Two leading orthopaedic surgeons recently set up the state-of-the-art Limb Reconstruction and Musculoskeletal Infection Unit at Mediclinic Durbanville, treating anything from complex orthopaedic trauma cases to musculoskeletal infections.
After identifying a need for a private specialised limb reconstruction and musculoskeletal infection unit in Cape Town’s northern suburbs, orthopaedic surgeons Dr Gadi Epstein and Professor Nando Ferreira opened a specialist unit in February this year at Mediclinic Durbanville.
The bulk of their work is to treat complications of orthopaedics trauma in the local area, Dr Epstein says. “This now allows the orthopaedic surgeons with whom we work to offer patients with complicated pathologies access to specialised healthcare closer to where they live. These patients have often seen multiple surgeons and had several operations.
“It’s good to have a unit, because Professor Ferreira and I are constantly in conversation about the most appropriate care for patients. We bounce ideas off one another and we also operate together.” Dr Epstein, who completed a limb reconstruction fellowship, adds that the combination of the knowledge he gained, and Professor Ferreira’s years of experience is extremely valuable.
The partners have a particular interest in complex trauma, and post-traumatic complications, including malunions, nonunions, and bone defects. The limb reconstruction unit also helps patients with musculoskeletal infections, such as acute and chronic osteomyelitis (a serious infection of the bone) and fracture-related infection.
Malunions and nonunions
A malunion is when a bone grows with unacceptable alignment and is no longer straight, Dr Epstein says. “Each bone has its own general alignment that we consider acceptable. When a fracture heals in a position that isn’t in an acceptable alignment, that's called a malunion,” he explains. “A bone nonunion is when a broken bone doesn’t heal at all. This causes pain and often requires surgery.”
While musculoskeletal infections can occur spontaneously, they are more common in children. “This is called acute hematogenous osteomyelitis, which spreads from the bloodstream into the bones, and it’s generally an emergency,” Dr Epstein says. “Another type of musculoskeletal infection is chronic osteomyelitis, which persists.”
Fracture-related infections are those that occur in the setting of fractures and fracture management, explains Dr Epstein. “Following orthopaedic procedures to fixate fractures, patients may develop an infection around the implant – something we have a particular interest in managing.”
In the unit, Dr Epstein and Professor Ferreira have successfully treated multiple patients with fracture-related infections, as well as tumours – benign and malignant bone tumours, and tumours that have metastasised from other sites to the musculoskeletal system. “We've also managed several noteworthy cases of malunions and nonunions. The unit is currently in the process of managing a malunion with the use of a 3D-printed replica of the patient’s deformity to allow for surgical rehearsal; where they use the replica to prepare for the surgery.
Another remarkable case is that of 17-year-old Vincent Bronkhorst. “Due to an injury, my leg rotation was 30° out; it was tilted inwards and was very painful to walk on,” Vincent explains. As a result, he was referred to Dr Epstein at the specialised unit. “He replaced the pin in my leg with a thicker one and fixed the rotation on my leg. The recovery was very fast, and everything happened as promised.”
Vincent is grateful to have had access to the unit. “Before I went there, I didn’t have any hope of recovery and walking properly again. They gave me hope and now, thanks to them, I can walk again and enjoy life.”
One of the advantages of having Professor Ferreira in the unit is his vast experience in limb reconstructive surgery. His work at Tygerberg Hospital is at the forefront of advances and research in the field, says Dr Epstein. “I’m very grateful to have him as a colleague and a mentor. His work and research provide exposure and education into complex orthopaedic pathologies and their management.”
For example, there have been exciting technological advances in the management of leg length discrepancies where one limb is longer than the other due to trauma, infection or congenital abnormalities. “In the past 10 years, intramedullary nail fixations have become very valuable for us in terms of lengthening limbs,” says Dr Epstein. “Motorised implants that can lengthen a millimetre every day are now available to us in South Africa.”
The unit also specialises in bone defects – missing bone – for which there are a growing number of novel treatment options. For example, 3D titanium trusses can be printed and applied to the management of severe bone defects. “The exciting and innovative technology that goes with some of the conditions we see makes limb reconstruction a very exciting place to be.”
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