No abstract

Cost saving strategies are important especially in a resource constrained environment. One such strategy well supported in literature is the reuse of temporary monolateral external fixator components, a strategy we utilize at our institution. The aim of the study was to determine the safety and cost saving associated with the reuse of definitive circular external fixator components in a resource constrained environment. Method:We performed a retrospective review of all adult patients who were treated with either new or reused circular external fixators from a single manufacturer between January and December 2017. Reused circular external fixator components, excluding half pins and wires, were subjected to an in-house reprocessing protocol. Cost savings were calculated as the difference between the price of a completely new frame and the amount invoiced for new components only in a reused frame.Results: 33 patients were included in the study with an average age of 31.9 years. The mean duration of treatment with a circular external fixator was 5.8 months. No mechanical failure events were recorded during the study period. Our institution saved approximately 52% (R717 503.89) and 63 % (R136 568.19) of expected total cost for hexapod and Ilizarov frames respectively. Conclusion:The strategy of reusing circular external fixator components is unconventional and this study was conducted to evaluate the safety and potential savings in a resource constrained environment. We demonstrated this practice to be reasonably safe and to result in significant cost savings which might be relevant in low-and-middle income countries (LMICs).

Background: Hip fractures are common, and account for significant morbidity and mortality. While surgical intervention remains the gold standard, nonoperative treatment protocols are seldom analysed and may be of value in select settings. Objectives: We sought to review our conservatively treated pertrochanteric fractures and present a case series that outlined indications, treatment protocol and early outcomes. Materials and Methods: A retrospective review of medical records and radiographic imaging of all patients who presented with stable pertrochanteric fractures and were treated nonoperatively, from September 2017 to February 2021, at a Level 2 District Hospital in South Africa. Results: Of the 242 patients who were admitted with pertrochanteric fractures, 12 (4.9%) fractures were radiographically classified as AO 31A1.2 (stable, minimally displaced) and eligible for active nonoperative management. Within 6 weeks of injury, 10 (84%) of the patients who received active nonoperative treatment achieved union. Two patients (16%) failed the treatment protocol and required surgery, with one failing during the hospital phase of the treatment protocol and the other on follow up. In the group of united fractures, the neck shaft angle was on average within 3 degrees of the contralateral hip with a range of 0 to 5 degrees. At follow-up, two (16%) patients had a measurable shortening of 5 mm at union. There was no medical morbidity associated with this protocol. Conclusions: In our case series, the active nonoperative management protocol, involving early mobilisation and serial radiographs, in select cases of stable pertrochanteric fractures yielded acceptable outcomes. This is of relevance in low-middle income countries with limited surgical capacity.

Background: Subtrochanteric femur fractures remain challenging injuries to treat. There is paucity of literature evaluating their outcomes and complications following low-velocity civilian gunshots. The purpose of this study is to evaluate the results of intramedullary nailing of subtrochanteric femur fractures secondary to low-velocity gunshots.

Background: To determine the pass rate of the final exit examination of the College of Orthopaedic Surgeons of South Africa [FC Orth(SA)] and to assess the correlation between the written component with the clinical and oral component. Methods: Results of candidates who participated in the FC Orth(SA) final examination during a 12-year period from March 2005 through to November 2016 were assessed retrospectively. Pass rates and component averages were analysed using descriptive and inferential statistics. Spearman's rho test was used to determine the correlation between the components. Results: A total of 399 candidates made 541 attempts at the written component of the examination; 71.5% of attempts were successful and 387 candidates were invited to the clinical and oral component, of which 341 (88%) candidates were certified. The second-attempt pass rate for those candidates who wrote the written component again was 42%. The average annual increase in the number of certified candidates was 8.5%. The overall certifying rate increased by 1.5% for this period. Invited candidates who scored less than 54% for the written component were at significant risk of failing the clinical and oral component. The written component showed weak correlation with the clinical and oral component (r=0.48). Conclusion: While the written component was found to be an effective gatekeeper, as evidenced by a high eventual certifying rate, the results of this component of the FC Orth(SA) final examination did not correlate strongly with the performance in the clinical and oral component. This finding confirms the value of the written component as part of a comprehensive assessment for the quality of orthopaedic surgeons.