantly less (P < 0.0001) for EM at 230.54 μGy (range, 51-660 μGy; SD, 0.17 μGy) compared with 690.27 μGy (range, 200-2310 μGy; SD, 0.52 μGy) for FH. There were 2 misplaced drill bits in FH and 3 in EM. This was not statistically significant (P = 0.888). CONCLUSIONS The electromagnetic targeting device (Sureshot) significantly reduced radiation exposure during placement of distal interlocking screws, without sacrificing operative time, and was equivalent in accuracy when compared with the FH technique. LEVEL OF EVIDENCE Therapeutic level II

Double pathology, sarcoidosis associated with multiple myeloma: A case report

The association of sarcoidosis with multiple myeloma is not well known. Including this case report, 12 cases of patients with both sarcoidosis and multiple myeloma have been reported in the literature. The skeletal lesions of both conditions have many clinical and radiological similarities, and unless clinicians are aware of the association and the possibility of dual pathologies, the diagnosis of multiple myeloma in patients known with sarcoidosis may be missed. We present a case of a patient known with longstanding sarcoidosis who was found to have multiple lesions on magnetic resonance imaging (MRI) involving the pelvis and both proximal femurs. Histological analysis revealed the presence of both non-necrotising granulomas consistent with sarcoidosis, and sheets of plasma cells consistent with a plasma cell neoplasm

Topics, Skills, and Cases for an Undergraduate Musculoskeletal Curriculum in Southern Africa

Background: Most patients with orthopaedic pathology in low to middle-income countries are treated by nonspecialists. A curriculum to prepare undergraduate medical students for this duty should reflect the local pathology and skills that are required to manage patients in a resource-restricted environment. The aim of this study was to establish and prioritize a list of core orthopaedic-related knowledge topics, clinical cases, and skills that are relevant to medical students in southern Africa and areas with a similar clinical context. Methods: A modified Delphi consensus study was conducted with 3 interactive iterative rounds of communication and prioritization of items by experts from Africa, Europe, and North America. Preferred priorities were selected but were limited to 50% of all of the possible items. Percent agreement of ≥75% was defined as consensus on each of these items. Results: Most of the 43 experts who participated were orthopaedic surgeons from 7 different countries in southern Africa, but 28% were general practitioners or doctors working in primary or secondary-level facilities. Experts prioritized cases such as patients with multiple injuries, a limping child, and orthopaedic emergencies. Prioritized skills were manipulation and immobilization of dislocations and fractures. The most important knowledge topics included orthopaedic infections, the treatment of common fractures and dislocations, any red flags alerting to specialist referral, and back pain. Surgical skills for the treatment of urgent care conditions were included by some experts who saw a specific need in their clinical practice, but these were ranked lower. Conclusions: A wide geographic, academic, and expertise-specific footprint of experts informed this international consensus through their various clinical and academic circumstances. Knowledge topics, skills, and cases concerning orthopaedic trauma and infection were prioritized by the highest percent agreement. Acute primary care for fractures and dislocations ranked high. Furthermore, the diagnosis and the treatment of conditions not requiring specialist referral were prioritized. This study can inform national curricula in southern Africa and assist in the allocation of student clinical rotations