Severe soccer injuries in amateurs.

OBJECTIVES: To ascertain the number and type of severe soccer injuries admitted to King Edward Hospital in South Africa over 42 months. METHODS: This was a retrospective study of all patients admitted for treatment or observation to the orthopaedic unit only. Patients treated as outpatients, irrespective of severity, are also presented for comparison. RESULTS: Thirty two patients were admitted with severe injuries. The injuries included 18 fractures of the tibial and femoral shaft. Two tibial shaft fractures were compound. Four tibial plateau fractures and five epiphyseal injuries were identified. One patient had a fracture-dislocation of the hip. One patient with a popliteal artery injury presented 48 hours after the injury had occurred. He had an above knee amputation. In the same period 122 patients were treated as outpatients. The types of injury in this group were similar to soccer injuries reported in other countries. CONCLUSIONS: Very serious injuries are sustained by casual soccer players in South Africa. Urgent measures need to be taken to prevent such injuries.

Chronic shoulder dislocations.

Thirty-two patients with chronic dislocation of the shoulder were diagnosed over a 5-year period at King Edward VIII Hospital, Durban, South Africa. Thirty-one patients had an anterior subcoracoid dislocation. One patient had a chronic posterior dislocation. The duration of dislocation ranged from 6 days to 2 years. Six patients were epileptic, and it was an affliction of all ages. None of the patients had a vascular deficit, but 4 had neurologic damage on presentation. Closed manipulation was only successful in 1 patient. Ten patients' shoulders were left unreduced in the dislocated position. Twenty-one patients, including the patient with a single posterior dislocation, underwent open reduction. The author treated 10 patients with chronic anterior dislocations surgically. The coracoid was transferred to the glenoid, and acromiohumeral K-wire fixation was used for 4 weeks in this group. These 10 cases, as well as 5 cases left unreduced, were followed up for more than 2 years. The results were evaluated by the system proposed by Rowe and Zarins and showed that surgically treated patients fared better than those whose shoulders were left unreduced regardless of the duration of the dislocation or the age of the patient. This series differs from previous reports in several respects. All but one of the dislocations were anterior, the incidence of epilepsy was lower, and successful reduction by manipulation was rarely achieved. In all 10 cases in which the author performed the operation, the shoulder was successfully relocated without neurovascular complications. Dissection of the axillary vessels and nerves was never necessary.

Prominence of penicillinase-producing strains of Neisseria gonorrhoeae in gonococcal arthritis--experience in Durban, South Africa.

Penicillin resistance amongst gonococcal strains causing disseminated gonococcal infection (DGI) has been infrequently reported worldwide. The clinical records of 34 patients with gonococcal arthritis seen over a 53-month period were reviewed. The study population consisted of 32 blacks and two Indians with a mean age of 23.5 yr (range 14-46 yr) and a female to male ratio of 2.8:1. The diagnosis of gonococcal arthritis was made on the basis of isolation of Neisseria gonorrhoeae from the SF alone in 20 patients, SF and genital site in nine genital site alone in two and genital site and synovial tissue in one patient and synovial tissue alone in two patients. Eighteen of the 32 (56%) synovial isolates were penicillinase-producing strains of N. gonorrhoeae (PPNG). Monoarthritis was the commonest mode of presentation and seen in 73% of patients. The joints most frequently involved were the wrist (44%), knee (41%), ankle (15%) and shoulder (12%). None of the patients had cutaneous lesions. The occurrence of DGI is usually associated with protein 1-A serotype and arginine, hypoxanthine and uracil requiring auxotype, but all isolates available for auxotyping in this study were prototrophic. This study shows a very high prevalence of PPNG strains causing DGI, an observation which has important therapeutic implications.

Aspergillus osteomyelitis of the spine.

Aspergillosis involving either the vertebral body or the intervertebral disc is a rare cause of osteomyelitis of the spine. The following is a report of five cases of Aspergillus fumigatus infection of the spine treated successfully with amphotericin B and 5-flucytosine. In three patients, the diagnosis was established at closed-needle biopsy; two patients with paraplegia had an anterior decompression and fusion. The follow-up period ranged from 19 to 48 months.

Brachial plexus lesions in soldiers--the 'sandbag palsy'. A report of 5 cases.

The development of brachial plexus palsy in 5 young men undergoing military training is described. In all cases the posterior cord was predominantly involved and the lesions were the result of repetitive traction, which occurred when the recruits ran approximately 20 km while carrying 50 kg sandbags behind the neck across the shoulders. In this position the shoulders were abducted and externally rotated, while the forearm was fully pronated, i.e. the palms were facing upwards and the fingers backwards. All patients recovered fully once the offending exercise programme was stopped. Military personnel should modify training methods to prevent such lesions in future.

Carpal tunnel syndrome in black South Africans.

The incidence and the aetiology of chronic carpal tunnel syndrome in black South Africans was evaluated. This study showed that the incidence of idiopathic carpal tunnel syndrome was very low in this population group and that most patients who presented with symptoms and signs of chronic carpal tunnel syndrome had a specific pathology. A rare case of tumoral calcinosis causing carpal tunnel syndrome is presented. A case of perineural lipofibroma causing carpal tunnel syndrome is also described.

Simultaneous dislocation of the interphalangeal joints. A report of 2 cases.

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.

Results of surgical decompression in chronic tuberculous paraplegia.

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.