A Horn

Distal interlocking screw placement in the femur: free-hand versus electromagnetic assisted technique (sureshot).

Objectives: To compare the free-hand (FH) technique of placing interlocking screws to a commercially available electromagnetic (EM) targeting system in terms of operating time, radiation dose, and accuracy of screw placement. Methods: Between September 2011 and July 2012, we prospectively randomized 100 consecutive femur shaft fractures in 99 patients requiring intramedullary nails to either FH using fluoroscopy (n = 43) or EM targeting (n = 38; Sureshot). Setting: Single Level 1 University Hospital Trauma Center. Main Outcome Measurements: The 2 groups were assessed for distal locking with respect to time, radiation, and accuracy. Results: Eight-one fractures had data accurately recorded (38 EM/43 FH). The average total operative time was 50 minutes (range, 25–88 minutes; SD, 13.9 minutes) for the FH group and 57 minutes (range, 40–103 minutes; SD, 16.12 minutes) for the EM group. The average time for distal locking was 10 minutes (range, 4–16 minutes; SD, 3.56 minutes) with FH and 11 minutes (range, 6–28 minutes; SD, 10.24 minutes) with EM. Average radiation dose for distal locking was significantly less (P < 0.0001) for EM at 230.54 &mgr;Gy (range, 51–660 &mgr;Gy; SD, 0.17 &mgr;Gy) compared with 690.27 &mgr;Gy (range, 200–2310 &mgr;Gy; SD, 0.52 &mgr;Gy) for FH. There were 2 misplaced drill bits in FH and 3 in EM. This was not statistically significant (P = 0.888). Conclusions: The electromagnetic targeting device (Sureshot) significantly reduced radiation exposure during placement of distal interlocking screws, without sacrificing operative time, and was equivalent in accuracy when compared with the FH technique. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

The orthopaedic management of myelomeningocele

Despite improvement in antenatal care and screening, myelomeningocele remains the most common congenital birth defect, with a reported incidence of 1 - 2.5/1000 patients in the Western Cape, South Africa. The multidisciplinary team involved in the Spinal Defects Clinic at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa consists of neurosurgeons, urologists, orthopaedic surgeons, stomatherapists and orthotists. Orthopaedic surgeons have a protean involvement in the management of myelomeningocele.

Double pathology, sarcoidosis associated with multiple myeloma: A case report

The association of sarcoidosis with multiple myeloma is not well known. Including this case report, 12 cases of patients with both sarcoidosis and multiple myeloma have been reported in the literature. The skeletal lesions of both conditions have many clinical and radiological similarities, and unless clinicians are aware of the association and the possibility of dual pathologies, the diagnosis of multiple myeloma in patients known with sarcoidosis may be missed. We present a case of a patient known with longstanding sarcoidosis who was found to have multiple lesions on magnetic resonance imaging (MRI) involving the pelvis and both proximal femurs. Histological analysis revealed the presence of both non-necrotising granulomas consistent with sarcoidosis, and sheets of plasma cells consistent with a plasma cell neoplasm.

A reduction of necrotising enterocolitis at Groote Schuur Hospital nursery

Necrotising enterocolitis (NEC) is an gastro-intestinal emergency occurring almost solely in preterm, low birth weight infants. Mortality, morbidity and the complication rate are high. An increase in NEC at the Groote Schuur Hospital nursery in 2008 prompted a change of practice, resulting in a significant decrease in the condition.