Lee Van Rensburg - Academia.edu (original) (raw)

Papers by Lee Van Rensburg

$Research paper thumbnail of Virtual fracture clinics: be vigilant for the ligamentous elbow injury$

Journal of Surgical Case Reports

The Covid-19 pandemic encouraged remote healthcare and led to dependency on virtual fracture clin... more The Covid-19 pandemic encouraged remote healthcare and led to dependency on virtual fracture clinics (VFC). VFC are orthopaedic consultant-led clinics where cases are reviewed virtually following referral by emergency department clinicians. Success is contingent on a comprehensive initial history and examination. This pathway has high patient satisfaction rates and cost-saving benefits. However, clinicians must be vigilant for high-energy mechanisms or examination findings suggestive of greater underlying injury. In this case, VFC missed a rare ipsilateral annular ligament injury in a 15-year old with an undisplaced radial neck fracture, following a fall from a horse. This led to radial head dislocation and delayed surgical repair. Untreated, radial head dislocations lead to pain and reduced range of movement. Despite the rarity of this injury pattern, face-to-face orthopaedic examination would have raised concern for significant ligamentous injury. A high-energy mechanism of injury...

International Orthopaedics, 2012

Purpose This study describes a case series of 15 patients with radial head fractures who underwen... more Purpose This study describes a case series of 15 patients with radial head fractures who underwent radial head excision using an arthroscopic technique. Methods Over a four year period, 15 patients (average age 49.6 years) who had sustained a radial head or radial neck fracture underwent an arthroscopic excision of the radial head. Four patients had an unreconstructable comminuted fracture (early group; EG) and 11 patients had pain and loss of motion with an associated non-or malunion (late group; LG). Results The mean time to surgery following injury was three weeks (one to five) for the EG and 27 weeks (eight-58) for the LG. The average visual analogue scale (VAS) was 1.7 (zero to four), and the average Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score was 24.7 (16-44). At final follow-up, average supination was 62.0°(range 45-75°) and pronation was 63.3°(range 45-75°). There were no complications. Conclusion This series demonstrates that arthroscopic excision of fractures of the radial head and neck is reliable, reproducible and safe, with similar results to open excision. There may also be additional benefits in the short term with regards to speed of healing and rehabilitation.

$Research paper thumbnail of Nonoperative treatment of humeral shaft fractures revisited$

PURPOSE The purpose of this study was to examine the union rate of humeral shaft fractures treate... more PURPOSE The purpose of this study was to examine the union rate of humeral shaft fractures treated nonoperatively and to establish whether a particular fracture type is more likely to go on to nonunion. METHODS Radiographs and patient records of 207 humeral shaft fractures occurring during 5 years were retrospectively reviewed. All patients were initially managed nonoperatively and placed in a U-slab on diagnosis in the emergency department; this was converted to a functional humeral brace at 7 to 10 days after injury. Fracture location, morphology and comminution were assessed radiologically. Union was defined as the absence of pain and movement at the fracture site in the presence of radiographic callus formation. Nonunion was defined as no evidence of bone union by 1 year after injury or fractures requiring delayed fixation, defined as operative fixation undertaken more than 6 weeks after injury. RESULTS The study included 138 humeral shaft fracture patients; 18 patients (11%) we...

Objectives Educational theory suggests that lectures may not be the best way to impart knowledge... more Objectives Educational theory suggests that lectures may not be the best way to impart knowledge to students. The aim of this study was to compare the use of didactic lectures with that of interactive discussion sessions in undergraduate teaching of orthopaedics and trauma.

Osteoarthritis changes at the sternoclavicular joint (SCJ) have been shown to be present on compu... more Osteoarthritis changes at the sternoclavicular joint (SCJ) have been shown to be present on computed tomography in more than 90% of people over the age of 60 years. Although usually asymptomatic, when symptoms do occur, they can be very debilitating. Most patients respond favorably to conservative treatment, but there is a small cohort of patients who continue to be symptomatic despite adequate conservative treatment. Surgical management with an open SCJ excision has been shown to give satisfactory results. However, probably due to concerns with regard to damage to the mediastinal structures, instability, and scarring, there is a high threshold for surgery. Arthroscopic SCJ excision has been shown to achieve similar results to an open procedure while avoiding some of the risks. In this Technical Note, we describe the indications, imaging, and the technique of an arthroscopic excision of the SCJ.

We describe an unusual case of pseudo-aneurysm of the lateral circumflex femoral artery following... more We describe an unusual case of pseudo-aneurysm of the lateral circumflex femoral artery following fixation of an undisplaced intracapsular neck of femur fracture. We highlight the need for a high index of suspicion and the value of angiography as the investigation of choice.

$Research paper thumbnail of Mid-term outcomes of surgical management of complex, isolated radial head fractures: a multicentre collaboration$

European Journal of Orthopaedic Surgery & Traumatology

Objectives The available literature discussing optimal surgical management of Mason II and III ra... more Objectives The available literature discussing optimal surgical management of Mason II and III radial head (RH) fractures without concomitant bone or ligamentous injuries is limited. We aim to help determine the appropriate management of these functionally significant injuries. Design We present our retrospective cohort study of outcomes of surgically managed isolated, displaced RH fractures Setting Study from three trauma centres. Patients/Participants Adults who underwent surgical treatment for isolated displaced RH fractures. Intervention RH open reduction internal fixation (ORIF), replacement or excision Main outcome measurements Elbow range of motion (ROM), pain and function using Oxford Elbow Score (OES), Mayo Elbow Performance Score (MEPS), Patient-Rated Elbow Evaluation (PREE) and QuickDASH (QD). Results Of 46 patients included (mean age 47 years and mean follow-up 48 months), 12 type II fractures were treated with ORIF and 34 type III injuries had ORIF (16), replacement (12) or resection (6). ROM was comparable in all groups, with mean arcs of flexion–extension of 131° and pronation–supination of 147°. Mean visual analogue score for pain was 1.3 in those treated with ORIF compared to 1.9 with arthroplasty and 2.5 with excision. Mean functional scores were 41, 92, 14 and 14 for OES, MEPS, PREE and QD, respectively. Complication rates were 39% for ORIF, 33% for arthroplasty and 33% for resection. Overall re-operation rate was 13%. Conclusions Functional outcome is similar in all groups of surgically treated patients with isolated, displaced RH fractures. Complication rates are higher than that reported previously in the literature but with low re-operation rates. Level of evidence IV

$Research paper thumbnail of The incidence of medial end clavicle fractures is higher than had previously been considered$

Shoulder & Elbow

Background Previous X-ray epidemiological studies have estimated the incidence of medial end clav... more Background Previous X-ray epidemiological studies have estimated the incidence of medial end clavicle fractures to account for 2–3% of all clavicle fractures. Materials and methods At our institution X-rays of every patient attending the Emergency Department are reviewed at a Virtual Fracture Clinic by a Consultant Orthopaedic Surgeon. Patients with a fracture are referred to the Shoulder and Elbow Fracture Clinic. Patients without a fracture are contacted and, if there are on-going concerns, are referred to the Shoulder and Elbow Fracture Clinic. Over an 18-month period we identified every patient that attended our Emergency Department that had sustained a clavicle fracture. Results In total 558 clavicle fractures were identified (139 (24.9%) – lateral, 360 (64.5%) – middle, 59 (10.6%) – medial). Of the 59 medial end fractures, 31 (52.5%) were identified on presentation at the Emergency Department, 13 (22%) at the Virtual Fracture Clinic, 6 (10.2%) on computed tomography scan at th...

European Journal of Orthopaedic Surgery & Traumatology

We present three cases of proximal radioulnar translocation in adults. Although rare, it is most ... more We present three cases of proximal radioulnar translocation in adults. Although rare, it is most commonly seen in paediatric cases. There have been three previously documented cases in adults, all requiring surgery and associated with ulnohumeral dislocations. Two of our cases required operative intervention, whilst one was reduced closed and did not require stabilisation. Furthermore, we have for the first time shown that proximal radioulnar translocations can occur in isolation in adults without an ulnohumeral dislocation. Level of evidence Level IV.

$Research paper thumbnail of Displaced medial end clavicular fractures treated with an inverted distal clavicle plate contoured through 90 degrees$

Journal of Shoulder and Elbow Surgery

BACKGROUND This study assessed whether treating medial end clavicular fractures using an inverted... more BACKGROUND This study assessed whether treating medial end clavicular fractures using an inverted distal clavicle locking plate, twisted through 90° around its axis, would allow for a less invasive surgical approach and improve screw trajectory insertion. MATERIALS AND METHODS We searched the databases of the 2 senior authors for patients who had sustained an acute, displaced fracture of the medial end of the clavicle and had undergone operative fixation using an inverted distal clavicle plate contoured through 90°. Through an inferior incision, a contoured locking plate was positioned on the anterior surface of the medial end of the clavicle. Up to 8 unicortical screws were inserted from anterior to posterior through the medial end of the plate. The lateral end was contoured and fixed to the superior clavicular surface. The patients were assessed preoperatively and at 1 month, 4 months, and final follow-up. Preoperative and postoperative plain x-ray images and computed tomography scans were reviewed. RESULTS The study included 8 patients (average age, 31.3 years; range, 15-59 years) with displaced fractures who underwent fixation. The median follow-up time was 30.5 months (range, 24-45 months). All patients reached clinical and radiographic union at 4 months. The mean 11-item version of the Disabilities of the Arm, Shoulder, and Hand score was 0.6 (range, 0-2.3). All of the patients had returned to their preinjury level of sport and activity. None of the patients had a complication. CONCLUSION Contouring an inverted distal clavicle plate through 90° may improve fixation options by allowing access to the anterior clavicle when treating medial clavicular fractures.

Shoulder & elbow, 2018

BESS Surgical Procedure Guidelines (SPGs). The British Elbow and Shoulder Society (BESS) SPGs are... more BESS Surgical Procedure Guidelines (SPGs). The British Elbow and Shoulder Society (BESS) SPGs are a series of evidence and consensus developed by BESS surgeons and physiotherapists to help drive quality improvement and achieve the best possible surgical outcomes for UK patients. This SPG on primary and revision elbow replacement surgery is supported and endorsed by both the British Orthopaedic Association (BOA) and the Getting It Right First Time (GIRFT) Programme.

$Research paper thumbnail of Increased wound complication with intramedullary screw fixation of clavicle fractures: Is it thermal necrosis?$

Journal of orthopaedic surgery (Hong Kong)

Adult mid-shaft clavicle fractures are common injuries. For displaced fractures, open reduction w... more Adult mid-shaft clavicle fractures are common injuries. For displaced fractures, open reduction with plate or intramedullary (IM) fixation is the widely used techniques. All methods have their own potential drawbacks, especially related to local soft tissue complications. There is little information about outcome and management of local wound complications after clavicle fracture fixations. Ninety-seven patients underwent open reduction and internal fixation, 17 were treated with IM screw fixation and 80 with plate fixation. Wound complication occurred in eight patients (8.2%) and rates differed significantly between IM and plate fixations (29.4% vs. 3.8%). Patients were assessed on average 58.3 months with visual analogue pain scores (VASs), Oxford Shoulder Score (OSS), and QuickDash (QD) score. Five patients had wound breakdown and three patients had wound erythema. In seven patients with stable fixation, it was possible to "dress and suppress" with average 3 weeks of or...

BMJ case reports, Jan 6, 2017

Unexplained dysphagia requires prompt investigation to rule out a possible underlying malignancy.... more Unexplained dysphagia requires prompt investigation to rule out a possible underlying malignancy. We describe the case of a 60-year-old man who presented to his family practitioner with a 1-year history of increasing dysphagia with associated pain over the front of his chest. He was referred on to an ear, nose and throat specialist where no obvious laryngeal pathology was found at direct laryngoscopy, but an 'indentation' of the right anterior larynx, which increased with external pressure on the sternoclavicular joint (SCJ), was noted. A subsequent CT scan of his neck demonstrated osteoarthritis of the right SCJ with an abnormally large posterior osteophyte. The patient was subsequently referred on to an orthopaedic surgeon specialising in SCJ surgery and underwent an arthroscopic excision of his right SCJ. Soon after surgery, the patient's dysphagia had settled and his symptoms remain resolved 1 year post surgery.

Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.], 2016

Figure 1 Radial neck shaft angle. (Reprinted with permission from Goldfarb et al). To the Editor:... more Figure 1 Radial neck shaft angle. (Reprinted with permission from Goldfarb et al). To the Editor: While recently planning a distal humeral osteotomy for the correction of a gun-stock deformity, we used, for our anatomic correction, reference values published in the article entitled “Elbow radiographic anatomy: measurement techniques and normative data” by Goldfarb et al from 2012. In making measurements for the distal humeral articular surface angle, we noted a discrepancy between the angle as shown in the article’s Figure 2 (shown here as Fig. 1) and the text relating to the distal humeral articular angle. In the article, the figure displays the angle marked “X” on the ulnar side of the distal humerus. The associated text states that “An increasing angle (ie, closer to 90°) represents decreasing valgus through the distal humerus.” In fact, increasing the distal humeral articular angle as represented by the X will increase the valgus at the elbow. We note that the findings of the article relating to the distal humeral angle measurements are of an angle of 84° to 85°, which would represent a varus distal humeral angle. This parallels the findings in the article by Keats et al entitled “Normal axial relationships of the major joints,” which measured the distal humeral articular angle to be 82° to 84°. These measurements were made on the medial side, resulting in a varus angulation, although whether this distal humeral angle represents a varus or valgus angulation is not described in that article. We would greatly appreciate some clarification on this because it has potential implications for planning surgical corrections.

Bedside Procedures in the ICU, 2011

A compartment syndrome is characterized by increasing pressure in any fixed volume space within t... more A compartment syndrome is characterized by increasing pressure in any fixed volume space within the body. This will lead to decreasing blood flow into the compartment with reduced tissue perfusion and subsequent tissue ischaemia. The term compartment syndrome is most commonly associated with the musculoskeletal system. It is worth bearing in mind that it is obviously possible for the same mechanism to occur in other closed body cavities, most noticeably as abdominal compartment syndrome (see Chap. 15). Despite the fact that it is a mostly clinical diagnosis, it should be confirmed by measuring the pressure within the muscle compartments. Indications Two-thirds of acute compartment syndromes (ACS) are associated with a fracture. It is important to remember it may also follow significant soft tissue injury. ACS in the absence of trauma can be caused by

$Research paper thumbnail of Nonoperative treatment of humeral shaft fractures revisited$

Journal of Shoulder and Elbow Surgery, 2015

The purpose of this study was to examine the union rate of humeral shaft fractures treated nonope... more The purpose of this study was to examine the union rate of humeral shaft fractures treated nonoperatively and to establish whether a particular fracture type is more likely to go on to nonunion. Radiographs and patient records of 207 humeral shaft fractures occurring during 5 years were retrospectively reviewed. All patients were initially managed nonoperatively and placed in a U-slab on diagnosis in the emergency department; this was converted to a functional humeral brace at 7 to 10 days after injury. Fracture location, morphology and comminution were assessed radiologically. Union was defined as the absence of pain and movement at the fracture site in the presence of radiographic callus formation. Nonunion was defined as no evidence of bone union by 1 year after injury or fractures requiring delayed fixation, defined as operative fixation undertaken more than 6 weeks after injury. The study included 138 humeral shaft fracture patients; 18 patients (11%) were lost to follow-up, an...

International Journal of Surgery, 2014

Techniques in hand & upper extremity surgery, Jan 24, 2015

Surgical exposure of the radial head, proximal radius, capitellum, and proximal ulna can be achie... more Surgical exposure of the radial head, proximal radius, capitellum, and proximal ulna can be achieved through several different approaches. The most commonly used are: the Kocher, Kaplan, and extensor digitorum communis splitting. Each of these approaches has its own limitations and dangers. In this article we describe a modified version of the less commonly used Boyd approach. We have used this approach with a transosseous lateral collateral ligament and annular ligament repair for operative treatment of fractures involving the radial head, proximal radius, proximal ulna including the coronoid, capitellum, and lateral column of the distal humerus. In our experience, the approach results in superior exposure of the lateral elbow while minimizing the risk of injury to the posterior interosseous nerve.

$Research paper thumbnail of Virtual fracture clinics: be vigilant for the ligamentous elbow injury$

Journal of Surgical Case Reports

International Orthopaedics, 2012

$Research paper thumbnail of Nonoperative treatment of humeral shaft fractures revisited$