Biomedical subjects
Publications and source records attributed to S Govender.
Dislocations involving both proximal and distal interphalangeal joints in only one finger are rare. Two such cases are presented; the one was treated conservatively and the other surgically. Early reduction is mandatory for a good functional hand.
We reviewed 32 patients with open pelvic fractures treated over a 5-year period. Eleven patients had isolated fractures of the ilium and in 21 patients pelvic ring disruption was associated with a perineal laceration. Three patients died from massive haemorrhage soon after admission and one patient from severe sepsis. Early pelvic stabilization and meticulous attention to the soft tissue injury proved invaluable in the management of open unstable pelvic fractures.
We reviewed 30 patients with burst fractures of the thoracic and lumbar spine treated by anterior surgical decompression and fusion between January 1983 and December 1987; 21 had partial neurological involvement while nine had complete paraplegia. At follow-up all patients with partial neurological involvement improved by one to three Frankel grades, whereas of the nine patients with complete paraplegia only one improved. Late kyphotic deformity was seen in 12 patients.
We reviewed 47 children with spinal injuries. Three distinct patterns of injury were observed: subluxations and dislocations without a fracture (type 1), spinal cord injury without radiographic abnormality (type 2), and spinal fractures which may be associated with subluxation or dislocation (type 3). The neurological recovery was poor in complete lesions associated with type 2 injuries.
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We reviewed 16 patients with salmonella osteitis or septic arthritis. All patients were immunologically normal and none had a history of typhoid fever. We discuss the importance of obtaining a bacteriological diagnosis and provide guidelines on the duration of antibiotic treatment.
Eighty-five children with femoral shaft fractures were studied prospectively to determine the benefits of early application of a single-hip spica cast. They were compared with 85 children with similar fractures treated by skin traction for 4 weeks followed by a spica cast for 2 weeks. The study revealed that femoral shaft fractures in children can be treated in a single-hip spica cast with results comparable to those achieved by traction. The additional advantages were substantial savings in cost, early reunion of child with parents and increased availability of beds.
The level of termination of the spinal cord in 115 autopsies on subjects ranging from a 20-week stillborn to an 8-month-old infant is reported. The study showed that the adult level (lower border L1) is attained at birth. In a clinical study of 10 children with diastematomyelia between the ages of 3 years and 7 years the spinal cord, which was found to terminate in the region of the lower lumbar spine, was tethered by a short thickened filum terminale.
Four patients who developed tuberculous paraplegia during pregnancy are described. They delivered at term without complications and then underwent successful decompression for paraplegia.
We report on four patients with osteomyelitis due to Sporothrix schenckii who were successfully treated with potassium iodide.
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The anterior exposure of the upper thoracic spine using standard methods is often difficult and limited. We report our experience using a technique described by Sundaresan et al. (1984) in which the medial portion of one clavicle and part of the manubrium sterni are excised. In 10 cases we found this to be a useful and safe procedure.
In a retrospective review of 302 clinically suspected cases of congenital syphilis, bone changes were found in 197. The skeletal manifestations were periostitis (102 cases), osteitis (20), and metaphyseal changes (71). Combinations of more than one lesion were found in 61. Pseudoparalysis was a presenting sign in 34 infants; 12 of these were found to have had pathological fractures and four had dactylitis. Complete radiological healing without residual changes was seen in all 59 cases that were recalled for review. The orthopaedic surgeon should consider the diagnosis of congenital syphilis when destructive lesions of bone are seen in an infant.
The results of surgical decompression in 117 patients with chronic tuberculous paraplegia, defined as paraplegia persisting for more than 3 months, were reviewed. After surgery 90 patients were able to walk. Significant findings at surgery were marked extradural fibrosis with very little caseation and pus. The study showed that paraplegia of greater than 6 months' duration was associated with a poor result. There were no cases of reactivation of the disease in the follow-up period ranging from 1 year to 4 years.
A case of spinal tuberculosis after a closed fracture, differing from the usual tuberculous spondylitis in that trauma appeared to have predisposed the affected vertebrae to haematogenous infection, is described.
A series of 42 patients with fractures of the dens is reported. All patients were initially treated on traction and then immobilized in a SOMI brace or a cervical collar with a chin piece. Union was obtained in 37 patients. There has been no case of delayed myelopathy in the severely malunited fractures.
Hydatid disease due to Taenia echinococcus involves bone in about 1% of all cases. The spine is involved in about 50% of cases. Neural compression is common in the form of paraplegia or nerve root compression. The prognosis with spinal involvement is generally regarded as very poor and often likened to that of spinal cancer. Four cases of spinal hydatid with neural involvement are presented. Three were treated by anterior spinal decompression and all four were treated with mebendazole. The results show good neural recovery and it is concluded that the prognosis is not as dismal as it was formerly thought to be.
Cryptococcal infection in man is widely disseminated and commonly involves the central nervous system. Primary bone involvement is rare. We report on 2 cases of localized cryptococcal osseous lesions treated successfully by surgery.