Intramedullary nailing appears safe and effective for treatment of metastatic bone disease, and confers good functional results, pain relief, and mobility.

Background: In paediatric trauma, measured increase in prevertebral soft tissue thickness on a lateral cervical spine (C-spine) X-ray is interpreted as swelling, raising suspicion of C-spine injury. Defining swelling in absolute measurements is cumbersome-children's sizes vary. Published recommendations are largely lacking in evidence. There may be potentially more consistent tools, for example, to measure soft tissue thickness as a ratio of vertebral body width. The aim of this study was to determine whether consistent, measurable prevertebral soft tissue to vertebral body width ratios exist for use as simple diagnostic tools in the assessment of swelling and injury in paediatric C-spine trauma. Patients and methods: C-spine trauma X-rays taken at a South African children's hospital were randomly sampled. Seventy-one unintubated X-rays from 85 controls were used to identify normal ratios. The authors measured vertebral bodies and soft tissue at each level, created all possible ratios, then chose the two least variable-one for the upper and one for the lower C-spine. Twenty cases aided in determining diagnostic accuracy for C-spine injury. Results: Mean soft tissue at the second cervical vertebral level (c2) was 38% of the seventh vertebra (C7) (95% confidence interval [CI]: 34-41.9%, standard error [SE]: 2.0%). Mean c6 soft tissue was 65.6% of C7 vertebra (95% CI: 61.9-69.3%, SE: 1.9%). In diagnosing C-spine injury, a receiver operating characteristic (ROC) curve calculation gave an empirical optimal cut-point of 53.9% and 74.4% respectively. Using practical cutoffs of 55% at c2 and 75% at c6 yielded specificities of 93.8% (95% CI: 84.8-98.3%) and 81.8% (95% CI: 70.4-90.2%), with negative predictive values of 90.9% (95% CI: 81.3-96.6%) and 91.5% (95% CI: 81.3-97.2%) respectively. Conclusion: Consistent and specific ratios exist in the upper and lower paediatric C-spine. Both ratios have poor sensitivities and positive predictive values and so are poor screening tools; however, a positive result can raise suspicion of C-spine injury in high-risk individuals. This can help to motivate for further investigations such as computer tomography (CT) or magnetic resonance imaging (MRI), which may not be easily accessible in under-resourced settings. However, further research is required to validate the diagnostic value of these ratios.

Introduction Institutions are increasingly using technology to augment the class learning experience of medical students. Especially in Africa, local content is key to allow insights and knowledge to emerge and build transformative capacity for students and patients. There is currently no peer-reviewed video content produced to provide insight into Orthopaedic conditions for medical students and patients in this region. Our goal was to evaluate the demographic and geographic viewership as well as video-specific statistics of orthopaedic teaching videos for medical students on a YouTube channel, with the expressed aim of informing future content production. Methods Videos were produced by local medical students for their in problem-based collaborative projects. Student-owned smartphones and various free video editing software were used to produce these videos, which were then assessed by a group of orthopaedic specialists and uploaded onto a Youtube channel (UCTeach). The analytic reports of this channel generated by Google and YouTube were analysed regarding watch time per day (minutes), average view duration (minutes), most watched videos, top geographies, age, and gender. Results A total of 83 videos of the UCTeachOrtho Channel where uploaded in a two year period with a total watch time of 857 062 minutes and 337 983 views. The majority of viewers where between the ages 18 and 34 years (85%). India had the most views (n=69,089) followed by the United States (n=66,257) and South Africa (n=21,882). Most of the videos where watched on mobile phones (n= 183,299) and computers (n=128,228). The most watched video was produced in April 2016 on physiological and pathological gait with 51,314 views. Conclusion Our study highlights that a low-cost collaborative video project can lead to high view counts and watch time on YouTube, and is accessible to an audience in low and middle income countries. Student-centred local content in orthopaedic surgery also reached a global audience consistently over a two-year period.