Publisher: SciELO   (Total: 911 journals)

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Showing 1 - 200 of 911 Journals sorted alphabetically
Abanico Veterinario     Open Access   (Followers: 3)
ABCD. Arquivos Brasileiros de Cirurgia Digestiva     Open Access   (Followers: 3, SJR: 0.207, CiteScore: 1)
ACIMED     Open Access   (Followers: 1)
Acta Agronómica     Open Access  
Acta Amazonica     Open Access   (Followers: 7, SJR: 0.36, CiteScore: 1)
Acta Bioethica     Open Access   (SJR: 0.196, CiteScore: 0)
Acta Bioquimica Clinica Latinoamericana     Open Access   (Followers: 1)
Acta Botanica Brasilica     Open Access   (Followers: 3, SJR: 0.325, CiteScore: 1)
Acta botánica mexicana     Open Access   (Followers: 1, SJR: 0.212, CiteScore: 0)
Acta Botánica Venezuelica     Open Access   (Followers: 1, SJR: 0.103, CiteScore: 0)
Acta Cirurgica Brasileira     Open Access   (SJR: 0.395, CiteScore: 1)
Acta Limnologica Brasiliensia     Open Access   (Followers: 4, SJR: 0.28, CiteScore: 1)
Acta Literaria     Open Access   (Followers: 5, SJR: 0.1, CiteScore: 0)
Acta Medica Colombiana     Open Access   (Followers: 1)
Acta Médica Costarricense     Open Access   (Followers: 2)
Acta Medica Peruana     Open Access   (Followers: 2)
Acta Neurológica Colombiana     Open Access   (Followers: 2)
Acta Nova     Open Access   (Followers: 1)
Acta Obstétrica e Ginecológica Portuguesa     Open Access   (Followers: 1)
Acta Ortopédica Brasileira     Open Access   (Followers: 1, SJR: 0.343, CiteScore: 1)
Acta Paulista de Enfermagem     Open Access   (Followers: 3, SJR: 0.275, CiteScore: 1)
Acta Pediátrica Costarricense     Open Access   (Followers: 1)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Portuguesa de Nutrição     Open Access   (Followers: 1)
Acta Scientiarum. Agronomy     Open Access   (Followers: 6, SJR: 0.431, CiteScore: 1)
Acta Scientiarum. Animal Sciences     Open Access   (Followers: 4, SJR: 0.25, CiteScore: 0)
Acta zoológica mexicana     Open Access   (Followers: 1)
Actas Odontológicas     Open Access   (Followers: 1)
Actualidades Biológicas     Open Access   (Followers: 2)
African Human Rights Law J.     Open Access   (Followers: 19)
African Natural History     Open Access   (Followers: 4, SJR: 0.198, CiteScore: 1)
Afro-Asia     Open Access  
Ágora - studies in psychoanalytic theory     Open Access   (Followers: 3, SJR: 0.132, CiteScore: 0)
Agricultura Tecnica     Open Access   (Followers: 5)
Agricultura, Sociedad y Desarrollo     Open Access   (Followers: 3)
Agrociencia     Open Access   (Followers: 1, SJR: 0.2, CiteScore: 0)
Agrociencia Uruguay     Open Access  
Agronomía Mesoamericana     Open Access   (Followers: 1)
Agronomía Tropical     Open Access   (Followers: 2)
Aisthesis     Open Access   (Followers: 7, SJR: 0.106, CiteScore: 0)
Ajayu Órgano de Difusión Científica del Departamento de Psicología UCBSP     Open Access  
Alea : Estudos Neolatinos     Open Access   (Followers: 2, SJR: 0.1, CiteScore: 0)
Aletheia : Revista de Desarrollo Humano, Educativo y Social Contemporáneo     Open Access   (Followers: 1)
Alfa : Revista de Linguística     Open Access  
Alpha (Osorno)     Open Access   (SJR: 0.138, CiteScore: 0)
Alteridades     Open Access   (Followers: 2)
Ambiente & sociedade     Open Access   (Followers: 3, SJR: 0.235, CiteScore: 0)
Ambiente & Agua : An Interdisciplinary J. of Applied Science     Open Access   (Followers: 1, SJR: 0.263, CiteScore: 1)
Ambiente Construído     Open Access   (Followers: 1)
América Latina en la historia económica     Open Access   (Followers: 4, SJR: 0.134, CiteScore: 0)
Anais Brasileiros de Dermatologia     Open Access   (Followers: 2, SJR: 0.52, CiteScore: 1)
Anais da Academia Brasileira de Ciências     Open Access   (Followers: 2, SJR: 0.418, CiteScore: 1)
Anais do Museu Paulista : História e Cultura Material     Open Access  
Anales de Medicina Interna     Open Access   (Followers: 1)
Anales del Instituto de la Patagonia     Open Access  
Anales del Sistema Sanitario de Navarra     Open Access   (Followers: 1, SJR: 0.157, CiteScore: 0)
Análise Psicológica     Open Access   (Followers: 1, SJR: 0.16, CiteScore: 0)
Análise Social     Open Access   (Followers: 4, SJR: 0.16, CiteScore: 0)
Análisis Economico     Open Access  
Andean geology     Open Access   (Followers: 9, SJR: 0.674, CiteScore: 1)
Anestesia Analgesia Reanimación     Open Access   (Followers: 1)
Anestesia en México     Open Access   (Followers: 1)
Antipoda : Revista de Antropología y Arqueología     Open Access   (Followers: 5, SJR: 0.135, CiteScore: 0)
Antropología Social y Cultural en Uruguay     Open Access   (Followers: 1)
Anuario Colombiano de Historia Social y de la Cultura     Open Access   (SJR: 0.1, CiteScore: 0)
Anuario de Historia Regional y de las Fronteras     Open Access  
Anuario de Letras : Lingüística y Filología     Open Access   (Followers: 1)
Apuntes : Revista de Estudios sobre Patrimonio Cultural - J. of Cultural Heritage Studies     Open Access   (Followers: 7)
Aquichán     Open Access   (Followers: 2, SJR: 0.137, CiteScore: 0)
Archivos de Medicina Interna     Open Access   (Followers: 1)
Archivos de Medicina Veterinaria     Open Access   (Followers: 1, SJR: 0.194, CiteScore: 0)
Archivos de Neurociencias     Open Access   (Followers: 3, SJR: 0.111, CiteScore: 0)
Archivos de Pediatria del Uruguay     Open Access   (Followers: 3)
Archivos de Prevención de Riesgos Laborales     Open Access   (Followers: 1)
Archivos de Zootecnia     Open Access   (Followers: 1, SJR: 0.202, CiteScore: 0)
Archivos Españoles de Urología     Open Access   (SJR: 0.178, CiteScore: 0)
Archivos Latinoamericanos de Nutrición     Open Access   (Followers: 2)
Archivos Venezolanos de Farmacología y Terapéutica     Open Access   (SJR: 0.101, CiteScore: 0)
Argos     Open Access   (Followers: 1)
ARQ     Open Access   (Followers: 6, SJR: 0.113, CiteScore: 0)
Arquitectura y Urbanismo     Open Access   (Followers: 4)
Arquivo Brasileiro de Medicina Veterinária e Zootecnia     Open Access   (SJR: 0.248, CiteScore: 0)
Arquivos Brasileiros de Cardiologia     Open Access   (Followers: 2, SJR: 0.381, CiteScore: 1)
Arquivos Brasileiros de Endocrinologia e Metabologia     Open Access  
Arquivos Brasileiros de Oftalmologia     Open Access   (Followers: 1, SJR: 0.518, CiteScore: 1)
Arquivos Brasileiros de Psicologia     Open Access   (Followers: 1, SJR: 0.196, CiteScore: 0)
Arquivos de Gastroenterologia     Open Access   (Followers: 1, SJR: 0.396, CiteScore: 1)
Arquivos de Medicina     Open Access   (Followers: 1)
Arquivos de Neuro-Psiquiatria     Open Access   (SJR: 0.448, CiteScore: 1)
Arquivos do Instituto Biológico     Open Access   (Followers: 1)
Arquivos Internacionais de Otorrinolaringologia     Open Access  
ARS     Open Access   (Followers: 4)
Atenea (Concepción)     Open Access   (SJR: 0.112, CiteScore: 0)
Atmósfera     Open Access   (Followers: 3, SJR: 0.449, CiteScore: 1)
Audiology - Communication Research     Open Access   (Followers: 10)
Austral J. of Veterinary Sciences     Open Access   (Followers: 2)
Avaliação : Revista da Avaliação da Educação Superior (Campinas)     Open Access  
Avaliação Psicológica     Open Access   (SJR: 0.164, CiteScore: 0)
Avances en Enfermería     Open Access   (Followers: 3)
Avances en Odontoestomatologia     Open Access   (Followers: 1, SJR: 0.105, CiteScore: 0)
Avances en Periodoncia e Implantología Oral     Open Access   (Followers: 1)
Bakhtiniana : Revista de Estudos do Discurso     Open Access   (SJR: 0.103, CiteScore: 0)
BAR. Brazilian Administration Review     Open Access   (Followers: 2, SJR: 0.137, CiteScore: 0)
Bioagro     Open Access   (Followers: 1, SJR: 0.207, CiteScore: 0)
Biosalud     Open Access   (Followers: 1)
Biota Neotropica     Open Access   (SJR: 0.381, CiteScore: 1)
Biotecnología Aplicada     Open Access   (SJR: 0.146, CiteScore: 0)
Biotecnología en el Sector Agropecuario y Agroindustrial     Open Access  
Boletim Academia Paulista de Psicologia     Open Access  
Boletim de Ciências Geodésicas     Open Access   (SJR: 0.188, CiteScore: 0)
Boletim de Educação Matemática     Open Access   (SJR: 0.196, CiteScore: 0)
Boletim do Museu Paraense Emílio Goeldi. Ciências Humanas     Open Access   (Followers: 1, SJR: 0.238, CiteScore: 0)
Boletin Chileno de Parasitologia     Open Access  
Boletín Científico : Centro de Museos. Museo de Historia Natural     Open Access   (Followers: 1)
Boletín de Filología     Open Access  
Boletín de la Sociedad Botánica de México     Open Access  
Boletin de la Sociedad Chilena de Quimica     Open Access  
Boletín de la Sociedad Geológica Mexicana     Open Access   (SJR: 0.291, CiteScore: 1)
Boletín del Museo Chileno de Arte Precolombino     Open Access   (Followers: 1, SJR: 0.233, CiteScore: 0)
Boletin Mexicano de Derecho Comparado     Open Access   (Followers: 2, SJR: 0.107, CiteScore: 0)
Bosque     Open Access   (Followers: 2, SJR: 0.29, CiteScore: 1)
Bragantia     Open Access   (Followers: 2, SJR: 0.555, CiteScore: 1)
Brazilian Archives of Biology and Technology     Open Access   (Followers: 3, SJR: 0.281, CiteScore: 1)
Brazilian Business Review     Open Access  
Brazilian Dental J.     Open Access   (Followers: 4, SJR: 0.476, CiteScore: 1)
Brazilian J. Geology     Open Access   (Followers: 1)
Brazilian J. of Biology     Open Access   (Followers: 3, SJR: 0.523, CiteScore: 1)
Brazilian J. of Chemical Engineering     Open Access   (Followers: 5, SJR: 0.395, CiteScore: 1)
Brazilian J. of Food Technology     Open Access   (Followers: 3, SJR: 0.206, CiteScore: 0)
Brazilian J. of Medical and Biological Research     Open Access   (SJR: 0.611, CiteScore: 2)
Brazilian J. of Microbiology     Open Access   (Followers: 5, SJR: 0.63, CiteScore: 2)
Brazilian J. of Oceanography     Open Access   (Followers: 1, SJR: 0.425, CiteScore: 1)
Brazilian J. of Oral Sciences     Open Access   (Followers: 2, SJR: 0.131, CiteScore: 0)
Brazilian J. of Pain (BrJP)     Open Access  
Brazilian J. of Physical Therapy     Open Access   (Followers: 2, SJR: 0.802, CiteScore: 2)
Brazilian J. of Plant Physiology     Open Access   (Followers: 3, SJR: 1.178, CiteScore: 3)
Brazilian J. of Veterinary Research and Animal Science     Open Access   (Followers: 8, SJR: 0.225, CiteScore: 0)
Brazilian Oral Research     Open Access  
Brazilian Political Science Review     Open Access   (Followers: 2)
Bulletin of the World Health Organization     Open Access   (Followers: 22, SJR: 2.532, CiteScore: 3)
Caderno CRH     Open Access   (Followers: 3, SJR: 0.233, CiteScore: 0)
Caderno de Estudos     Open Access  
Cadernos CEDES     Open Access   (Followers: 1, SJR: 0.119, CiteScore: 0)
Cadernos de Pesquisa     Open Access   (Followers: 2, SJR: 0.183, CiteScore: 0)
Cadernos de Saúde Pública     Open Access   (Followers: 1, SJR: 0.568, CiteScore: 1)
Cadernos de Tradução : Universidade Federal de Santa Catarina     Open Access  
Cadernos Metrópole     Open Access   (Followers: 1)
Cadernos Nietzsche     Open Access  
Cadernos Pagu     Open Access   (SJR: 0.356, CiteScore: 0)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Caldasia     Open Access   (SJR: 0.195, CiteScore: 0)
Calidad en la educación     Open Access   (Followers: 1)
Case Reports     Open Access  
Cerâmica     Open Access   (Followers: 6, SJR: 0.186, CiteScore: 0)
CERNE     Open Access   (Followers: 1, SJR: 0.368, CiteScore: 1)
CES Medicina     Open Access  
CES Medicina Veterinaria y Zootecnia     Open Access   (Followers: 1)
CES Psicología     Open Access   (Followers: 1)
Chilean J. of Agricultural & Animal Sciences     Open Access   (Followers: 1)
Chilean J. of Agricultural Research     Open Access   (Followers: 1, SJR: 0.377, CiteScore: 1)
Chungara (Arica) - Revista de Antropologia Chilena     Open Access   (Followers: 1, SJR: 0.565, CiteScore: 1)
Ciência & Saúde Coletiva     Open Access   (Followers: 2, SJR: 0.566, CiteScore: 1)
Ciência & Educação (Bauru)     Open Access  
Ciência Animal Brasileira     Open Access   (Followers: 1, SJR: 0.216, CiteScore: 0)
Ciência da Informação     Open Access   (Followers: 1, SJR: 0.121, CiteScore: 0)
Ciencia del suelo     Open Access   (Followers: 2)
Ciência e Agrotecnologia     Open Access   (SJR: 0.383, CiteScore: 1)
Ciencia e Cultura     Open Access   (Followers: 1)
Ciencia e Ingenieria Neogranadina     Open Access  
Ciencia e Investigación Agraria     Open Access   (Followers: 1, SJR: 0.211, CiteScore: 0)
Ciencia forestal en México     Open Access  
Ciência Rural     Open Access   (Followers: 2, SJR: 0.337, CiteScore: 1)
Ciencia y Enfermeria - Revista Iberoamericana de Investigacion     Open Access   (Followers: 3, SJR: 0.158, CiteScore: 0)
Ciencias Marinas     Open Access   (Followers: 3, SJR: 0.414, CiteScore: 1)
Ciencias Psicológicas     Open Access  
Cirugia Plastica Ibero-Latinoamericana     Open Access   (SJR: 0.166, CiteScore: 0)
Cirujano General     Open Access   (Followers: 1)
Civilizar Ciencias Sociales y Humanas     Open Access   (Followers: 3)
Civitas - Revista de Ciências Sociais     Open Access   (Followers: 3)
CLEI Electronic J.     Open Access  
Clínica y Salud     Open Access   (SJR: 0.173, CiteScore: 0)
Clinics     Open Access   (SJR: 0.536, CiteScore: 1)
Co-herencia     Open Access   (SJR: 0.106, CiteScore: 0)
CoDAS     Open Access   (SJR: 0.267, CiteScore: 0)
Cofin Habana     Open Access   (Followers: 1)
Colombia Internacional     Open Access   (Followers: 1, SJR: 0.218, CiteScore: 0)
Compendio de Ciencias Veterinarias     Open Access   (Followers: 1)
Computación y Sistemas     Open Access   (SJR: 0.226, CiteScore: 1)
Comuni@cción     Open Access   (Followers: 1)
Comunicación y sociedad     Open Access   (Followers: 2, SJR: 0.327, CiteScore: 0)
Concreto y cemento. Investigación y desarrollo     Open Access   (Followers: 1)
Confines     Open Access  
Contaduría y Administración     Open Access   (SJR: 0.219, CiteScore: 0)
Contexto Internacional     Open Access  
Convergencia     Open Access   (Followers: 3, SJR: 0.196, CiteScore: 0)
Correo Científico Médico     Open Access  
Corrosão e Protecção de Materiais     Open Access  
Crop Breeding and Applied Biotechnology     Open Access   (Followers: 3, SJR: 0.609, CiteScore: 1)
CT&F - Ciencia, Tecnología y Futuro     Open Access   (Followers: 1, SJR: 0.138, CiteScore: 0)
Cuadernos de Administración     Open Access   (SJR: 0.118, CiteScore: 0)

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SA Orthopaedic Journal
Number of Followers: 2  

  This is an Open Access Journal Open Access journal
ISSN (Print) 1681-150X
Published by SciELO Homepage  [911 journals]
  • Physician wellness in South Africa - 'Where are we going' And if we
           get there, will there be a place to park''

    •  
  • Short-term results following two-stage revision for periprosthetic
           joint infection

    • Abstract: BACKGROUND: Hip and knee arthroplasty procedures are successful surgical procedures, with total hip arthroplasty being named the operation of the 20th century. With there being an estimated rate globally of periprosthetic joint infection of 1% for hips and 2% for knees, this minimal infection rate represents a large global concern. The successful management of periprosthetic joint infection remains controversial with multiple proposed strategies. Our aim is to present our short-term data for a two-stage revision protocolMETHODS: A single centre retrospective review of an existing database starting from January 2013 and including April 2019 was conducted looking at patients having undergone two-stage revision for periprosthetic joint infection. The unit utilised a standard approach to two-stage revisions. Data was collected from the existing database to ascertain short-term success based on the Delphi-based international multidisciplinary consensus criteriaRESULTS: A total of 2 125 entries were reviewed from the database comprising 1 912 primary arthroplasty procedures. From all revision cases 19 patients were identified to have undergone a two-stage revision by our unit. Of these patients we managed to collect sufficient data to gauge treatment success in 12 patients. Of these 12 patients with a mean follow-up of 25.6 months, ten reported complete wound healing, pain improvement and no subsequent surgery. One patient demised from septic complications and one required subsequent arthrodesis which controlled the sepsisCONCLUSION: Our results showed a high infection eradication rate following our two-staged revision protocol despite frequent delays between first and second stages as a result of resource constraints and limitationsLevel of evidence: Level 4
       
  • Low dislocation rates achieved when using dual mobility cup hip implants
           for femur neck fractures

    • Abstract: BACKGROUND: Total hip replacements done for intracapsular neck of femur fractures (NOF) have a dislocation rate of up to 14%. This is seven times higher than in total hip arthroplasty (THA) done for osteoarthritis. Using a dual mobility cup (DMC) has been shown to be effective in addressing dislocation in elective THA. Our hypothesis is that the use of DMC in NOF will do the same. This study aims to determine the incidence proportion of dislocation of DMCs one year after surgery in patients who received THA for NOF and to compare it to dislocation rates as documented in existing studiesMETHODS: A retrospective study was done on 86 patients treated with DMC THA for an intracapsular NOF fracture from 2012 until 2016. A minimum one-year follow-up period was required for inclusion into the study. The number of dislocations at one year after surgery was notedRESULTS: Forty-one patients with a mean age of 60.7 years were included (26 females and 15 males). All patients were operated via the posterior approach. None of the patients had dislocated after one yearCONCLUSION: Low dislocation rates can be achieved using DMC THA in the management of intracapsular NOF fractures. Our one-year dislocation rate of 0% compares favourably to conventional THA and is comparable to similar DMC studies done outside of South AfricaLevel of evidence: Level 4
       
  • Percutaneous intra-articular tranexamic acid following total knee
           arthroplasty without drainage to reduce blood loss

    • Abstract: BACKGROUND: Administration of tranexamic acid (TXA) peri-operatively is a well-recognised strategy used by orthopaedic surgeons to reduce blood loss during total knee arthroplasty (TKA). Furthermore, not using a drain has been advocated to be a safe and effective way to further reduce blood loss. The main aim of this study is to assess the effect of a combination of these two strategies on total blood loss associated with TKAMETHODS: This is a retrospective study conducted on a single surgeon's data gathered over a two-year period. This study compares the blood loss in two groups of patients. The control group received no antifibrinolytic agents and a drain was inserted, while the study group received TXA and the drain was omittedRESULTS: A total of 109 patients were included in the analysis, with 86 patients in the study group and 23 patients in the control group. The two groups were compared in terms of pre-operative haemoglobin, American Society of Anesthesiologists (ASA) score and body mass index (BMI). The mean age of the study group was lower than that of the control group (64±8 years vs 68±9 years; p=0.03). The mean total blood loss was lower in the study group compared to the control group (mean difference 171.8 ml; 95% CI 31.2-312.2; p=0.01). Duration of hospital stay was also reduced in the study group (2.4 days vs 3.1 days; p=0.003). There was, however, no difference in the functional outcome according to the Knee injury and Osteoarthritis Outcome Score (KOOSCONCLUSION: These findings are in accordance with previous studies, indicating that intra-articular administration of TXA and omission of negative pressure drainage may be associated with a reduction in blood loss following TKA. Larger, well-designed studies are required to determine the optimal TXA administration strategyLevel of evidence: Level 4
       
  • The use of three-dimensional models in tibial plateau fractures

    • Abstract: BACKGROUND: To compare three-dimensional (3D) printed models with 3D computed tomography (CT) images in terms of the reliability of the classification of tibial plateau fractures using the Hohl and Moore and the Schatzker classification systems, and whether there was any influence on surgical managementMETHOD: The sample comprised the 20 CT scans of patients with tibial plateau fractures available in the radiology archive of Dr George Mukhari Academic Hospital (Ga-Rankuwa). Standardised illustrated guides to the Schatzker and the Hohl and Moore classification systems were used by six observers of varying orthopaedic experience. They completed questionnaires individually in three different sessions. In session one the observers had access to the 3D CT images only. On average two to Ave days later, in session two the observers assessed only the 3D models. In the third session, another two-to-five days later, the observers assessed the 3D CT images while handling and inspecting the corresponding 3D modelRESULTS: The inter-observer reliability of the Schatzker system (moderate reliability) was superior to the Hohl and Moore system (fair reliability) when comparing the assessment using the images and models separately. When all observations were combined, there was no difference between the systems. For the six possible surgical management options given to the observers, there was an overall difference in agreement based on assessing only the CT images compared with assessing only the models, of 19% (23 of the possible 120 procedures). Of these 23 differing procedures, 15 were more invasive. The 3D models were considered superior to 3D CT imaging in terms of spatial awareness and the observers' ability to assess intra-articular fracture patterns. The models were assessed as being superior to the imaging when considering the ability to estimate the quantity of bone graft requiredCONCLUSION: Although the inter-rater reliability of classification was not significantly improved, there were several advantages to using the 3D-printed models both separately from the CT images and together with the images. The effect of 3D models on patient outcome remains untested. The clinical impact of the use of 3D models (including cost, manufacturing time and radiation exposure) should be weighed against the potential benefitsLevel of evidence: Level 4
       
  • Correlation of Soft tissue Projection in Injured NEcks (CSPINE) -
           Prevertebral soft tissue measurement in paediatric cervical spine trauma

    • Abstract: 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 traumaPATIENTS AND METHODS: C-spine trauma X-rays taken at a South African children's hospital were randomly sampled. Seventy-one un-intubated 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 cut-offs 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%) respectivelyCONCLUSION: 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 ratiosLevel of evidence: Level 4
       
  • Epidemiology of paediatric and adolescent fractures admitted to a South
           African provincial hospital

    • Abstract: BACKGROUND: There are limited studies available that examine the epidemiology of children and adolescents admitted with orthopaedic injuries in developing countries. Several unique factors in South Africa, such as a large socio-economic divide and a public health sector with limited resources, are suggested to influence injury patterns and fracture management. The data emanating from this study may play a role in identifying potential preventative measures. The aims of the study were to determine the age, sex, duration of admission, aetiology and management regimen of paediatric and adolescent patients admitted with fractures in a South African provincial hospitalPATIENTS AND METHODS: We did a cross-sectional review of medical records for the period 1 January 2016 to 31 December 2017 at a South African provincial hospital. Convenience sampling was done, and demographic and clinical data was collected from patient records. All patients younger than 18 years at the time of injury who were admitted with fractures of the limbs, pelvis or spine were included. Patients with incomplete clinical records were excluded.RESULTS: A total of 731 patients were admitted during this period. After excluding patients with incomplete records, 526 (72%) were included in the study. From these records we found a higher percentage of males admitted (73%) and the average age was 7.72 years. The average duration of admission was 8.59 days. A fall on ground level was the most common mechanism of injury (70.0%), followed by pedestrian vehicle accidents (12.2%). The most frequently fractured regions were the forearm (36.4%), humerus (26.5%) and femur (18.9%). Multiple fractures were sustained by 2.4% and additional non-skeletal injuries were sustained by 2.9%. There was one fatality: a patient who presented with gunshot traumaCONCLUSION: Despite fall-related injuries being the most common cause for admission, pedestrian vehicle accident prevention can have the greatest effect on admissions. They require significantly longer hospitalisation and present more frequently with additional injuries. By implementing safety strategies and improving road infrastructure, we can theoretically decrease the number of serious paediatric admissionsLevel of evidence: Level 4
       
  • The risk of early complications in patients with hand infections

    • Abstract: BACKGROUND: The aim of this study was to identify the risk factors associated with the development of early complications in patients with hand infections. A secondary objective was to describe the bacteriology and resistance profile in our study populationMETHODS: This retrospective observational descriptive study was performed at a regional referral centre in South Africa. All primary hand infection cases treated over a period of one year were reviewed. Children under 18 years, cases with incomplete primary outcome data and post-operative infections were excluded. Clinical and demographic data was extracted from clinical records. Amputation, re-debridement and tissue loss requiring skin grafting were regarded as early complications. Bacteriological analysis comprised identification of causative organisms as well as evaluation of their resistance profiles. Risk factors that were found to be significant for development of early complications were entered into a multivariate regression analysisRESULTS: After inclusion and exclusion criteria were applied, 78 patients were deemed eligible for inclusion to the study. The patient-associated risk factors that were found to be associated with the development of early complications after univariate analysis were increasing age and poorly controlled diabetes mellitus. Human bites and polymicrobial infections were the only aetiological factors that were identified to be significant on a univariate level. Initial presentation to a private sector general practitioner (GP) was the only management factor to reach significance on univariate analysis. Human immunodeficiency virus (HIV) infection, Cd4 count, viral load and duration of ARV treatment were not found to be significantly associated with the development of early infections. On multivariate logistic regression analysis, poorly controlled diabetes mellitus, human bites and first presentation to a private GP were the only risk factors that remained significant for the development of early complications. The culture yield was 68%. Staphylococcus aureus (S. aureus) was the most frequently isolated organism (37%), followed by polymicrobial infections (10%). S. aureus encountered in our study population remained mostly sensitive to cloxacillin; however, high levels of resistance (50%) to ampicillin were observed. Klebsiella sp. and Acinetobacter sp. were the most frequently observed Gram-negative organismsCONCLUSION: After multivariate regression analysis, hand infections in poorly controlled diabetic patients, infections occurring after human bites as well as those affected by polymicrobial infections were identified as independent risk factors for development of early complications in patients with hand infections. HIV infection was not found to be a significant risk factor. Our bacteriological profile is in keeping with trends demonstrated in the literature where S. aureus infections seem to be declining in frequency while polymicrobial infections seem to be encountered more frequentlyLevel of evidence: Level 4
       
  • Management of femur neck fractures in young adults under the age of 60
           years

    • Abstract: Femur neck fractures in young adults account for 3-10% of all hip fractures, and management remains a challenge for the orthopaedic surgeon. Reoperation rates remain high after fixation of these fractures due to avascular necrosis, non-union, implant failure and removal of hardware. Complication rates are higher in displaced fractures, and patients who undergo revision to total hip arthroplasty (THA) have poorer outcomes compared with primary THA. Injury factors, fracture pattern, physiological age, timing of surgery, the role of capsulotomy and implant choice all need to be carefully considered in managing these fractures. Preserving the native hip joint is the standard of care in these patients but primary THA is becoming an attractive option due to the improvements in bearing surfaces and longevity of implants. There is no role for conservative management of fractures in this age group. Absolute anatomic reduction and stable fixation remains the goal of hip-preserving surgery. Open reduction is often necessary. Various fixation options are available from the more commonly used cannulated screws and dynamic hip screw to the newer generation hybrid plates with telescoping screws. Cannulated screws (CS) are adequate for stable fracture (Garden 1 and 2) patterns, whereas the dynamic hip screw (dHS) is biomechanically superior for unstable fractures. Neck shortening after using sliding screws is common but does not seem to influence clinical outcomes. Cephalomedullary nails are an acceptable load-bearing alternative. Proximal femur locking plates have high failure rates and should be avoided. New generation hybrid plates have shown promising results with fewer non-union rates than CS and DHS systems. Primary THA can be considered in exceptional cases where there are significant comorbidities, poor bone stock or in a patient that will be unable to tolerate a second surgery if fixation fails. Hemiarthroplasty should be avoided in this age group. The management of these fractures in South African government hospitals should be supervised by experienced surgeons whenever possible.Level of evidence: Level 5
       
 
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