East African Orthopaedic Journal

Beyond the X-ray: redefining success in orthopaedic surgery

J.W.M. Kigera, D.N. Omwoyo — Tue, 02 Jun 2026 00:00:00 +0000

No abstract.

Patient outcomes after management of middle third clavicle fractures: A prospective review at a South African tertiary hospital

H. Wilson, A. Younus, J. du Plessis — Tue, 02 Jun 2026 00:00:00 +0000

Background: Literature has not reached consensus on a suitable approach for the management of midshaft clavicle fractures in adults, even though recent multicentre, randomised, controlled trials have shown superior functional results following operative intervention. Local literature on this topic is sparse.

Objective: The aim of this study was to compare the functional results of operatively and nonoperatively treated patients with midshaft clavicle fractures in the South African context.

Methods: We conducted a prospective review of 54 patients, aged more than 18 years, who were managed at a single tertiary centre in Johannesburg, South Africa between 2017 and 2023. Outcome analyses included a file audit, the American Shoulder and Elbow Society scoring tool via a telephonic questionnaire, and photographic evaluation of shoulder abduction and flexion.

Results: Overall, 21 of 54 patients (39%) were operatively treated with plate osteosynthesis and 33 of 54 patients (61%) were non-operatively treated with a sling for 6 weeks. There were no statistical differences in demographics, occupation, and dominant side injuries between the groups. More patients in the operative group reported being satisfied with the result (16 of 21; 76%) compared to the non-operative group (17 of 33; 52.5%; Odds Ratio [OR] 3.78). The operative group also showed a superior mean patient reported functional score of 86.2 (Interquartile rage [IQR] 70 to 100; Standard Deviation [SD] 16.5) versus 76.6 (IQR 53 to 99; SD 22; p = 0.124) in the non-operative group. The OR for having significant chronic shoulder pain following non-operative treatment was 2.61. There were no differences in the mean measured shoulder abduction for the operative group (160°; IQR 145 to 180°) compared with the non-operative group (160°; IQR 135 to 180°; p = 0.735). The complication rates between the operative and non-operative groups were also similar (19% vs 15%, respectively; p = 0.279).

Conclusion: Operative treatment of patients with midshaft fractures yields superior pain scores, less chronic shoulder pain, and a higher likelihood of patient satisfaction compared with non-operatively treated patients. This study proposes operative management of midshaft clavicle fractures in the South African context.

Short-term functional outcomes of patients with metatarsal fractures following intramedullary K-wire osteosynthesis at Muhimbili Orthopaedic Institute

D. Cosmas, M. Muhamedhussein, F. Mrita, G. Njambilo — Tue, 02 Jun 2026 00:00:00 +0000

Background: Metatarsal fractures are common orthopaedic injuries, constituting up to 35% of all foot fractures. Intramedullary K-wire osteosynthesis is frequently used for their management. Despite its widespread use, functional outcomes following this treatment remain underexplored in our setting.

Objective: To determine the short-term functional outcomes of patients with metatarsal fractures after intramedullary K-wire osteosynthesis at Muhimbili Orthopaedic Institute (MOI).

Methods: This was a prospective cohort study conducted at MOI. Patients aged 18 years and above with AO/ICI Type A metatarsal fractures treated with K-wire osteosynthesis were enrolled. Functional outcomes were assessed using the Maryland Foot Score at 12 weeks postoperatively. Statistical analysis was performed using STATA 17, with a significance level set at p<0.05.

Results: A total of 33 patients were included. The mean age was 30 ± 11.71 years, with 90% being male. Over half (57.58%) achieved good functional outcomes, while 3.03% experienced treatment failure. Pain levels were minimal in 75.75% of participants, and 70% demonstrated good mobility. No statistically significant associations were found between functional outcomes and independent variables.

Conclusion and Recommendations: Intramedullary K-wire osteosynthesis for metatarsal fractures results in favorable short-term functional outcomes. However, further multicenter studies with larger sample sizes and longer follow-up periods are recommended to assess long-term recovery trends.

Epidemiology of low back pain: An experience from patients attending physiotherapy sessions at a national hospital in Tanzania

G. Njambilo, E. D. Masoud, O. C. Swai, M. Muhamedhussein — Tue, 02 Jun 2026 00:00:00 +0000

Background: Lower Back Pain (LBP) is a common health condition affecting a large portion of the world population, often leading to considerable disability and significant healthcare costs, particularly in low-resource settings like Tanzania. Various factors have been implicated such as socio-demographic, occupation and lifestyle related. Previously, LBP was seen in the elderly; however, there is a significant rise in the number of patients in the working age group which resulted in functional disability and reduction of productivity necessitating the need for early interventions.

Objective: We aimed at studying the epidemiology of lower back pain among patients attending physiotherapy sessions at Muhimbili Orthopaedic Institute (MOI), Tanzania. To investigate the sociodemographic factors; disease duration, severity and level of disability; and factors associated with functional disability due to low back pain among patients attending physiotherapy sessions at MOI, Tanzania.

Methods: A hospital based descriptive cross-sectional study was conducted among patients with lower back pain attending physiotherapy sessions at MOI. A Swahili version structured questionnaire was used to collect data on social demographic characteristics, duration of pain, pain severity and functional disability using Oswestry Disability Index (ODI) Score by convenient sampling method.

Results: Two hundred and twelve participants were enrolled with the mean age of 52.67± 13.69 years, with the majority of them (50.9%) between the ages of 40-60 years. Females comprised 70.3% of the participants and 59.4% of them reported prolonged sitting (>4 hours) at work. Chronic LBP was reported in 95.8% of participants, most of which had moderate pain level (53.3%). Based on the Oswestry Disability Index, 48.1% had mild disability, 39.6% moderate, 7.1% severe, and 5.2% had no disability. Significant factors associated with disability included prolonged driving (AOR=3.592, 95% CI: 1.171–10.875, p=0.025), lifting heavy objects (AOR=0.502, 95% CI: 0.255–0.994, p =0.046), employed (AOR = 3.096, 95% CI: 1.354–7.148, p = 0.007), marital status (married/cohabiting) (AOR = 0.392, 95% CI: 0.210–0.738, p = 0.021) and educational level (AOR=45.33 for no schooling, 95% CI: 3.563–574.650, p=0.003).

Conclusion: There were a significant number of patients with chronic low back pain in our setting most of which were associated with prolonged sitting, heavy lifting, being employed, married or cohabiting and low education as predictors of functional disability among them. These findings highlight the need for targeted occupational and educational interventions to mitigate disability risks.

Orthopaedic injuries In South African “zama-zama” gold miners: The Johannesburg West Rand experience with illegal gold mining

P. Ntombela, Q. Qwabe, M. Mashigo, S. Chiliza, L. Nhlapo, W. Ndou — Tue, 02 Jun 2026 00:00:00 +0000

Background: In South African local language, illegal artisanal gold miners are called “zama-zamas”, a slang word for “hustlers”. There is paucity of orthopaedic literature evaluating orthopaedic injuries associated with this sector of mining.

Objective: The aim of our study is to evaluate orthopaedic injuries associated with artisanal mining and the factors that influence them.

Methods: We undertook a retrospective study evaluating medical records and radiological images of patients treated for orthopaedic trauma injuries between January 2024 and April 2025. We evaluated patient demographic data, nature of injury, Mechanism of Injury (MOI), treatment instituted and nationality.

Results: The study population included 23 patients, 22 (95.6%) males and 1 (4.3%) female all of whom were black Africans. The mean age was 28.9 years old (19 - 41). Two (9%) of the patients were South Africans, 65% foreign nationals and 26% did not disclose. Seventeen (63%) of the injuries were to the lower limb while 14.8% were to the upper limb. One patient had a fracture-dislocation of the spine and we recorded three complex pelvic injuries. The most common mechanism of injury were rock falls (n=12) followed by gunshots (n=5). Two injuries were falls from height and one was from assault. Three patients had an unknown mechanism of injury. Majority of patients (61%) were treated surgically with two needing transfer to a tertiary centre.

Conclusion: Illegal gold mining is a cause of high energy orthopaedic trauma predominantly in male foreign nationals. Majority of these injuries require surgery and a long hospital stay.

Morphometry of the glenoid bare spot and its reliability as a landmark: A cadaveric study

Tue, 02 Jun 2026 00:00:00 +0000

Background: The glenoid bare spot has been proposed as a central landmark for arthroscopic quantification of glenoid bone loss in shoulder instability, but some studies have questioned its consistency and centrality. No cadaveric data exist from the local Kenyan population.

Objective: To describe the presence, morphology, and location of the glenoid bare spot in a Kenyan cadaveric sample and assess its reliability as a geometric center.

Methods: Fifteen formalin-fixed shoulders (7 right, 8 left) from 10 adult cadavers were dissected. Shoulders with damage or degeneration were excluded. Bare spot presence, shape, and diameter were recorded. Distances from the bare spot center to anterior and posterior glenoid rims were measured. Descriptive statistics were applied.

Results: The bare spot was present in all 15 specimens. Shapes were oval (40%), circular (33%), irregular (13%), and crescentic (13%), with median diameter 4.87mm (range 2.34–14.56mm). Mean distance to anterior rim was 7.33mm (range 3.99–9.58 mm); to posterior rim, 9.23mm (range 3.97–17.02mm), indicating anterior eccentricity.

Conclusion: In this cadaveric cohort, the glenoid bare spot was universally present but variable in size/shape and consistently anteriorly eccentric. These findings support existing evidence that it is not a reliable central landmark for assessing glenoid bone loss, with potential to overestimate anterior defects if used arthroscopically.

Knowledge and competency in orthopaedic training among level six medical students at The College of Health Sciences, University of Nairobi, Kenya

G.O. Munoka, F.C. Sitati, K.O. Awori — Tue, 02 Jun 2026 00:00:00 +0000

Background: Knowledge of trauma and orthopaedic surgery is a key component in the practice of medicine in Kenya, with an increase in morbidity and mortality from road traffic accidents. Medical officers play a fundamental role in the initial management of these fractures, underscoring the need to assess medical students’ competency. Lower practical skill acquisition noted in undergraduate students points out how musculoskeletal conditions may be handled subpar by physicians, and the study suggests possible remedies for future undergraduate training.

Objective: To determine the level of knowledge and competency and association between the two in orthopaedic training among undergraduate medical students at the Faculty of Health Sciences, University of Nairobi, Kenya.

Methods: This was a cross sectional study. The study recruited 237 out of 440 level six medical students who had finished their orthopaedic surgery rotations at the University of Nairobi. Consecutive sampling technique was utilized. Data collection was done using a structured questionnaire, which included the Friedman and Bernstein musculoskeletal competence test. Descriptive statistics were used to analyse the characteristics of participants. Binary logistic regression was used to investigate the factors associated with competency among level six medical students.

Results: Students who had adequate knowledge in orthopaedic training were 25 (10.5%). Some 33% of the students were willing and interested in pursuing further orthopaedic training. Using the Friedmann and Bernstein competency examination tool, the results showed a mean score of 47.5% (SD ± 26.2). The competency cut-off was set at 73.1%, and only 11.8% of the respondents scored above this threshold. Respondents who had adequate knowledge of orthopaedic surgery training were found to be 2.7 times more likely to have high competency compared to those with inadequate knowledge, Odds Ratio (OR) = 2.73, 95% Confidence Interval (CI): 1.99 – 7.55, p =0.005.

Conclusion and recommendations: The levels of both knowledge and competency were low in level six undergraduate orthopaedic surgery training, highlighting a major gap. Adequacy of knowledge was more likely to improve competency. Thus, there is need to revise the curriculum to include more comprehensive and structured orthopaedic modules, to have more confidence in basic practical skills.

Beyond the cemented–cementless divide: Personalised fixation strategies in revision total hip arthroplasty

D.B. Geldenhuys, M. Asmal, P. Ramiah, N. Elebo, N. Sikhauli, J.R.T. Pietrzak — Tue, 02 Jun 2026 00:00:00 +0000

Background: As primary Total Hip Arthroplasty (THA) is increasingly performed in younger, more active patients, revision procedures have become more frequent and technically demanding. The choice between cementless and cemented femoral fixation in revision THA remains controversial, with each approach offering distinct biological and mechanical advantages.

Objective: To synthesise current biological principles and clinical evidence comparing cemented and cementless femoral fixation in revision THA, with particular attention to complications, fixation strategies, and applicability in Lowand Middle-Income Countries (LMICs).

Data source: A narrative review of contemporary orthopaedic literature, including national joint registry data, systematic reviews, and key clinical studies evaluating femoral fixation methods in revision THA.

Data selection and extraction: Relevant studies were identified based on clinical relevance to revision THA, fixation method, patient age, bone quality, infection status, and reported outcomes. Data were qualitatively synthesised with emphasis on survivorship, complications, and functional outcomes.

Results: Cementless stems provide biological durability through osseointegration, while cemented stems offer immediate mechanical stability and are particularly advantageous in osteoporotic bone or in infected cases when antibiotic-loaded cement is utilised. Registry data demonstrate a clear age-related shift, with cementless fixation predominating in patients younger than 75 years and cemented fixation remaining preferred in older patients. Long-term methods: survivorship is comparable between fixation methods; however, cementless stems are associated with higher risks of periprosthetic fracture and early subsidence. Functional outcomes are equivalent in most cohorts. Challenges specific to LMICs, including implant availability, cost constraints, and variable bone quality, influence fixation strategy selection.

Conclusions: No single fixation strategy is universally superior in revision THA. Patient-specific selection guided by age, bone stock, and infection status remains paramount. Emerging advances in biologics, nanotechnology, additive manufacturing, and artificial intelligence hold promise for further refinement of fixation strategies and outcomes in revision hip arthroplasty.