Дисертації з теми "Orthopaedic and trauma surgery"
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1
Clasper, Jonathan C. "Mortality and orthopaedic injury following military trauma." Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/8964/.
Анотація:
This thesis details my contribution to the literature on military surgery, based on both front-line surgical experiences as well as research carried out on causes of death and disability, particularly in relation to limb injuries, the most common site of wounding in conflict. Injury analysis (6 papers). Injury prevention/mitigation (5 papers). Management (8 papers). Outcome (13 papers). Education (9 papers).
2
Bouthors, Charlie. "Etude de pédagogie médicale sur la simulation procédurale en chirurgie orthopédique et traumatologique pour les étudiants en 2ème et 3ème cycle des études médicales." Electronic Thesis or Diss., université Paris-Saclay, 2024. http://www.theses.fr/2024UPASW001.
Анотація:
La simulation procédurale est en pleine expansion en chirurgie orthopédique et traumatologique (COT) mais en France, son utilisation pour les étudiants de 3ème cycle n'a pas encore été répertoriée. L'amélioration de la formation des gestes techniques enseignés en simulation aux étudiants du 2ème cycle implique le développement de nouvelles méthodes d'enseignement et de simulateur procéduraux.Une enquête nationale sur le déploiement de la simulation procédurale a été réalisée auprès des enseignants universitaires et des étudiants de 3ème cycle en COT. Cet état des lieux a montré que le déploiement n'était pas encore à son maximum. Les principales raisons évoquées étaient un manque de financement et de temps. L'intérêt de la simulation était malgré tout reconnu par les enseignants et les étudiants. L'uniformisation et les collaborations à l'échelle régional et nationale pourrait améliorer cette situation.L'enseignement traditionnel d'une procédure implique une démonstration ininterrompue de l'ensemble de la procédure à l'apprenant qui doit ensuite être capable de la réaliser. La décomposition de la procédure en plusieurs étapes clés montrées séquentiellement à l'apprenant selon une méthode dite par « micro-tâches », pourrait améliorer l'apprentissage du geste technique. Parmi une population d'étudiants en médecine du 2ème cycle formés à la manchette plâtrée en simulation, immédiatement après la formation, la performance évaluée par des grilles d'évaluation était meilleure chez ceux formés par la technique par « micro-tâche » par comparaison à la méthode traditionnelle. Six mois après la formation, le niveau de performance était diminué et identique entre les deux groupes. L'unique facteur indépendant lié à une bonne performance était le fait d'avoir effectué un stage de COT. Pour être efficace, le processus de formation en simulation implique donc un enseignement qui doit être répété et poursuivi en pratique clinique.Le développement d'un simulateur physique procédural pourrait améliorer la formation à la pose et à l'ablation de la manchette plâtrée. Un membre supérieur en taille réelle a été modélisé et construit par impression en trois dimensions (3D). Afin d'enregistrer de manière objective les comportements de l'opérateur, différents capteurs ont été incorporés au simulateur (pression, mobilité articulaire et « fracturaire », température, vibrations de la lame de scie, contact scie-peau). Le simulateur a été utilisé par deux groupes de participants au niveau d'expertise différent (novices et experts). Bien que le réalisme ait été jugé satisfaisant dans les deux groupes, son aspect est encore relativement éloigné d'un humain, notamment au niveau des parties molles. Le simulateur a permis d'enregistrer les comportements des opérateurs en lien avec leur gestuelle et semble pouvoir différencier deux niveaux d'expertises. L'intérêt pédagogique du simulateur sera évalué dans un autre travailProcedural simulation is expending in orthopaedic and trauma surgery (OT) but in France its implementation amongst residents has not yet been reported. To enhance procedural training for medical students implies development of new teaching methods and simulators.A national survey was conducted amongst academic teachers and residents in OT. Results showed maximal potential was not reached. Main reasons were lack of funding and time. Both teachers and residents acknowledged the advantages of simulation.The traditional method to teach a procedure implies a continuous and uninterrupted demonstration of the entire procedure to the learner who is then expected to replicate it. To deconstruct the procedure into several key steps showed sequentially (micro-task method) could enhance learning of technical skills. Amongst a population of medical students undergoing simulation training on below elbow cast, immediately after the training session students trained by micro-task method demonstrated higher performance than by traditional method according various grading scales. Six months after the training, performance was decreased and equal in both groups. The only independent factor linked to better performance was a rotation in OT. To be effective, simulation training requires repeated practice and bedside teaching.The development of a procedural simulator for below elbow cast application and removal could enhance this training. A real size upper limb was modelized and constructed through three-dimensional printing. To objectively monitor the operator's gesture, different captors (pression, fracture and wrist mobility, temperature, cast saw vibrations, cast saw skin touch) were integrated to the simulator. Participants with different levels of expertise (novices and experts) tested the simulator. Although realism was deemed satisfactory in both groups, it did not mimic human's aspect perfectly, notably the soft tissues. The simulator appropriately recorded the participants' gesture and seemed to differentiate different levels of expertise. Its pedagogical interest remains to be evaluated
3
Tarazi, Kamal. "Computer assisted orthopaedic surgery." Thesis, Imperial College London, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.321608.
4
Ashby, Elizabeth. "Morbidity following orthopaedic surgery." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10054431/.
Анотація:
Morbidity following hip and knee arthroplasty has previously been poorly recorded. This is the first time the Post-Operative Morbidity Survey (POMS) has been used for this purpose. The POMS identifies clinically significant morbidity using indicators of organ system dysfunction rather than traditional diagnostic categories. The most common types of morbidity following hip and knee arthroplasty are infection and renal morbidity. Pulmonary, pain and gastro-intestinal morbidity are less common. Cardiovascular, wound, neurological and haematological morbidity are least common. Many arthroplasty patients remain in hospital without morbidity. The POMS identifies these patients and thus has potential as a prospective bed utilisation tool. To be used for this purpose, the POMS must identify all clinically significant morbidity. Mobility is an important factor for safe discharge of arthroplasty patients. Addition of a ‘mobility’ domain could improve the utility of POMS as a bed utilisation tool following orthopaedic surgery. This study showed no association between post-operative morbidity defined by the POMS and longer-term patient-reported outcome measures (PROMs). This study does not support the POMS as an early surrogate marker of long-term PROMs in orthopaedic patients. The wound domain of the POMS has a high specificity, reasonable sensitivity, high negative predictive value and low positive predictive value compared to the inpatient ASEPSIS (Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, inpatient Stay over 14 days) score. The wound domain of POMS could be replaced with a validated definition of wound infection such as ASEPSIS. On the same series of orthopaedic patients, surgical site infection (SSI) rate according to the Centres for Disease Control (CDC) definition was 15.45%, according to the Nosocomial Infection National Surveillance Scheme (NINSS) definition was 11.32% and according to the ASEPSIS definition was 8.79%. This highlights the need for a consistent definition of SSI.
5
White, John William. "A search for the pathophysiology of the non-specific occupational overuse syndrome (RSI) : a research project undertaken in the Department of Orthopaedics and Trauma, Royal Adelaide Hospital and the Department of Surgery, University of Adelaide /." Title page, contents and abstract only, 1995. http://web4.library.adelaide.edu.au/theses/09PH/09phw5853.pdf.
6
Widman, Jan. "Blood saving in orthopaedic surgery /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-220-5.
7
Sharifi, Husham. "Cost Effectiveness Analysis in Orthopaedic Surgery." Yale University, 2010. http://ymtdl.med.yale.edu/theses/available/etd-03302010-163307/.
Анотація:
The purpose of this thesis was to explore the use of cost effectiveness for interventions in orthopaedics. This was done through three cost effectiveness articles that have been published by the author. In each of these articles, similar methodologies were used. Decision models were constructed for cost-effectiveness analyses of competing orthopaedic interventions. Outcome probabilities and effectiveness values were derived from the literature. Effectiveness was expressed in quality adjusted life years gained. Cost data were compiled and verified from either hospital cost data or from Medicare data. Costs and utilities were discounted in accord with the United States Panel on Cost Effectiveness in Health and Medicine. Principal outcome measures were average incremental costs, incremental effectiveness, incremental quality-adjusted life years, and, in the case of one article, net health benefits. In particular the articles compared the following: 1. Core decompression versus conservative management for osteonecrosis of the hip as a way to delay hip replacement; 2. Total knee arthroplasty versus unicompartmental knee arthroplasty; and 3. Periacetabular osteotomy versus total hip arthroplasty for a young adult with developmental dysplasia of the hip. The more cost effective intervention was identified in each case, along with implications of the results for clinical and operative decision-making. Cost effectiveness was found to be a useful tool in orthopaedic surgery under limited circumstances of either scarce data on new interventions or the need to use more resources to achieve greater effectiveness. It also can provide excellent insight into ways to direct future clinical research.
8
Hauck, Robert. "Virtual surgery and orthopaedic surgery : towards training using haptic technology." Thesis, University of Nottingham, 2017. http://eprints.nottingham.ac.uk/38530/.
Анотація:
Medical education and practical training in surgery is changing, by shifting from an on the job learning paradigm, which possesses problems such as that it is unpredictable, dependent on clinical needs and that patient safety may be jeopardised, to an evidence-based surgical skills training driven by curricular needs, and acquiring basic surgical skills prior to assisting in the operating theatre and thus reducing operation duration. Towards achieving this goal, virtual reality (VR) simulators are used in minimally invasive surgery for technical skills training at the beginning of the learning curve, but have not yet been adapted for open surgery due to its complexity for simulation. This thesis investigated the potential of using a VR simulator for training in orthopaedic hand surgery, with an emphasis on providing a meaningful, effective and motivating addition to current training methods for surgical procedures. A review of literature, preliminary research projects and currently available surgical systems revealed limited results on whether a VR simulation of orthopaedic hand surgery could be created, fulfilling the needs of medical experts. Therefore, a study investigating the current state of medical education and to understand the expectations on such a simulator was carried out, which resulted in the identification of promising medical scenarios for simulation (such as carpal tunnel release, distal radius fracture treatment or surgical incision) and in requirements for its development. Different software frameworks have been evaluated for their ability for use by analysing five developed demonstrators, with the result that a custom implementation of a six-degrees-of-freedom haptic algorithm was required. By following a human-centred design approach, a VR surgical simulator with inbuilt objective measures of assessment has been developed, allowing applying a plate, drilling holes, measuring their lengths, inserting screws and taking virtual X-rays, supported by haptic feedback for increased realism and teaching aspects not possible by common computer-based simulators, such as feeling the resistance when drilling through the cortical bone. By close collaboration with medical experts and following user interface design principles, a carried out medical evaluation of the simulator showed that the simulator was well-received by the targeted young doctors and medical students, that relevant aspects of the implemented medical scenario are taught and that the users’ performance can be assessed. The findings of this work showed that it is possible to create an interactive VR simulator aimed at early stages to learn basic orthopaedic principles of open surgery using the example of the treatment of distal radius fractures in a meaningful manner. It addresses issues in the current medical education and enables learning educational objectives repeatedly in reusable medical scenarios and in a safe and controlled environment, without the risk of harming patients, and thus contributing to improved quality and patient safety when proceeding to the operating theatre.
9
Rodriguez, y. Baena Ferdinando Maria. "Improving accuracy in robotic assisted orthopaedic surgery." Thesis, Imperial College London, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.407196.
10
Ozanian, Takouhi Ovaness. "Image analysis for computer-assisted orthopaedic surgery." Thesis, University of Hull, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310255.
11
Hurst, Simon. "Electronic patient centred outcomes in orthopaedic surgery." Thesis, Imperial College London, 2016. http://hdl.handle.net/10044/1/57103.
Анотація:
This thesis primarily reports on the national pilot of an electronic patient reported outcomes (ePRO) system for orthopaedic patients. Also reported on within the pilot is a new electronic patient centred outcome measure (ePCO) with focus on activity participation, and aspiration. At the time of publishing the pilot remains the largest of its kind within the speciality, and the first of its kind with respect to ePCOs. A background with historical perspective is provided for the use of outcomes in orthopaedic surgery, including a discussion surrounding current practices, and controversies. The engineering principles behind the construction of an ePCO/PCO system are also explained, along with the current regulatory guidelines governing them in Europe and the United States. The development and piloting of three individual software platforms are explained, evaluated, and discussed. This includes in the appendix a discussion on their wider context within industry, and within an increasingly technological able society. The final platform (Software C) is piloted in a large cohort both nationally, and internationally. Results from the pilot are presented and discussed in terms of the software usability, the ability for PROs to be successfully digitalised to ePROs within the software, and patient’s opinion of the technology. Objective outcome data obtained from a instrumented treadmill is used as an adjunct to the analysis of the impact of ePROs collected during the pilot, and also helping to address the validation parameters for the ePCO. Finally, the PCO is reported on. This includes the principles providing its conception, and foundation. It is tested using parameters for outcome score validation in both an initial paper-based pilot study, and in a national pilot using a modified digitalised format of the PCO.
12
Li, Qingde. "Registration techniques for computer assisted orthopaedic surgery." Thesis, University of Hull, 2002. http://hydra.hull.ac.uk/resources/hull:13615.
Анотація:
The registration of 3D preoperative medical data to patients is a key task in developing computer assisted surgery systems. In computer assisted surgery, the patient in the operation theatre must be aligned with the coordinate system in which the preoperative data has been acquired, so that the planned surgery based on the preoperative data can be carried out under the guidance of the computer assisted surgery system. The aim of this research is to investigate registration algorithms for developing computer assisted bone surgery systems. We start with reference mark registration. New interpretations are given to the development of well knowm algorithms based on singular value decomposition, polar decomposition techniques and the unit quaternion representation of the rotation matrix. In addition, a new algorithm is developed based on the estimate of the rotation axis. For non-land mark registration, we first develop iterative closest line segment and iterative closest triangle patch registrations, similar to the well known iterative closest point registration, when the preoperative data are dense enough. We then move to the situation where the preoperative data are not dense enough. Implicit fitting is considered to interpolate the gaps between the data . A new ellipsoid fitting algorithm and a new constructive implicit fitting strategy are developed. Finally, a region to region matching procedure is proposed based on our novel constructive implicit fitting technique. Experiments demonstrate that the new algorithm is very stable and very efficient.
13
Wilkinson, Andrew James. "Biomimetic topography in orthopaedic ceramic." Thesis, University of Glasgow, 2016. http://theses.gla.ac.uk/7791/.
Анотація:
The primary objective of this research was to perform an in vitro assessment of the ability of microscale topography to alter cell behaviour, with specific regard to producing favourable topography in an orthopaedic ceramic material suitable for implantation in the treatment of arthritis. Topography at microscale and nanoscale alters the bioactivity of the material. This has been used in orthopaedics for some time as seen with optimal pore size in uncemented hip and knee implants. This level of topography involves scale in hundreds of micrometres and allows for the ingrowth of tissue. Topography at smaller scale is possible thanks to progressive miniaturisation of technology. A topographic feature was created in a readily available clinically licensed polymer, Polycaprolcatone (PCL). The effect of this topography was assessed in vitro. The same topography was transferred to the latest generation composite orthopaedic ceramic, zirconia toughened alumina (ZTA). The fidelity of reproduction of the topography was examined using scanning electron microscopy (SEM) and atomic force microscopy (AFM). These investigations showed more accurate reproduction of the topography in PCL than ZTA with some material artefacts in the ZTA. Cell culture in vitro was performed on the patterned substrates. The response of osteoprogenitor cells was assessed using immunohistochemistry, real-time polymerase chain reaction and alizarin staining. These results showed a small effect on cell behaviour. Finally metabolic comparison was made of the effects created by the two different materials and the topography in each. The results have shown a reproducible topography in orthopaedic ceramics. This topography has demonstrated a positive osteogenic effect in both polycaprolactone and zirconia toughened alumina across multiple assessment modalities.
14
Dunn, Robert. "Posterior segmental spinal fixation in Scoliosis surgery." Master's thesis, University of Cape Town, 2001. http://hdl.handle.net/11427/2839.
Анотація:
Includes bibliographical references.Spinal deformity was recognised in the ancient works for philosophy, religion, myths, and fairy tales dating back as far as 3500BC[1,6]. Scoliosis was first described in the 5th century BC by Hippocrates. He recommended treatment with axial distraction on an extension apparatus (figure 1).
15
Evangelidis, Alexander E. "A robotic system for minimally invasive orthopaedic surgery." Thesis, Imperial College London, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.444136.
16
Davies, Benjamin Michael. "Optimising mesenchymal stromal cell harvesting in orthopaedic surgery." Thesis, University of Oxford, 2015. https://ora.ox.ac.uk/objects/uuid:aeb65824-d07b-4c73-bb51-aedaf7a7b0c2.
Анотація:
Musculoskeletal tissue is prone to age-related degeneration and to damage which heals poorly. Many current treatments are able to treat only the end stages of these conditions, such as the use of total knee replacements in osteoarthritis. Cellular therapies are seen as a potential source of effective treatments for the earlier stages of these conditions. Orthopaedic surgery has been at the forefront of cellular therapies with treatments such as microfracture and autologous chondrocyte implantation to treat chondral defects. As the largest area of current cell therapy research, stem cells have become an area of high interest for developing novel treatments. Mesenchymal stromal cells (MSCs) have provided the basis of the majority of orthopaedic treatments because of the relative ease of obtaining them. Despite the development of a number of treatments using both freshly harvested MSCs and culture expanded MSCs there is still a large gap in our knowledge of the mechanisms of actions of these cells and the most appropriate locations for obtaining autologous samples. This thesis seeks to examine the best source of MSCs for surgery around the knee, comparing the pelvis to the femur and tibia. It also seeks to determine if it is possible to improve the yield of MSCs using a simple modification of the standard method of aspiration. Assessments of the yield of all cells and MSCs showed that the pelvis was the optimum source for MSCs in terms of cell numbers. There was also a large amount of inter-subject variation in the number of cells obtained. There was no difference in the functional abilities of cells from any location. Modification of the aspiration technique did not improve the cell yield. Future work should focus on improving yields from the pelvis and investigate methods of overcoming the inter-subject variability in yields if standardised treatments are to be successfully developed.
17
Ahwal, Fadi Odeh. "Robotic assisted laser bone ablation for orthopaedic surgery." Thesis, University of Hull, 2006. http://hydra.hull.ac.uk/resources/hull:15104.
Анотація:
The needs for better quality patient care and improved surgical procedures drive the development of new surgical tools and techniques that can augment the human surgeon capabilities. Over the past decade or so there have been significant advances in the design and development of computer assisted image guided surgery systems that can potentially perform complex tasks with high dexterity, speed and flexibility. The aim of this research work is to investigate various aspects in the design of a new computer assisted surgical tool capable of sawing, drilling and sculpturing of bone in support of image guided surgery that aims to reduce invasiveness, minimise blood loss and improve surgical outcome. The research of this thesis focuses on the design of an active positioning system (robotic end-effector) that uses a laser to cut bone to replace some of the currently available tools. This thesis starts by reviewing medical lasers and laser delivery systems, and discussing the effects of different lasers and lasers' parameters on tissue ablation time, rate and depth. It then defines criterion for the selection of the most appropriate laser and laser delivery system for bone cutting, drilling and sculpturing applications. Secondly, the thesis presents a unique design of a robotic laser end-effector. This end-effector is designed to provide accurate laser guidance for precise surgical performance (tissue ablation). This design is supported by an in-depth forward and inverse kinematic analysis to determine the end-effector workspace, resolution, positioning accuracy and manipulation flexibility. Thirdly and perhaps most importantly, the thesis presents two innovative laser feedback techniques, developed by the author, to determine the laser ablation depth and rate in real time during laser tissue interaction. These techniques are presented with complete analysis and supported by real time feedback examples. The techniques showed high measurement accuracy and reliability. Finally the thesis reviews the overall system performance supported by an error analysis model to determine the effects of different errors on the manipulation and positioning performance of the laser end-effector. It also presents some possible end-effector design modifications, alternative feedback techniques and suggestions for future work.
18
Ohrt, Gary Thomas. "Surgical simulation training models for orthopaedic fracture surgery." Thesis, University of Iowa, 2013. https://ir.uiowa.edu/etd/4888.
Анотація:
Articular fracture reduction is a complex surgical task that requires surgeons to be competent at multiple surgical skills to successfully complete. The list of skills needed includes the ability to use fluoroscopic images to build a 3D mental model of the fracture during reconstruction, the proper handling and use of surgical instruments, how to manipulate the fracture fragment into a reduced configuration with minimal hand motion, proper k-wire placement, and the preservation of surrounding soft tissues. Current training methodology is based on an apprenticeship model. The resident learns by watching a senior surgeon, and then preforms the procedure on live patients under the guidance of the senior surgeon to gain competence. This endangers the patient and does not provide the best outcome for either patient or resident.
The work presented in this thesis is the early development of an articular fracture reduction simulator, the subsequent use of the simulator in the training of orthopaedic residents, and assessment of the improvement of residents after practice on the simulator. To date, the simulator has been tested on four different groups of residents,3 different groups from the University of Iowa and one group from the University of Minnesota. Considerable effort has been made to validate the improvement seen in resident performance through objective means. The Objective Structured Assessment of Technical Skills (OSATS) is a global rating score and procedural checklist that has been previously validated to objectively measure surgical skill. Other assessment metrics include hand motion capture to count the number of discrete actions and measure distance traveled during the surgical procedure, fluoroscopic usage and radiation exposure, articular `step-off', the surface deviation from an intact or ideal reconstruction, and contact stress exposure.
The results indicate that the goals for the simulator have been met, that the simulator provides a means of training orthopaedic residents, assessing improvement, decreased the cost of training, and improved patient safety. The simulator is not without limitations including sample size, and radiation exposure. The task being trained is complex and can be broken down into basic subtasks that could be trained individually. Even with flaws, the simulator is an improvement over current training methods and is an excellent first step toward creating a surgical skills curriculum to comply with new mandates from orthopaedic surgery's governing bodies.
19
Moonda, Zaheer. "Does the Intra-operatively measured Leg Length Correction compare to the Post-operative radiograph in Total Hip Replacement surgery?" Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33852.
Анотація:
Aims This study aims to compare the leg length correction (LLC) measured intra-operatively using the Vertical Measurement SystemTM (VMS) in total hip arthroplasty (THA), with the LLC measured on a 6-week post-operative Xray. We also wanted to quantify any residual leg length discrepancy (LLD) using this method. Patients and Methods A prospective cohort study was conducted, in which patients undergoing primary THA were enrolled at two centres in Cape Town, over a period of 19 weeks. THA's were performed by four surgeons. Pre-operative leg length discrepancy measurements were obtained in 92 patients. The VMS was used to predict intra-operative leg length correction (LLC), and this measurement was compared to the post-operative leg length correction measured on the 6-week follow-up X-ray. These measurements were statistically compared using Mann-Whitney U Test. Results The difference between the intra-operative VMS calculation and the 6-week radiological measurement was not significant (p>0.05), with the difference in their mean values being 0.07 ± 3.26mm. In the cohort, 81.52% of the patients (n=75) were within 5mm of the target LLC, and 95.65% of patients (n=88) were within 10mm of the target LLC. The mean absolute residual LLD at 6 weeks was 3.22 ± 3.13mm. Conclusion The intra operative LLC measurement obtained using the VMS accurately predicts the 6-week post op radiographic LLC measurement.
20
Laubscher, Maritz. "Subtotal capsulectomy for idiopathic chondrolysis of the hip : a clinical, radiological and histological study." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13251.
Анотація:
Includes bibliographical references.The purpose of this study will be to review the outcome of a subtotal capsulectomy of the hip for idiopathic chondrolysis. Idiopathic chondrolysis of the hip is a very rare condition. It is characterized by cartilage necrosis of the hip joint not associated with trauma, SUFE, infections or other demonstrable causes. It was first described in 1971 by Jones from the Princess Alice Orthopaedic Hospital in Cape Town. It occurs mainly in adolescent girls. The outcome in South Africa has been reported as a progressive downhill course resulting in a painful, stiff hip. The aetiology of the disease remains unknown. Theories suggested are mechanical (decreased movement with loss of synovial nutrition; increased joint pressure) and an auto-immune response in genetically predisposed individuals. The differential diagnosis includes atrophic-type tuberculosis of the hip. Suggested treatment ranges from NSAIDs and range of motion exercises alone to early aggressive surgical treatment. Our experience with continuous passive motion (CPM) and NSAID treatment have been disappointing.
21
Wever, Stefan. "The Management of acute lateral ankle sprains: A survey of South African Surgeons and best evidence available." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33083.
Анотація:
Introduction: Ankle sprains remain the single most frequent injury in modern sports with increasing evidence that it is not as innocuous as previously thought. Conservative treatment options include various forms of immobilization such as casts, moonboots and stirrup braces, followed by a rehabilitation period involving different modalities. Despite clinical evidence there seems to be a divergence between research and practice with an increase in acute surgical repair especially with regards to professional athletes. Design: Descriptive cross-sectional survey analysis Aim of the study: To assess the approach on management of acute ankle sprains by orthopaedic surgeons in South Africa. Methods: A two part study. Firstly, a questionnaire was emailed to participating orthopaedic surgeons, consisting of eight treatment options for a grade 3 lateral ankle sprain in a non-professional athlete. Secondly, a literature review to establish the current best practice concerning ankle sprain management. Results: The total number of respones where 129 out of 719 that were sent out. Surgical repair was offered in 24 (19%). Conservative treatment including either cast or moonboot for a period of 6 weeks was chosen by 49 (38%) and 2 to 4 weeks by 55 (43%) as their preferred treatment. Only 39 (30%) of responding SAOA members chose a short period of immobilization followed by functional rehabilitation in accordance with the current best evidence available, based on the literature review done. Conclusion: Despite good clinical evidence there seem to be a lack of consensus in the management of grade 3 lateral ankle sprains.
22
Held, Michael. "Evaluation of diagnostic advances in musculoskeletal tuberculosis; the automated xpert MTB/RIF assay." Doctoral thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20495.
Анотація:
The aim of this thesis was to investigate the diagnostic accuracy of Xpert for musculoskeletal TB and for rifampicin resistance against a gold standard of culture or histology. Site of disease, HIV status, and age of patients, and accuracy in spinal compared to extraspinal TB were investigated as secondary objectives. The overarching hypothesis was that Xpert is more accurate and would provide results faster than the gold standard for musculoskeletal TB, and that it would have a higher yield in HIV infected patients, adult patients, and patients with spinal disease.
23
Kauta, Ntambue. "The management of fragility fractures of the hip: a quality assessment project." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25067.
Анотація:
Introduction: Fragility fractures of the hip (FFH) constitute the most serious complication of osteoporosis carrying a mortality rate of up to 20 – 30% in the first year after injury and are associated with post injury decay in patient's level of activity in more than 50% of the cases. It is also a predictor of future osteoporosis related fractures. Surgical fixation of the hip fracture within 48 of admission, multimodal pain management, deep vein thrombo-prophylaxis, early physical therapy, appropriate assessment and management of osteoporosis and frailty in a multidisciplinary approach are the standard of care for FFH to keep the mortality and morbidity rate as low as possible and prevent future fragility fractures. Aim: To assess the standard of care of FFH at our institution and determine areas of care which need more attention and improvement. Methods: Retrospective review of clinical and radiographic records of all patients admitted at our level 1 trauma unit for fragility fracture of the hip from 1st January 2014 to 31st December 2014. The waiting time from admission to surgical fixation of the hip fracture, pain control and thrombo-prophylaxis strategies, the rate of geriatric referrals and the extent of osteoporosis management were assessed. Results: We admitted 113 fragility fractures of the hip from 1st January to 31st December 2014. Ninety- eight clinical records and 98 pelvis radiographs were included in the study. The other 15 clinical records were incomplete and were therefore excluded. The average waiting time from admission to surgery was 49 hours (range 9 -120). Low dose morphine, paracetamol and tramadol were the only perioperative pain control medication used for all patients. All patients had low molecular weight heparin and compression stockings prescribed for thrombo-prophylaxis. Only 2 (2, 04%) of patients had some osteoporosis investigations ordered. There were no geriatric referrals made and no formal osteoporosis management in all reviewed records. Conclusion: While the waiting time from admission to surgery was largely within the recommended time frame, there were no signs of a multidisciplinary approach to the management of fragility fractures of the hip at our institution leaving osteoporosis and frailty largely untreated.
24
Roussot, Mark. "Amputation rate following tibia fractures with associated popliteal artery injuries." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25507.
Анотація:
Objectives: 1. Determine the amputation rate; and 2. identify risk factors in patients with tibia fractures and associated popliteal artery injuries. Intervention: Amputation or limb salvage. Design: Retrospective case-control study. Setting: Level 1 trauma center. Patients: Thirty popliteal artery injuries with ipsilateral tibial fractures. Outcome measures: Primary and delayed amputation rates were determined. Risk factors tested for significance (Fischer's Exact) included: mechanism of injury, signs of threatened viability, compartment syndrome, fracture pattern, surgical sequence, and time delay from injury or presentation to revascularization. Results: The study group consisted of 22 males and 8 females, with a mean age of 31 years. Motor vehicle accidents and gunshot wounds constituted the mechanism in 17 and 11 patients respectively. Twenty-one were polytrauma victims. Intra/extra16 articular metaphyseal fractures (OTA 41 A-C) were recorded in 19 and diaphyseal (OTA 42 A-C) in 7 patients. Primary amputation was performed in 7 and delayed in 10 patients (overall rate 57%). No individual risk factors were predictive of amputation; however, the "miserable triad" of a proximal tibia fracture (OTA 41) with signs of threatened viability, and delay to revascularization ≥ 6 hours from injury or ≥ 2 hours from presentation was predictive of amputation (p = 0,036 and p = 0,018 respectively). Conclusions: We should aim to intervene within 6 hours following injury or 2 hours following presentation to reduce the risk of amputation. This provides a target for trauma teams even with uncertain time of injury. Level of Evidence: III.
25
HIlton, Thomas. "Clinical outcomes following reduction and pinning of lesser arc injuries without repair of the scapholunate interosseous ligament." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20373.
Анотація:
Study Rationale: Purely ligamentous lesser arc, Mayfield grade 3 and 4, perilunate dislocations (PLD's) are uncommon. Current recommendations are for open reduction and repair of the interosseous ligaments to prevent the development of scapholunate dissociation and degeneration to a scapholunate advance collapse (SLAC) wrist. This study proposes a less invasive treatment method which includes closed reduction and pinning alone without repair of the scapholunate interosseous ligament. We propose that the majority of patients will obtain good function and pain scores and the few that develop instability may still have a reconstruction performed through a naïve surgical field. Methods: Dislocations were reduced anatomically and held with buried k-wires which were removed at 6 weeks with no specific rehabilitation protocol observed. Subjective assessment included MAYO wrist scoring system, wrist range of movement, instability and grip strength testing. Radiological measurements included scapholunate distance, scapholunate angle, radiolunate angle and osteoarthritis. Results: 10 male patients, median age of 35, were followed-up for a median of 22 months. 7 patients underwent a closed reduction and anatomical pinning while 3 underwent open reduction due to unachievable reduction by closed means. All of these patients presented at a median of 14 days after the injury occurred. None of the patients had their scapholunate ligaments repaired or reconstructed. MAYO scores included, 3 excellent scores, 2 good scores and 5 fair scores. Instability was found clinically in 1 asymptomatic patient who had a positive Watson shift test. Radiological scores include a median scapholunate distance of 2mm, a scapholunate angle of 70° and a radiolunate angle of 15°. Osteoarthritis was found in 2 patients, all of whom were asymptomatic. Discussion: Current recommendations in the literature are that PLD's should be reduced via an open surgical technique with repair of the SLIL and percutaneous pinning. However the results of this treatment strategy are not optimal and do not confer uniformly good results. We propose a closed anatomical reduction and percutaneous pinning of the PLD. Our study shows that the majority of patients will demonstrate good function and pain scores when managed this way. A smaller number of these injured wrists will go on to develop instability. However the advantage of our method over the current recommendations is that when this happens the reconstruction of the SLIL will be made easier through a naïve surgical field. Conclusion: We recommend the closed reduction and anatomical pinning of a purely ligamentous lesser arc injury. This treatment strategy yields good results at medium term follow-up and preserves the option for the reconstruction of the scapholunate interosseous ligament should instability develop.
26
Naude, Petrus Hendrik. "Prospective study to compare the difference in cerebral perfusion in patients undergoing shoulder surgery with the standard beach chair position compared to 30˚ inclination." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20785.
Анотація:
There have been devastating reports of patients suffering permanent neurological damage following surgery in the beach chair position. Recent literature have shown that placing a patient under general anaesthesia in the beach chair position may place patients at risk of complications. There is no set angle of inclination used by all orthopaedic surgeons. Previous research have used angles of 70˚-90˚. At these angles patients suffered a significant number of cerebral desaturation events that may lead to ischaemic neurological events. This angle is far more upright than what is used in our practice. We postulated that decreasing the angle of inclination may be protective of cerebral perfusion. We performed a prospective randomised single blind study. 45 consecutive patients presenting for shoulder surgery were randomised to 2 groups. The control group patients were placed in the normal position used by the surgeon for the procedure and this angle was measured. The patients in the trial group were all placed at 30˚. Patients with known cerebrovascular disease, younger than 18 years, ASA grade 4 and 5, allergy to local anaesthetic, pre-existing coagulopathies or a failed interscalene block were excluded. Cerebral oxygenation were measured with the INVOS system along with the other standard observations in theatre. The 2 most important parameters measured were mean arterial pressure and cerebral oxygenation levels.
27
Marais, Christoff de Villiers. "Functional outcomes and patient satisfaction after fasciotomy performed for chronic exertional compartment syndrome." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25068.
Анотація:
Study Rationale: Chronic exertional compartment syndrome often forces patients to change their sporting activities or reduce their level of participation. Many undergo surgery with the aim to return to their activities symptom free. The aim of the study was to determine if fasciotomies for chronic exertional compartment syndrome are a reliable treatment option with a predictable outcome to allow patients to return to the same level of activities. Objective: The evaluation of the functional outcomes and patient satisfaction in an active population who had surgery, namely fasciotomies, for chronic exertional compartment syndrome (CECS) of the lower leg. Design: A retrospective descriptive cohort study with a telephonic follow-up interview. Patients: A consecutive series of 41 patients that were surgically treated for CECS by a single orthopaedic surgeon from July 2005 to October 2013. Main Outcome Measures: Patient records were reviewed to determine their presenting symptoms, diagnostic investigations and surgical procedures performed. A questionnaire was completed by each participant to assess pain and level of activity before and after surgery, level of improvement after surgery and patient satisfaction with surgical outcomes. Results: Twenty-one of the 41 patients that were included in the study were categorized as active sportsmen, participating at a competitive or a non-competitive level. The remaining 20 were experiencing symptoms during leisure activities. The majority of all the patients (63%) had to stop their activity due to their symptoms. After surgery 95% were able to return to participate in the same level of activities as before surgery. Ninety percent of the active sportsmen were able to return to participation at a competitive or non-competitive level, with 45% reporting an increase in the level of intensity that they could maintain. Overall satisfaction was reported by 80% of participants although only 46% were completely pain free. Conclusions: Fasciotomies are a viable surgical treatment option for chronic exertional compartment syndrome in active patients, including athletes. There is an 87% return rate to previous activities within 6 months and an 80% satisfaction rate reported by patients post-surgery. We do acknowledge that some of the data collected regarding symptomology is subject to recall bias due to the interval between surgery and completion of the questionnaire.
28
Dachs, Robert. "An assessment of undergraduate musculoskeletal training at Medical Schools in South Africa." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/2837.
29
Kruger, Neil. "The Oxford Shoulder Score: Cross-cultural adaption and translation validation into Afrikaans." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29797.
Анотація:
Purpose: The Oxford Shoulder Score (OSS) is a robust and universally utilised shoulder score that has been translated for use in Western and Asian countries. This study aimed to translate, cross-culturally adapt and psychometrically validate the Afrikaans version of the OSS for use in Africa. Methods: Translation and cross-cultural adaptation was performed in accordance with guidelines in the literature. 108 consecutive patients with either degenerative or inflammatory pain of the shoulder were prospectively enrolled. Patients were evaluated by completing the Afrikaans OSS, Constant-Murley, quickDASH, and the Subjective Shoulder Value (SSV) scores. Comprehensibility and acceptance, as well as any floor or ceiling effects, were calculated. Reliability was assessed through reproducibility. Internal consistency was assessed using Cronbach’s alpha. Validity was determined using a Pearson Correlation Co-efficient between the Afrikaans OSS and the other validated shoulder scores. Results: Comprehensibility and acceptance were excellent, and no floor or ceiling effects were observed. Reproducibility (r = 0.99) and internal consistency (Cronbach’s alpha = 0.93) were both excellent. Correlation of the Afrikaans OSS with the Constant-Murley and quickDASH was excellent (r = 0.84; r = 0.81 respectively), and very good with the SSV and VAS pain score (r = 0.73; r = 0.66). Conclusion: The Afrikaans OSS proved understandable, acceptable, reliable and valid. It is an appropriate instrument for use in Afrikaans speaking patients with shoulder pain from degenerative or inflammatory origin.
30
Louw, Frederik Marthinus. "Neurovascular complications in displaced extension-type supracondylar fractures in children : outcome of conservative management." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/12517.
Анотація:
Includes bibliographical referencesThe aim of our study was to review our conservative management of neurovascular complications in displaced extension-type supracond ylar fractures of the humerus in children. We critically analysed the outcomes. Our results shall aim to clarify the management of this contentious issue.
31
Jordaan, Pieter Willem. "Surface replacement of proximal interphalangeal joint (SR-PIPJ) arthroplasty - A case series." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20858.
Анотація:
Surface replacement (SR) proximal interphalangeal joint replacement consists of a cobalt-chrome alloy component articulating with an ultra-high molecular weight polyethylene component. After experiencing a high rate of subsidence and complications with a pyrocarbon implant, our unit has changed to the cemented SR system in the hope of decreasing these complications. The main aim of this study was to determine whether this change in practice has led to a decrease in subsidence and complications. A retrospective chart review was performed including 43 joints in 28 patients. Subsidence was noted in 26% of the joints and complications in 31% of the joints. Even though subsidence remains a problem, the change in implant has led to a decrease in subsidence and other complications.
32
Maqungo, Sithombo. "Tuberculosis of the foot and ankle in children." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10763.
Анотація:
The purpose of our retrospective study is to critically assess the long-term outcome of tuberculosis of the foot and ankle in children and to define an initial classification system that would relate to prognosis.
33
Charilaou, Johan. "Quantitative fit analysis of acromion fracture plating systems using three-dimensional anatomical modelling." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31486.
Анотація:
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.
34
Fleming, Mark Alexander. "How does pre-reduction MRI affect surgeon's behaviour when reducing Distraction-Flexion injuries of the cervical spine?" Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/2840.
35
Nortje, Marc Boydell. "Single pin versus multiple pin fixation in the management of slipped upper femoral epiphysis." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/2846.
36
Thiart, Gerhard. "The influence of different connecting rod configurations on the stability of the Ilizarov Frame: A biomechanical study." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27557.
Анотація:
Background: The Ilizarov external fixator (IEF) is frequently used in trauma and elective orthopaedics. Many of its biomechanical variables (ring size; wire diameter; wire number; half pins versus wires; etc.) and their influence on stability and stiffness have been investigated. There is however a paucity in the literature regarding the influence of the connecting rod numbers and configurations between the rings on IEF stability. Objectives: Primarily to compare the stability between four and three rod IEF configurations. Secondarily to assess the difference in stability between symmetrical and asymmetrical spacing of the IEF rods. Methods: A custom jig was designed to facilitate mounting of a basic two ring IEF in a hydraulic press. Controlled centre and off centre (thus simulated bending) axial loading was then applied across the frame. The configurations were loaded up to 4000 Newtons. The frame deformation was plotted and the data was then analysed and interpreted. Results: Negligible differences were observed between different four and three rod configurations as long as the applied force at the loading point (LP) was within the area of support (AOS) created by the rods. The different four rod constructs were always more stable than the three rod constructs during bending. Conclusions: There is comparable stiffness between a four rod and a three rod IEF construct as long as the loading point (LP) is within the area of support (AOS) created by the rods. A four rod IEF is stiffer than a three rod IEF in bending.
37
Dix-Peek, Stewart. "Pelvic osteotomies for exstrophy : a review of techniques and outcomes at Red Cross Children's Hospital." Master's thesis, University of Cape Town, 2007. http://hdl.handle.net/11427/2838.
38
Sluis-Cremer, Timothy Richard. "Minimally invasive CT-guiding excision of benign bone tumours." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29681.
Анотація:
Background: The management of osteoid osteoma (OO) and other small primary benign lesions of bone has evolved over the past 50 years from open surgery with wide resection margins to less invasive surgical techniques such as image guided intralesional excision and percutaneous radiofrequency ablation. We aim to evaluate the outcomes of patients treated with computerised tomography (CT guided) intralesional excision and bone grafting of small benign lesions of bone. Method: A retrospective folder review of patients treated in a large academic hospital in Cape Town, South Africa, between March 2012 and May 2016 was performed. Patient demographics, details of presentation, clinical information and outcome following treatment were analysed descriptively. Pre-operative diagnosis based on radiological examination was compared with histological diagnosis. Result: Eleven patients (5 male) with a median age of 16 years (range 5-33) were included. Pain was the most common presenting feature. A histological diagnosis of OO was confirmed in 5 of 9 patients with a suspected diagnosis of OO preoperatively. Of the 4 patients whose diagnosis changed after the procedure the diagnoses included a benign spindle cell lesion, a benign fibrous histiocytoma, subacute osteitis and an osteochondral defect with geode cyst formation. Of the 2 patients where OO was not suspected preoperatively, chondroblastoma was confirmed in one while a benign spindle cell lesion was reported in the other. Overall histological yield was thus 100%. There were no complications or repeat procedures at a median follow up of 42 months (range 30-52 months). Conclusion: CT guided intralesional curettage is a safe and minimally invasive technique. This is especially useful in less accessible regions of the skeleton as it provides a means of accurately locating the lesion with minimal risk of complications and morbidity to the patient. We consider this to be the optimal method of treatment in our setting as it provides high success rates, few complications and a histological diagnosis without the need for any additional and expensive equipment.
39
Grey, Barend Christiaan. "Humeral stem loosening following reverse shoulder arthroplasty - systematic review and meta-analysis." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24990.
Анотація:
Background: Aseptic stem loosening following reverse shoulder arthroplasty (RSA) is an uncommon complication. The majority of literature on RSA consists of case series with short follow-up periods. It remains unknown which factors contribute to aseptic stem loosening in RSA. Our analysis aimed to compare the incidence of aseptic stem loosening, humeral radiolucent lines (RLL) and revision for stem loosening between: 1) cemented and uncemented stems, and 2) different etiological subgroups Methods: In a systematic review 75 articles were included after assessment of study methodology and a meta-analysis of 1660 cemented and 805 uncemented stems was performed. We compared the incidence of aseptic stem loosening, humeral RLL, and revision for stem loosening between: 1) cemented and uncemented stems from cohorts with short (< 5 years) mean follow-up periods, long (≥ 5 years) mean follow-up periods, and all cohorts combined; and 2) different etiological subgroups. Results: The overall incidence of aseptic stem loosening was 1%. When comparing cemented to uncemented stems, there was no significant difference in the incidence of aseptic stem loosening or of revision for stem loosening in both the short and long term follow-up groups. Humeral RLL were more common with cemented stems (15.9% versus 9.5%, p = 0.002). The highest incidence of aseptic stem loosening occurred in the tumor subgroup (10.81%), followed by RSA as revision for failed arthroplasty (3.66%). No stem loosening was seen in the acute fracture or fracture sequelae groups. Conclusion: Aseptic stem loosening occurred more commonly in cohorts with long follow-up times (2% vs 0.8%, p = 0.01). There was no difference in the incidence of aseptic stem loosening or revision for stem loosening between cemented and uncemented stems. Humeral RLL occurred more frequently when cemented stems were used. Patients treated with RSA following excision of proximal humerus tumors and RSA as revision for failed arthroplasty were at greater risk of aseptic stem loosening.
40
Michael, Held. "Reliability of shoulder symptom recall after one year in a retrospective application of the oxford shoulder score." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/2842.
41
Koller, Ian M. "Locking plates for distal femur fractures does an increased working length improve healing?" Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/2844.
Анотація:
Includes abstract.Includes bibliographical references.
Distal femur locking plates have become a very popular means of internal fixation because of their ability to provide stable distal periarticular fixation. In spite of this enthusiasm however several studies have reported significant problems with healing. In the distal femur it is recognized that locking plate fixation may be too rigid if used in certain configurations that limit the essential micro movement required for biological healing. Implant failure may arise from rigid configurations that cause excessive hardware stress concentrations. In an attempt to address these problems longer plates and an increased working length have been proposed to reduce construct rigidity. The purpose of our study is to investigate whether an increased working length translates into improved healing.
42
Mcguire, Duncan Thomas. "Pyrocarbon proximal interphalangeal joint arthroplasty." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11636.
Анотація:
Arthritis of the proximal interphalangeal joint of the hand can be debilitating disease resulting in pain and stiffness. Treatment is initially conservative but with diseasse progression surgical treatment often becomes necessary. Arthroplasty is one of the surgical options available.
43
Garrett, Benjamin R. "Knee pain, swelling and stiffness after total knee replacement : a survey of South African knee surgeons." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/2841.
44
Maree, Michelle Nerine. "An alternative treatment for type B Ulnar Polydactyly." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/2845.
Анотація:
Includes summary.Includes bibliographical references (leaves 47-50).
Rudimentary ulnar polydactyly is one of the most common congenital hand anomalies. These are conventionally treated by suture ligation in the neonatal period or by formal excision, when the child is one year of age. For the last three years, the Congenital Hand Unit at Red Cross Children’s Hospital has used vascular clip ligation as an alternative method of treatment for rudimentary ulnar polydactyly, based on the same principle as suture ligation, but with less associated complications. A study was performed at the unit, where two hundred and nineteen supernumerary digits were treated over a two-year period. The digits were ligated using a vascular clip, as an outpatient procedure.
45
White, Clive David. "Late-onset Blount's disease." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11634.
Анотація:
Includes bibliographical references.In 1937 WP Blount published a review of tibia vara or osteochondrosis deformans of the proximal tibia. Late-onset Blount's disease is varus deformity of the proximal tibia that occurs at or after 6 years old (excluding late presenting infantile Blount's) and has an associated femoral varus.
46
McCollum, Graham. "An investigation into the intramedullary pressure rise during femoral nailing: does the level and type of fracture determine peak pressures during the procedure?" Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/12605.
Анотація:
Includes bibliographical references.First introduced by Kuntshner, femoral nailing has become the 'Gold Standard' of treatment for femur fractures. The efficacy and benefit of early osteosynthesis by this technique is well established. Some of the acute complications of intramedullary manipulation and nailing are fat embolism syndrome, pulmonary dysfunction and Adult Respiratory Distress Syndrome (ARDS). One of the causes of fat embolism is a raised intramedullary pressure. Investigators have shown the direct correlation of intramedullary pressure with fat intravesation and embolism in both animal and human studies. Fat embolism syndrome is unpredictable and the true incidence is unknown. Mortality from fat embolism syndrome ranges from 10-35%. The incidence is increased with associated pulmonary trauma and in the multiply injured patient. The aim of our study was to investigate the intramedullary pressure rise during reamed prograde femoral nailing and determine whether fracture level and complexity affect the peak pressures. The relevance is that certain fracture types or levels that result in the highest pressures can be identified before the operation. Measures could be taken to reduce the intramedullary pressure during the procedure, particularly in those patients at greatest risk of pulmonary complications from fat embolism. We hypothesised that more proximal, simple fractures generate higher pressures during nailing because there is a long 'closed tube' distal to the fracture. Pressure proximal to the fracture does not reach the same high levels because the intra-medullary content is able to decompress through the fracture as the reamer moves distally. With proximal fractures there is a greater volume of medullary content distal to the fracture which can enter the venous system and embolize. Fracture comminution and complexity should lead to lower intramedullary pressures because there is a greater length of the femur through which the intramedullary content can decompress. The study sought to answer the question of whether fracture level makes a difference with respect to the intramedullary pressure rise during reamed prograde nailing. The results of this study have not been submitted for publication at the time of submission of these results for the thesis.
47
Chivers, David Andrew. "Long term follow up of rotator cuff Magnetic resonance imaging changes in patients who underwent acromioplasty without repair of full thickness supraspinatus tendon tears." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16535.
Анотація:
Includes bibliographical referencesAim: To assess the MRI pathoanatomical changes 10 years after unrepaired full thickness supraspinatus tears in a population of patients that had acromioplasty done for symptomatic impingement with a rotator cuff tear.
48
Horn, Anria. "The effect of a change in plastering technique on the rate of Major Surgery in Congenital Talipes Equinovarus(CTEV)." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/21745.
Анотація:
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.
49
Bezuidenhout, Carel Willem. "The accuracy of clinical examination of rotational and sagittal laxity of the knee." Master's thesis, University of Cape Town, 2020. http://hdl.handle.net/11427/32462.
Анотація:
Purpose: This study evaluates the accuracy and reliability of clinical examination for knee laxity in degrees and millimetres when compared to movement measured by computer-assisted navigation. Methods: A cadaver lower limb was connected to a computer assisted knee surgery system (CAS) and calibrated through a mini medial parapatellar arthrotomy. Examiners estimated millimetres of sagittal and degrees of rotational laxity of the knee at 30º and 90º of knee flexion. This examination was done in the ligamentous intact knee and again after sequential release of the anterior cruciate ligament (ACL) and anterolateral ligament (ALL). The clinical assessments were compared with measurements produced by CAS. Intraclass correlation coefficient (ICC), correlation coefficient (CC) and Bland Altman plots were used to compare and summarize the data. Results: At least 21 participants assessed the knee after each sequence of ligament sectioning. The reliability of clinical examination when correlated with the CAS measurements was poor for all examination groups. The ICC was poor for sagittal laxity at 30º (R=0.02; p=0.04), rotational laxity at 30º and 90º (R=0.17; p=0.04) (R=0.3; p=0.04) respectively and sagittal laxity at 90º(R=0.47; p=0.04). The correlation coefficients were very weak for sagittal laxity at 30º (R=0.09; p=0.46), weak for rotational laxity at 30º (R=0.24; p=0.06) and 90º (R=0.3; p=0.01) and moderately weak for sagittal laxity at 90º(R=0.4; p=0.001). Clinical examination was only accurate in the detection of sagittal laxity greater than 11.6mm at 30°, and greater than 9.4mm at 90°. Clinical examination for rotational laxity was only accurate for rotational instability greater than 27.7° at 30°flexion, and 28.9° rotation at 90°. Conclusions: There was poor reliability and weak correlation between clinician estimated sagittal and rotational laxity and measurements produced by CAS. This study showed that participants could not accurately estimate laxity in degrees and millimetres and supports the need for accurate objective knee laxity measurements.
50
Joyce, Ann C. "Perspectives of Women in Orthopaedic Surgery on Leadership Development." Scholar Commons, 2016. http://scholarcommons.usf.edu/etd/6521.
Анотація:
Over the past 50 years, the demographics of medical school graduates in the United States has changed dramatically with the number of women (47%) almost equaling the number of men in 2014 (AAMC, 2014). However, the Association of American Medical Colleges (2014) reports that orthopaedic surgery has the lowest proportion of female residents, instructors, assistants, associate, and full professors of all the sub-specialties and little has changed in the past several decades.
Due to the healthcare reform and the changing needs of our society, it is importance to recruit, retain, and promote women into leadership positions. The purpose of this study is to ensure the success of women in orthopaedic surgery. A self-report survey was sent to all known women in orthopaedic surgery. The survey assessed perspectives of women in orthopaedic surgery in regards to organizational culture, leadership development, challenges, diversity, gender bias, recruitment, and retainment.
An examination of the data provides insights into areas of improvement and implications for institutional practice. The results indicated that although institutions are making progress, more advocacy for gender equality, pro-family policies, and employee retention is needed.