Browsing by Author "Marais, L. C."

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    Calcific myonecrosis following snakebite
    (South African Orthopaedic Association, 2017) Ferreira, N.; Marais, L. C.
    Calcific myonecrosis is a rare condition and is believed to be a late sequela of untreated compartment syndrome. Patients usually present with a progressively enlarging mass, years after the initial injury, that can be misdiagnosed as a soft tissue sarcoma. Calcific myonecrosis following snakebite is extremely rare. The anterior compartment of the leg is most frequently involved and appears to be especially vulnerable to developing this complication. Conservative management should be considered in asymptomatic patients but spontaneous soft tissue breakdown with sinus formation may develop and prolonged surveillance is advised. We report two similar cases of calcific myonecrosis of the anterior compartment of the lower leg that developed decades following snakebite.
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    Circular external fixation in the management of tibial plateau fractures in patients over the age of 55 years
    (South African Orthopaedic Association, 2018) Marais, L. C.; Ferreira, N.
    Introduction: Tibial plateau fractures in the elderly pose significant treatment challenges because of coexisting medical problems, pre-existing degenerative joint disease and osteoporosis. While several studies have reported promising results with the use of circular external fixation, little data is available on its use in older patients. This study aims to compare the complications and union rate of circular external fixation in patients over the age of 55 years with that achieved in younger patients. Materials and methods: We retrospectively reviewed all patients treated with circular external fixation over a six-year period. Patients were divided in two groups: Group 1 consisted of patients under the age of 55 years and Group 2 of patients 55 years and older. Group 1 consisted of 63 cases (mean age 37.2 ± 9.1 years and Group 2 of 16 cases (mean age 60.2 ± 5.8 years). Apart from the patient age, there was no significant difference between the two groups in terms of demographics, mechanism of injury (p-value = 0.9) or the prevalence of polytrauma (p=1.0). Results: At a mean follow-up of 19 ± 6.2 months all but two of the fractures had united. The mean overall duration of external fixation was 20.2 ± 8.2 weeks, with a slightly longer mean time-in-frame in Group 1 (20.9 ± 1.1 weeks) in comparison to Group 2 (17.8 ± 1.4 weeks, p=0.1). Complications occurred more frequently in patients over the age of 55 years (56% vs 37%, p-value = 0.2). Loss of reduction also occurred more frequently in patients over 55 years (19%), compared to patients younger than 55 years (6%) (p=0.1). Conclusion: Circular external fixation may be a viable treatment option in patients over the age 55 years who sustain high-energy tibial plateau fractures associated with significant soft tissue compromise. No significant difference was found in terms of the union rate or the development of complications when compared to younger patients.
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    HIV seroprevalence and its relation to bone infection, bone tumours and limb reconstruction patients in a South African tertiary hospital
    (South African Orthopaedic Association, 2017-11) Kruger, N.; O'Connor, M.; Ferreira, N.; Marais, L. C.
    BACKGROUND: HIV infection causes a relative immunodeficient state, potentially predisposing patients to osseous infection. It is also associated with non-AIDS defining cancers, and has been described in patients with limb girdle sarcomas and malignant fibrohistiocytic tumours. HIV is further known to suppress cells important in bone healing; however, it is unclear whether bone tumours and mal- or non-unions are more prevalent in patients with HIV. This study aimed to determine the HIV seroprevalence of patients attending a tumour, sepsis and reconstruction (TSR) unit, and explore its relationship to bone infection, bone tumours and patients undergoing limb reconstruction. METHODS: A retrospective review of all adult patients treated over a three-year period was performed. Patients were stratified according to pathology into bone infection, bone tumour, and limb reconstruction categories. Each patient had an opt-in HIV test as part of routine workup. Recruitment, prevalence and statistically significant relationship were then calculated relative to the HIV-uninfected cohort. RESULTS: Nine-hundred-and-six patients were included, 21.3% of whom were HIV positive. There were 313 patients with bone infection, 263 patients with bone tumours, and 330 limb reconstruction patients. All groups were similar in HIV prevalence. There was no statistically significant difference between the HIV-positive or -negative patients in any of the groups. CONCLUSION: This series found no significant difference in the incidence of bone infections, bone tumours or the need for limb reconstruction, between HIV-positive and -negative patients.
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    Optimising perioperative care for hip and knee arthroplasty in South Africa : a Delphi consensus study
    (BioMed Central, 2018-05-09) Plenge, U.; Nortje, M. B.; Marais, L. C.; Jordaan, J. D.; Parker, R.; Van der Westhuizen, N.; Van der Merwe, J. F.; Marais, J.; September, W. V.; Davies, G. L.; Pretorius, T.; Solomon, C.; Ryan, P.; Torborg, A. M.; Farina, Z.; Smit, R.; Cairns, C.; Shanahan, H.; Sombili, S.; Mazibuko, A.; Hobbs, H. R.; Porrill, O. S.; Timothy, N. E.; Siebritz, R. E.; Van der Westhuizen, C.; Troskie, A. J.; Blake, C. A.; Gray, L. A.; Munting, T. W.; Steinhaus, H. K. S.; Rowe, P.; Van der Walt, J. G.; Isaacs Noordien, R.; Theron, A.; Biccard, B. M.
    Background: A structured approach to perioperative patient management based on an enhanced recovery pathway protocol facilitates early recovery and reduces morbidity in high income countries. However, in low- and middle-income countries (LMICs), the feasibility of implementing enhanced recovery pathways and its influence on patient outcomes is scarcely investigated. To inform similar practice in LMICs for total hip and knee arthroplasty, it is necessary to identify potential factors for inclusion in such a programme, appropriate for LMICs. Methods: Applying a Delphi method, 33 stakeholders (13 arthroplasty surgeons, 12 anaesthetists and 8 physiotherapists) from 10 state hospitals representing 4 South African provinces identified and prioritised i) risk factors associated with poor outcomes, ii) perioperative interventions to improve outcomes and iii) patient and clinical outcomes necessary to benchmark practice for patients scheduled for primary elective unilateral total hip and knee arthroplasty. Results: Thirty of the thirty-three stakeholders completed the 3 months Delphi study. The first round yielded i) 36 suggestions to preoperative risk factors, ii) 14 (preoperative), 18 (intraoperative) and 23 (postoperative) suggestions to best practices for perioperative interventions to improve outcomes and iii) 25 suggestions to important postsurgical outcomes. These items were prioritised by the group in the consecutive rounds and consensus was reached for the top ten priorities for each category. Conclusion: The consensus derived risk factors, perioperative interventions and important outcomes will inform the development of a structured, perioperative multidisciplinary enhanced patient care protocol for total hip and knee arthroplasty. It is anticipated that this study will provide the construct necessary for developing pragmatic enhanced care pathways aimed at improving patient outcomes after arthroplasty in LMICs.