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\"This book provides detailed yet easily understandable information about sustainable energy alternatives in the context of growing public concern about climate change, the impending fuel crisis and environmental degradation. It deals with the history of energy use and the factors that have led to the current interest in energy alternatives and assesses the chance of renewable energy replacing fossil fuels in the future. The authors manage to make a highly complex and often intimidating subject not only accessible but also engaging and entertaining. This book unpacks but never simplifies the science of energy, leavening the more technical passages with anecdotes, metaphors, examples and imagery. By also dealing with the history, politics and economics of energy use, it offers both scientific and non-scientific readers a deeper understanding of the most important issue of our age\"-- Provided by publisher.

Background The clavicular hook plate is an accepted surgical procedure for distal clavicle fractures. The relationship of the characteristics of the hook plate, acromioclavicular joint and acromion morphology, and clinical outcome has remained poorly understood. We reviewed the clinical records of patients who had distal clavicle fractures with different lateral acromion angles treated using a clavicle hook plate and evaluated their clinical outcomes with respect to shoulder pain and acromial morphology. Methods We retrospectively reviewed 102 patients with distal clavicle fractures treated with hook plates at our institution from 2010 to 2017. They were divided into four groups according to lateral acromion angle on shoulder AP view X-rays. The angle was defined as the incline angle between the superior surface of distal clavicle and the inferior facet of acromion on coronal plane. We reviewed their clinical features, including Neer’s impingement sign, MRI findings, and outcomes using Japanese Orthopaedic Association Scores. The mean follow-up was 25.5 months (range, 24 to 28 months). Results All patients in group D (large lateral acromion angle (α) > 40°, acromion coronal angle (β) < 60°) complained of postoperative symptoms. Compared to those with common lateral acromion angle, the incidence of postoperative impingement in group D was undoubtedly much higher (100%). Japanese Orthopaedic Association (JOA) scores in group D were worse at 3 months post-surgery, 3 months post plate removal, and at the last follow-up despite a slightly earlier removal in this group. Conclusion Lateral acromion angle appears to be an important factor in the development of postoperative pain and worse outcomes (JOA scores) in patients treated with the hook plate. The incidence of subacromial impingement and rotator cuff lesion (RCL) increased with the α angle. Early limited mobility and removal of the implant may improve the prognosis and resolve the postoperative shoulder pain. Study design Retrospective review, level of evidence IV.

Generally considered the greatest test of endurance in sports, the Tour de France covers more than 2,200 miles in just over three weeks, climbing high into both the Alps and Pyrenees before ending on Paris's iconic Champs-âElysâees. This updated edition, with brand-new features and stories, gives an authoritative account of each major era up to and including the 2017 Tour--when Britain's Chris Froome joined an elite club of four-time and three-in-a-row winners. In addition to more than 300 photographs, some dating back to the nineteenth century, there are features on the superstars, coverage of memorable moments in every era, thrilling action shots, and pictures of souvenir brochures, period newspapers, posters, stickers, postcards, and letters will engross every fan of the sport.

The overhead throw is a fundamental movement utilised in numerous sports for a variety of reasons such as pitching in baseball, fielding in cricket, and passing or shooting in water polo. In the throwing athlete, the delicate balance of an external rotation gain (ERG) with a reciprocal glenohumeral internal rotation deficit (GIRD) while maintaining a 180° rotational arc is known as the thrower’s paradox, described in baseball pitchers. This narrative review aimed to evaluate research findings and clinical experiences for two popular South African sports, namely cricket and water polo, to determine if these throwing athletes possess similar musculoskeletal and throwing characteristics classically described for baseball pitchers. Cricket and water polo players displayed distinctly different musculoskeletal characteristics to baseball pitchers. Cricketers did not present with the shoulder ERG frequently identified in throwing athletes, while water polo players did not demonstrate the decrease in internal rotation range commonly seen in throwers. A decreased external to internal rotation strength ratio (ER:IR) is a common risk factor in baseball pitchers. Cricketers and water polo players maintained a normal ER:IR ratio but presented with a decrease in both internal and external rotation strength. Finally, both cricketers and water polo players present with a downwardly rotated scapula at rest, which is contrary to previous findings in throwers. Water polo players had a significantly greater upward scapula rotation angle at 90°, which refutes subacromial internal impingement as a mechanism of injury in this group of overhead throwing athletes. Further differences are demonstrated in the throwing biomechanics of both sports, with cricketers using less shoulder external rotation and thoracolumbar range of motion while throwing compared to pitchers. Limited evidence found that water polo players use greater shoulder elevation than baseball pitchers or cricketers during shooting. While the literature documenting the types of shoulder pathology for cricketers and water polo players are scarce, there is clinical evidence that the different throwing athletes may present with a broad spectrum of shoulder injuries. In clinical practice, these insights can be used to enhance both the clinical assessment and management of overhead athletes.

Background Access to healthcare services, particularly surgical interventions, remains a critical challenge in low-to middle-income countries (LMICs). Reverse shoulder arthroplasty (RSA) is the most frequently performed arthroplasty procedure of the shoulder and is recommended for the treatment of complex shoulder conditions in the elderly population. This study investigated the availability and accessibility of RSA within South Africa’s public healthcare system, focusing on equity in surgical care provision. Methods Using a multifaceted research approach, data were collected from 33 professionals across eight provinces, representing a significant proportion of the population. Results Results indicate significant disparities in access to RSA, with urban areas and tertiary hospitals having better resources and capacity. The majority of the tertiary level hospitals are easily accessible to urban compared to rural dwellers. Despite the growing need for RSA, particularly among older demographics, the study reveals a scarcity of skilled shoulder surgeons and inadequate infrastructure, especially in rural regions. Conclusion These findings underscore systemic barriers hindering equitable access to RSA and surgical care in South Africa. Recommendations include increasing resources for training, improving infrastructure, and enhancing referral systems to address these disparities and ensure universal access to essential surgical services.

Anterior shoulder dislocation is a common condition that most orthopaedic surgeons will have to deal with in their practice. Nonoperative management of the initial traumatic anterior shoulder dislocation is likely to lead to a recurrent shoulder dislocation in more than 90% of cases in the younger active population. Recurrent anterior shoulder dislocation can persist even after instability surgery in certain cases. A detailed, accurate assessment of the patient is of paramount importance for successful treatment. This review aims to provide insight into key concepts to consider in the assessment of an anterior shoulder dislocation. Predisposing factors, clinical examination and the role of imaging in the assessment of an anterior shoulder dislocation will be reviewed.

Background : Pre-operative planning for reverse shoulder arthroplasty (RSA) poses challenges, particularly when dealing with glenoid bone loss. This modified Delphi study aimed to assess expert consensus on RSA planning processes and rationale, specifically targeting low-resourced institutions. Our objective was to offer pre-operative decision-making algorithms tailored for surgeons practising in resource-constrained hospitals with limited access to computed tomography (CT) scans. Methods : A working group generated statements on pre-operative imaging and glenoid of glenoid morphology and intra-operative decision-making. The study was conducted in three stages, with virtual consensus meetings in between. Stages 2 and 3 consisted only of closed questions/statements. The statements with over 70% were considered consensus achieved and those with less than 10% were considered disagreement consensus achieved. Results : Twelve shoulder surgeons participated, with 67% having over five years of experience in shoulder arthroplasty. In the absence of glenoid bone loss, the sole use of plain radiographs for pre-operative planning reached consensus and is recommended by these groups, while 100% advise using CT scans when bone loss is present. Most surgeons (70%) recommend using patient-specific instrumentation (PSI) in cases of structural bone loss. Most of the statements on intra-operative decision-making related to component placement and enhancing stability failed to reach consensus. Conclusion : While consensus was achieved on most aspects of pre-operative imaging and planning, technical aspects of surgery lacked consensus. Planning for patients with structural glenoid bone loss necessitates CT scans and planning tools.

Introduction : Surgical treatment of displaced acromial and scapula spine fractures may be challenging due to the bony anatomy and variable fracture patterns. This difficulty is accentuated by the limitations of the available scapular plates for fracture fixation. This study compares the quantitative fitting of anatomic scapular plates and clavicle plates, using three-dimensional (3D) printed fractured scapulae. Methods : Fourteen scapulae with acromion and spine fractures were used for this study. Computerized tomographic (CT) scans of the fractured scapulae were obtained from the Philips picture archiving and communication system (PACS) database of patients admitted to a tertiary teaching hospital in Cape Town, South Africa between 2012 and 2016. The reconstructed scapulae were 3D printed and the anatomical acromion and clavicle plates were templated about the fracture regions. The fit assessment was performed by five observers who classified the plates as no-fit, intermediate fit, and anatomical fit according to the surgical guidelines. Results : The 6-hole anterior clavicle plate performed better than any of the scapular plates as they were able to fit 45.7% of the fractured acromion, including the spine. Among the pre-contoured anatomical scapula plates, both the short and the long acromion plates could fit only 27.3% of the fractured acromion. The intraclass correlation coefficient was 0.965 suggesting excellent consensus among the five observers. Conclusion : Clavicle plates were found to be better suited to fit around a scapula fracture in its acromion and spine region.

The duties and responsibilities of orthopaedic surgeons obliges us to be an advocate on multiple levels within our society. The American Medical Association stated in 2009 that ‘Physicians must advocate for the social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being’.

The duties and responsibilities of orthopaedic surgeons obliges us to be an advocate on multiple levels within our society. The American Medical Association stated in 2009 that ‘Physicians must advocate for the social, economic, educational, and political changes that ameliorate suffering and contribute to human wellbeing’. In our troubled South African society, exacerbated by the current Covid-19 crisis, our advocacy is needed even more than ever. We should already be advocates for transformation/diversity, alleviation of hunger, access to healthcare, the eradication of the scourge of gender-based violence, reduction of road deaths and gunshots, among others.