BACKGROUND: Paediatric diaphyseal femoral fractures account for less than 2% of all paediatric fractures. Studies suggest that children aged 5-11 years who weigh < 49 kg with femoral diaphyseal fractures may be the best candidates for titanium elastic nails. Elastic flexible nailing has gained wide use because it offers good results with minimal complications in stable femoral diaphyseal fractures. However, the effectiveness of titanium elastic nails for the management of unstable paediatric femoral fractures remains debatable. This study aimed to elicit the effectiveness of titanium elastic nails in unstable paediatric femoral diaphyseal fractures when combined with postoperative immobilisation with skin traction METHODS: This retrospective review included paediatric patients aged 3-11 years with unstable femoral shaft fractures treated with titanium elastic nails who were admitted to the paediatric orthopaedic department at a tertiary academic hospital between January 2017 and December 2020, and had a minimum follow-up of six months. The unstable fractures were spiral, comminuted, or long oblique fracture patterns RESULTS: A total of 67 patients were reviewed, with a mean age of 6 (4-7) years. Fracture union was noted at eight (8-9) weeks. Fifty patients (75%) had excellent overall outcomes according to the Flynn score CONCLUSION: Retrograde titanium elastic nailing may be indicated for the management of unstable paediatric femoral fractures when supplemented by postoperative immobilisation with skin traction in the initial two weeks LEVEL OF EVIDENCE: 4
BACKGROUND: The aim of this study was to retrospectively review adolescent idiopathic scoliosis (AIS) patients treated surgically at a tertiary institution in the Western Cape. Additional objectives were to determine whether clinical parameters prior to surgery are associated with specific peri- and postoperative outcomes, and to determine crude costs of AIS treatment in this spinal unit METHODS: A retrospective observational study of clinical and radiological records was performed for 62 AIS patients treated between 1 January 2011 and 31 December 2019 at a tertiary academic hospital. Patient demographics and clinical characteristics were recorded, and appropriate correlation and associations were investigated, with post-hoc tests being performed where necessary, to investigate differences between multiple groups RESULTS: The median age was 13.5 (interquartile range [IQR] 12-15) years and the cohort included predominantly females. It took a median of 405.5 (IQR 227-1 019) days before patients presented at the spinal clinic, after which they waited a median of 275 (IQR 207-379) days for surgery. The mean Cobb angle at presentation was 63.3° ± 18.5°, compared to 71.2° ± 18.3° prior to surgery, with 18% of participants progressing from a 'non-severe curve' (< 70°) to 'severe' (> 70°) while awaiting surgery. A weak positive correlation was observed between the curve magnitude prior to surgery and the total theatre time, with larger curves requiring more theatre time. As expected, a significant association between the curve magnitude and the number of vertebrae levels requiring fusion (p < 0.001) was observed. The cost of treatment for the total study cohort amounted to more than R9 million, with a crude estimate of R89 807 per patient CONCLUSION: AIS patients treated in this study demonstrated long waiting times for surgery with a significant use of financial and physical resources. Eighteen per cent of patients progressed from a non-severe to a severe curve type due to prolonged waiting times. Early detection of AIS could potentially result in significant reduction of patients requiring surgery and as such, school and other screening programmes should be investigated as a potential tool to identify at-risk patients LEVEL OF EVIDENCE: 4
BACKGROUND: Radiofrequency ablation (RFA) is a well-established treatment for spinal facet joint pain, especially in developed countries. However, several aspects of RFA lack high-quality evidence and the treatment remains contentious. In South Africa, little is known about the perception of RFA or how widely it is utilised. This study investigated the knowledge, attitude and practices of South African spine surgeons concerning the use of RFA to treat chronic axial back pain METHODS: A survey was conducted at the 2023 South African Spine Society Congress. Spinal orthopaedic surgeons and neurosurgeons were eligible to participate. Responses were presented using descriptive statistics: overall and by subgroups who did and did not practise RFA. Factors associated with conducting RFA were investigated in univariate and multivariate analyses RESULTS: Eighty-nine spine surgeons completed the survey, of which 43 (49%) conducted RFA. Full-time private practice had the strongest association with conducting RFA (adjusted risk ratio 2.52, 95% confidence interval [CI] 1.23-5.16). Overall, 62 of 87 (70%) respondents regarded RFA as a good treatment option in certain patients, including 19 of 45 (42%) of respondents who do not conduct the procedure. RFA training was heterogeneous, with course attendance the most common source of training (16 of 41, 39%). RFA practitioners conducted a median of 50 RFAs per year (interquartile range [IQR] 20-80 RFAs per year), although ten practitioners conducted ≥ 100 RFAs per year CONCLUSION: Among the spine surgeons surveyed, there was majority support for the use of RFA in certain patients, and approximately half of respondents conducted the procedure. Findings of potential concern included heterogeneity in RFA training and the observation that a few surgeons conducted particularly high volumes of RFA. Further research should explore whether RFA is used appropriately and effectively in the South African setting by investigating patient selection and technique LEVEL OF EVIDENCE: 3
