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Keller MM. National Health Insurance interprofessional practice implementation in hand rehabilitation service delivery in South Africa. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2024; 80:1969. [PMID: 38725966 PMCID: PMC11079339 DOI: 10.4102/sajp.v80i1.1969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/06/2024] [Indexed: 05/12/2024] Open
Abstract
South Africa's current healthcare system is unequal and inefficient, with 71% of the population accessing underfunded public healthcare facilities. The imminent National Health Insurance (NHI) aims to balance the inequality between private and public health services by providing universal healthcare. The high levels of road accidents, violence and injuries in South Africa, being one of the quadruple burdens of diseases frequently causing hand injuries with resultant devastating economic and functional implications without rehabilitation services, are concerning. The plea is that for specialised injuries, such as hand injuries, the NHI implementation requires innovative interprofessional health education and practice when managing individuals who sustained hand injuries optimally to return to preinjury functioning. When considering the devastating burden of mismanaged hand injuries on all levels of the International Classification of Functioning, Disability and Health (ICF) framework, all South Africans deserve rehabilitation by physiotherapists and occupational therapists based on each occupation's unique strengths. Anecdotally, a lack of interprofessional undergraduate and postgraduate hand rehabilitation education and hand-injured patient management exists in South Africa, highlighting the need for urgent change towards future practice and NHI. This commentary aims to apply the ICF core sets to inform interprofessional hand rehabilitation delivery by physiotherapists and occupational therapists. Clinical implication Interprofessional rehabilitation framed in the ICF Core Set, accompanied by inclusive interprofessional education opportunities according to the Health Professions Council of South Africa (HPCSAs) scope of practice, will benefit South Africans who sustained hand injuries to fully recover and maximise their functional performance considering the type of injuries sustained.
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Affiliation(s)
- Monique M Keller
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
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Ho TY, Hsu CE, Wang WC, Ting YN, Tsai MT, Chiu YC, Hsu JT. Biomechanical study of the fixation ability of the dorsal and volar locking plate for transverse metacarpal neck fractures. Medicine (Baltimore) 2023; 102:e34981. [PMID: 37682204 PMCID: PMC10489259 DOI: 10.1097/md.0000000000034981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Metacarpal neck fracture is one of the most common types of hand fractures; the literature suggests that applying a bone plate on the dorsal side provides higher fixation strength than that provided by other fixation methods. However, bone plate fixation on the dorsal side may result in postoperative tendon adhesion. So far, no studies have investigated the fixation of metacarpal neck fractures on the volar side by using a bone plate. The objective of this study was to investigate the differences in the fixation results between bone plate fixation on the dorsal side and bone plate fixation on the volar side of the metacarpal in the case of a metacarpal neck fracture. A saw blade was used to create a transverse metacarpal neck fracture on 14 artificial metacarpal bone specimens. The specimens were divided into 2 groups depending on the fixation method: a volar locking plate (VLP) group and a dorsal locking plate (DLP) group. All specimens were subjected to a cantilever bending test on a material testing system, and a force-displacement curve was used to measure the yield force and stiffness, which served as an indicator of the fixation ability of the 2 fracture fixation methods. For the experimental results, the Mann-Whitney U test was used to compare the fixation abilities of the 2 fixation methods. In terms of yield force, the DLP group (266.9 ± 68.3 N) scored significantly higher than the VLP group (32.6 ± 2.7 N) (P < .05); expressed in terms of median, the DLP group scored 8.2 times higher than the VLP group. Similarly, in terms of stiffness, the DLP group (69.0 ± 13.4 N/mm, median ± interquartile range) scored significantly higher than the VLP group (12.9 ± 1.4 N/mm) (P < .05); expressed in terms of median, the DLP group scored 5.3 times higher than the VLP group. The fixation strength of volar bone plates is only about one-third of that of dorsal bone plates.
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Affiliation(s)
- Tsung-Yu Ho
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-En Hsu
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Sports Recreation and Health Management Continuing Studies-Bachelor’s Degree Completion Program, Tunghai University, Taichung, Taiwan
| | - Wei-Chih Wang
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Orthopedic Surgery, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Yen-Nien Ting
- 3D Printing Medical Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan
| | - Yung-Cheng Chiu
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Jui-Ting Hsu
- Department of Biomedical Engineering, China Medical University, Taichung, Taiwan
- School of Dentistry, China Medical University, Taichung, Taiwan
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Zhang J, Shang Z, Jiang Y, Zhang K, Li X, Ma M, Li Y, Ma B. Biodegradable metals for bone fracture repair in animal models: a systematic review. Regen Biomater 2020; 8:rbaa047. [PMID: 33732493 PMCID: PMC7947587 DOI: 10.1093/rb/rbaa047] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/27/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022] Open
Abstract
Biodegradable metals hold promises for bone fracture repair. Their clinical translation requires pre-clinical evaluations including animal studies, which demonstrate the safety and performance of such materials prior to clinical trials. This evidence-based study investigates and analyzes the performance of bone fractures repair as well as degradation properties of biodegradable metals in animal models. Data were carefully collected after identification of population, interventions, comparisons, outcomes and study design, as well as inclusion criteria combining biodegradable metals and animal study. Twelve publications on pure Mg, Mg alloys and Zn alloys were finally included and reviewed after extraction from a collected database of 2122 publications. Compared to controls of traditional non-degradable metals or resorbable polymers, biodegradable metals showed mixed or contradictory outcomes of fracture repair and degradation in animal models. Although quantitative meta-analysis cannot be conducted because of the data heterogeneity, this systematic review revealed that the quality of evidence for biodegradable metals to repair bone fractures in animal models is 'very low'. Recommendations to standardize the animal studies of biodegradable metals were proposed. Evidence-based biomaterials research could help to both identify reliable scientific evidence and ensure future clinical translation of biodegradable metals for bone fracture repair.
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Affiliation(s)
- Jiazhen Zhang
- State Key Laboratory of Nonferrous Metals and Process, GRINM Group Corporation Limited (GRINM), No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China.,GRIMAT Engineering Institute Co., Ltd, No. 11, Xingke East St., Yanqi Economic Development Zone, Huairou District, Beijing 101407, P.R. China.,General Research Institute for Nonferrous Metals, No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China
| | - Zhizhong Shang
- School of Basic Medical Sciences, Evidence-Based Medicine Center, Lanzhou University, No 199, Donggang West Road, Chengguan District, Lanzhou 730000, P. R. China
| | - Yanbiao Jiang
- School of Basic Medical Sciences, Evidence-Based Medicine Center, Lanzhou University, No 199, Donggang West Road, Chengguan District, Lanzhou 730000, P. R. China
| | - Kui Zhang
- State Key Laboratory of Nonferrous Metals and Process, GRINM Group Corporation Limited (GRINM), No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China.,GRIMAT Engineering Institute Co., Ltd, No. 11, Xingke East St., Yanqi Economic Development Zone, Huairou District, Beijing 101407, P.R. China.,General Research Institute for Nonferrous Metals, No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China
| | - Xinggang Li
- State Key Laboratory of Nonferrous Metals and Process, GRINM Group Corporation Limited (GRINM), No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China.,GRIMAT Engineering Institute Co., Ltd, No. 11, Xingke East St., Yanqi Economic Development Zone, Huairou District, Beijing 101407, P.R. China.,General Research Institute for Nonferrous Metals, No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China
| | - Minglong Ma
- State Key Laboratory of Nonferrous Metals and Process, GRINM Group Corporation Limited (GRINM), No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China.,GRIMAT Engineering Institute Co., Ltd, No. 11, Xingke East St., Yanqi Economic Development Zone, Huairou District, Beijing 101407, P.R. China.,General Research Institute for Nonferrous Metals, No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China
| | - Yongjun Li
- State Key Laboratory of Nonferrous Metals and Process, GRINM Group Corporation Limited (GRINM), No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China.,GRIMAT Engineering Institute Co., Ltd, No. 11, Xingke East St., Yanqi Economic Development Zone, Huairou District, Beijing 101407, P.R. China.,General Research Institute for Nonferrous Metals, No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China
| | - Bin Ma
- School of Basic Medical Sciences, Evidence-Based Medicine Center, Lanzhou University, No 199, Donggang West Road, Chengguan District, Lanzhou 730000, P. R. China
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