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Hybrid organisations in global value chains: insights from Uganda's coffee sector
Full text linkGlobal value chains (GVCs) represent a core paradox of modern capitalism. While they generate employment opportunities in emerging economies, they also contribute to systemic inequalities, precarious labour, and environmental degradation. In response, upgrading has been proposed as a strategy for organisations to improve their position, capture value, and address social or environmental concerns. Hybrid organisations, those blending commercial and social goals, are increasingly recognised as important actors capable of challenging dominant GVC dynamics by promoting inclusive and sustainable upgrading. However, their role in African contexts remains under-researched. This study addresses this gap by investigating how hybrid organisations in Uganda's coffee sector contribute to GVC upgrading processes, by focusing on the challenges and opportunities they encounter. Uganda's coffee sector, which supports 1.8 million smallholder households and accounts for 22% of the country's export earnings, faces challenges such as price volatility, unequal power relations between local and international actors, weak infrastructure, and climate threats. These difficulties are indicative of broader global inequalities, in which, smallholder farmers in the global South commonly create value that is largely captured in the global North. Drawing on 49 interviews conducted across Uganda, the United Kingdom, and the United States, with stakeholders including farmers, hybrid organisation managers, industry experts, state actors, and international traders, the study applies a value chain analysis and examines 13 hybrid organisations using a comparative case study approach. Empirically, the findings show that hybrid organisations, positioned between smallholder farmers and international traders, contribute to economic upgrading by engaging in functional upgrading strategies such as domestic roasting, direct trade to consumer markets, and moving processing stages closer to origin. They also seek to enhance value capture at the local level by strengthening farmers' capabilities in quality control and post-harvest handling, which contributes to both product and process upgrading. In terms of social and economic upgrading, hybrids support more stable and inclusive farmer participation in the value chain by extending microloans, offering pre-financing to support farm-level investments, and providing agronomic training that strengthens farmers' agency and market positioning. Environmental upgrading is also promoted by hybrids through the adoption of climate- resilient practices, including agroforestry, composting, and soil management, which help farmers adapt to climate threats while improving long-term productivity. Yet these efforts face constraints. These include limited access to affordable finance, especially among locally embedded hybrids, and policy directions that are not well aligned with the quality-focused, socially embedded strategies many hybrids pursue. Conceptually, the study shows that hybrid organisations do not simply operate in weak institutional environments, they emerge in response to them. In areas where public or market-based support structures fall short, hybrids have emerged and filled such gaps. Their ability to combine commercial and social goals, and to work collaboratively across sectors and actors, positions them as relevant partners in efforts to promote more inclusive and sustainable upgrading in coffee value chains
Harmonizing core competencies for Master of Public Health Training programmes in Africa
No full textAfrica faces numerous health challenges, including high burdens of diseases and fragile health which hinder efforts to prevent, address, mitigate, and control these health challenges. The skills taught in MPH programs are recognized globally as being crucial to addressing these challenges and strengthening health systems. In recent years, the global community has experienced the emergence and re-emergence of disease outbreaks such as the Ebola and COVID-19 pandemics. These outbreaks have highlighted the need to strengthen programs like the MPH to equip graduates with the competencies necessary to address new and emerging health challenges. Additionally, they have highlighted the shared health systems challenges faced by different countries in Africa and the vulnerability of health systems to new challenges. The Association of Schools of Public Health in Africa (ASPHA) has acknowledged the lack of harmonization in the training received by MPH students from the different MPH programs on the continent. This lack of harmonization in MPH training within and across African countries has been attributed to the absence of a core competency framework, which outlines the competencies relevant to the public health work undertaken by MPH graduates in the region. Aim: This thesis identified the set of core competencies that are relevant to the public health work undertaken by MPH graduates across different work settings in Africa, including the challenges that could be encountered in adopting harmonized or common sets of core competencies across MPH programs in Africa Methods: A structured literature review was conducted to identify a preliminary set of core competencies for MPH programs in Africa. These competencies were subsequently refined through stakeholder engagement, resulting in a more focused and contextually relevant set of competencies that guided interviews with key informants. In order to elicit information from a broad range of country contexts, fieldwork was conducted in five African universities: one South African university (the University of Cape Town), in two Ghanaian universities (University of Ghana, Kwame Nkrumah University of Science and Technology); in one Nigerian university (University of Ibadan), and one Kenyan university (Great Lakes University of Kisumu). In each university, MPH graduates were surveyed to determine the applicability of competencies identified in the structured literature review to their work, the contribution of the MPH to competencies development, and graduates' level of confidence with each competence. Lecturers were interviewed and MPH curricula documents were reviewed to determine the depth of coverage of competency domains considered to be core in the five MPH programs. In-depth interviews were used to explore the perspective of a range of employers of MPH graduates from fourteen African countries on the actual sets of core competencies graduates need for public health work in Africa. Finally, interviews and surveys with lecturers and heads of MPH programs were used to explore the challenges that MPH programs in Africa could face in adopting harmonized or common set of core competencies across programs. Findings: A preliminary set of competencies – 187 competencies across nine discipline- specific and seven cross-cutting domains were identified for MPH programs in Africa through the literature review. Importantly, domains such as public health law and outbreak management which provides the foundation for creating equitable health systems and addressing emerging epidemics and pandemics, are missing from most MPH programs in Africa. Additionally, competencies in domains such as leadership, communication, monitoring and evaluation, community and intersectoral collaboration, outbreak management, and health promotion are the most applicable to graduates' work despite MPH programs contributing minimally to their development among graduates. Furthermore, the results show that while MPH programs in Africa generally equip graduates with foundational knowledge and skills in domains like Epidemiology, Biostatistics, Health Systems, Policy and Management, Health Promotion, Environmental Health Science, and Social and Behavioural Science, few programs provided graduates with the platform/opportunity to apply this knowledge and skills to real-life public health work during their MPH training. Across different African country settings, employer interviews found that MPH graduates in Africa perform critical roles that contribute significantly to health systems strengthening and were instrumental in the public health response to the COVID-19 pandemic. Employers reported that competencies in technical domains such as data analysis and interpretation, research proposal development, research grant application, outbreak management, public health-related law, teaching & coordination of health training programs, health promotion & advocacy, health resource mobilization, monitoring and evaluation, environmental health, Health financing and budgeting, and project management are crucial to the work of MPH graduates in Africa. Additionally, they emphasized that soft skills, including leadership, good time management, teamwork, conflict management, and communication and dissemination of public health information using tools like PowerPoint are important to the work of MPH graduates in Africa. Challenges to adopting harmonized or common sets of core competencies across Africa include institutional differences, chiefly regarding resources and culture, bureaucratic hurdles with integration into curriculums, resistance from faculty members, and resource limitations. Conclusion: This thesis used mixed methods in five different country settings, to identify the set of core competencies that are relevant to the public health work undertaken by MPH graduates in Africa. Challenges of adopting harmonized or common sets of competencies across MPH programs in Africa are identified. While competencies in key domains such as epidemiology, biostatistics, and research are already emphasized in most MPH programs in Africa, competencies in other key domains such as outbreak management, leadership, public health-related law communication, monitoring and evaluation, health financing, and project management are less emphasized or missing in most MPH programs in the region and need attention. There is a need for curriculum reforms among MPH programs in Africa to ensure that crucial and practical competencies are included or emphasized in MPH programs to better prepare graduates to effectively tackle the continent's health system challenges. A key limitation of the study was the limited representation of Francophone countries. Future work could explore competency frameworks in non-ASPHA and Francophone contexts and focus on building consensus among MPH education stakeholders in Africa on which competencies identified in this thesis should be included in MPH curricula. Future work could also focus on creating a core competency framework for MPH programs in Africa using the findings from this thesis as a guide
Automation of ultrasonic-based product tracking & traceability in supply chains
Full text linkIn the sweeping tide of digital evolution, the Internet of Things (IoT) is emerging as a significant catalyst, spearheading a colossal upsurge in deploying various sensors as the Industrial 4.0 buzzword continues dominating all platforms where industry captains converge. Modern-day Supply Chain Management (SCM), product tracking, and traceability are paramount for ensuring efficiency, quality control, and regulatory compliance. At the heart of IoT are wireless sensors and various other sensors forming the ecosystem of technologies that interact. This dissertation explores optimizing ultrasonic-based systems as wireless sensors for tracking and traceability in SCM and logistics. While widely used, traditional radio-frequency identification (RFID) tags and barcode systems encounter limitations in environments with interference or when tracking through dense materials. Ultrasonic technology, with its ability to penetrate various media and provide high- resolution data, presents a promising alternative for environments where other tracking technologies underperform. It can thus be used with near-field communication (NFC) technology and real-time GPS tracking, traditionally reserved for tracking goods in transit. The research investigates the unique attributes of ultrasonic signals for product identification, focusing on frequency modulation, signal processing techniques, and integration with existing digital frameworks. The study utilizes simulation models and field testing to examine the reliability, accuracy, and cost-effectiveness of ultrasonic-based tracking across various supply chain stages. Innovative algorithms and device design modifications address key challenges, such as signal attenuation, environmental noise, and energy consumption, enhancing signal clarity and data retrieval efficiency. This project primarily focused on the costs and benefits of using a simple ultrasonic sensor for product tracing and tracking. A cheap ultrasonic sensor was used and connected to an Arduino device and an affordable buzzer and LED for audible and visual alerts to anyone nearby. These simple, standard, low-cost devices were programmed with open-source code and libraries downloadable in Arduino IDE to achieve comparable results that previously cost an arm and a leg with current technologies such as Blockchain (BCT), global positioning system (GPS), or RFID. The sensor was programmed to sense objects passing through at a certain distance and then increment a count that displayed real- time results locally and on a centralized cloud platform. This enabled the results to be monitored and queried in any part of the world where there is internet connectivity. These methods in SCM have been quite expensive to set up and maintain, thus prompting the need for an IoT-based system with low-cost input but reliable performance to achieve the purpose. This project also aims to provide a solution for automatically tracking and tracing goods without human involvement before goods are packaged for transportation, where GPS tracking is ineffective. Results demonstrate that automated ultrasonic tracking can improve product traceability, particularly in complex industrial environments where traditional methods struggle. By incorporating ultrasonic technology, supply chains benefit from enhanced visibility, which supports real-time inventory management, reduces errors, and increases responsiveness to disruptions. This dissertation concludes with recommendations for implementing ultrasonic systems in conjunction with existing technologies such as Blockchain technology, RFID scanning and tagging systems, and other IoT based infrastructure, offering a heterogeneous approach that maximizes the strengths of each technology to create a robust, scalable solution for modern supply chains
Understanding the Decision to Sell a Home in South Africa
Full text linkWith various factors compounding competition in the real estate agency environment in South Africa, such as PropTech and the consequent disruptions to core business models, it is important that a study of the home seller is conducted to provide agencies with cutting-edge research to enhance their marketing strategies. To this end, this study aims to understand the behaviour of selling a home in South Africa. After establishing that the Theory of Planned Behaviour (TPB) would be the best-suited behavioural model, the theoretical gaps in knowledge that began to emerge were that, to the best of the researcher's ability, none of the prior literature in real estate using TPB dealt with selling a home, and none examined respondents who resided in South Africa. Therefore, the first research question of this study asks whether the TPB can be applied to the real estate environment with respect to selling a home. And the second research question asks what factors influence the decision to sell a home from the lens of this theoretical framework. An online survey was conducted using the database of the South African real estate agency Leadhome and the staff at the University of Cape Town (UCT) to improve the response rate and collect a sample of 175 respondents. Partial Least Squares Structural Equation Modelling (PLS-SEM) was the chosen statistical model employed. It was found that the attitude of the potential home seller has an impact on their intention, so real estate agencies should rather pursue leads who are happy to sell their homes. This could be achieved by generating marketing material that promotes the benefit of selling a home, which then resonates with those who have a positive attitude about potentially selling their home. It was also found that if influential individuals were supportive of the decision, the individual had a higher intention to sell their home. Therefore, marketing messaging should concentrate on what might resonate well with parents and other influential family members. The study showed that South Africans who intend to sell their home want to feel in control of the process. Therefore, marketing messaging may prove more effective if shown to support home sellers through the process
Shaping the undergraduate pain management curriculum in prehospital emergency care education: toward a curriculum and competency framework for South Africa
Full text linkIntroduction: Managing patients' pain is a common necessity in Prehospital Emergency Care. Research evidence suggests that pain and nociception are not optimally managed by Emergency Medical Services. One reason for this suboptimal management may be education that is misaligned with clinical and contextual needs. The knowledge gap is that Prehospital Emergency Care has not systematically developed evidence-informed competencies for pain management. Aim: This research aimed to develop a competency framework and provide recommendations for curriculum implementation to shape and guide the design of contextually relevant pain management curricula in South African Prehospital Emergency Care education. Methods: Subsequent to a narrative analysis of pain discourse, the research employed a scoping review of therapies to identify quality and therapeutic possibilities as evidentiary basis for competencies. Semi-structured interviews with educators explored contemporary education practice and documented knowledge broker perspectives on educational needs through thematic analysis. The initial competency framework was inductively derived from the above analyses. Content analysis of contemporary curriculum documents mapped key graduate attributes and identified deficient or absent learning intentions and related success criteria. An expert consensus panel provided critical input into the draft competency framework and made recommendations toward curriculum implementation. Findings: Contemporary curricula are fragmented and misaligned with pain assessment and management needs. Seven competency domains (given expression to by specific competency statements) should guide curriculum development: 1. Clinical Pain Praxis, 2. Foundational Sciences, 3. Practitioner Wellness and Safety, 4. Communication and Collaboration, 5. Duty of Care and Predisposition for Caring, 6. Ethical Practice, and 7. Scholarship. The expert panel made ten recommendations for implementing the framework in curricula, including the use of a ‘spiral' curriculum, focusing on the multidimensional nature of pain, and building relationships with clinical mentors. Conclusion: The novel output of the study is an evidence-based competency framework, compatible with micro credentialing or for local adaptation and progressive inclusion into emergency care curricula. This framework redresses the practice difficulties experienced by key stakeholders and enables higher education institutions and professional regulators to comprehensively and inclusively guide education providers in the noble pursuit of quality and equity in pain assessment and management across the lifespan and across clinical acuity and pain causation
An investigation of the association between structural proteins and lipids with scalp hair curvature
Full text linkScalp hair is increasingly being used as a non-invasive analytical sample in diagnostic and forensic medicine. However, variable sensitivities for detection of hair biomarkers were observed, whereby African hair generally incorporated higher drug levels than Asian and Caucasian hair types. It was hypothesized that higher absolute lipid amounts in African curly hair may affect the rate at which lipid-soluble metabolites are passively incorporated into the growing hair shaft. Furthermore, the interactions between structural proteins and lipids in scalp hair may be associated with hair curvature, though the exact mechanism is unknown. This study is the first to investigate the hair proteome and lipidome in the same group of hair samples using a multiomics approach to determine how they both relate to each other, and to hair curvature. After ethical approval, hair of varying curvature was collected from 90 participants and classified from straight to curly objectively (type I – VI) using a validated tool. Hair proteins were extracted and analysed using an ultra-high performance liquid chromatography quadrupole time of flight (UPLC-QToF) mass spectrometer and the data analysed using various bioinformatics tools and gene ontology analyses. Hair lipids were extracted and analysed using a gas chromatography-triple quadrupole (GC-QqQ) mass spectrometer, various bioinformatics tools, and lipid pathway enrichment analyses. The combined proteomics and lipidomics quantification data were analysed using both supervised and unsupervised classification methods to build hair proteolipidomic models. We identified a total of 420 hair proteins, which is comparable to the highest numbers in published hair studies. We also identified the largest number of chaperones compared to any published hair study, where nine out 15 are described for the first time in hair. Importantly, seven proteins, belonging to four protein groups (transketolase, iron-sulfur cluster scaffold homolog, proline-rich protein 29, heat shock protein family A) were differentially expressed (p-value < 0.05) and described in hair for the first time. Proline-rich protein 29 was the only differentially expressed protein with a linear increase from hair type I to VI. This is also the first study to report differentially expressed proteins between all six geometric hair types. The differentially expressed hair proteins regulate various aspects of energy metabolism, and they are involved in processes known to drive keratinocyte differentiation and maintain homeostasis in the hair follicle and skin. A total of 77,060 lipid features (RT and m/z) were found, and 3,084 were identified at the lipid species level (RT, m/z, and lipid subclass), which is the largest number of hair lipids identified in any published hair study to date. For the first time, 129 differentially expressed hair lipids (p-value < 0.01) in hair of different curvature were identified. A subset of 19 differentially expressed hair lipids belonging to nine lipid subclasses (sterol lipids, steroids, hydrocarbons, fatty acids, fatty acyl carnitines, ceramides, endocannabinoids, wax esters, and ethyl esters) were characterised and pre-validated using multiple reaction monitoring (MRM) in separate hold-out hair samples. These lipids regulate necroptosis, as well as sphingolipid signalling and metabolism (FDR < 0.05). We built hair proteolipidomic models for the first time, which revealed that the hair proteolipidome comprises several heterogeneous subclusters. Also, that proteins showed a poor correlation with hair curvature as confirmed by poor/moderate ROC scores (0.6 to 0.8), whereas lipids correlated well with hair curvature as confirmed by excellent ROC scores (0.96 to 1). The hair proteolipidome further revealed protein folding, formation of the extracellular matrix, and the Wnt/β-catenin signalling pathway as being associated with hair curvature (FDR < 0.05). In conclusion, our investigation of baseline lipid and protein profiles across various geometric hair types confirms previous data of low correlation between proteins and hair curvature. However, this study identified, for the first time, 9 novel chaperones in hair. Proline-rich protein 29, also novel, was the only protein which increased from hair type I to VI. This study also reports the largest number of lipids in any hair study, is the first to report lipid sub-classes and multi-omics which confirmed the high correlation between lipids and hair curvature. A limitation of this study is that a more robust computational quantification method for hair curvature variations was not used because it was published after this study commenced. Future studies are needed to elucidate the potential contribution of identified molecules to hair curvature variation
From proteomics to biotechnology. using the resurrection plant eragrostis nindensis to genetically engineer drought tolerant crops
Full text linkGlobal climate change is increasingly putting pressure on finding innovative solutions to ensure future food security in particular to developing African nations. Of great relevance are regionally adapted crops, known as orphan crops, which tend to have very little economic value but can provide a source of alternative food security. Vegetative desiccation tolerance is a remarkable feat of selective evolution and is only present in a small number of angiosperms. The ability of some plants, such as Eragrostis nindensis to survive complete cellular water deficit provides an attractive model for discovery-based omics to not only understand the mechanisms involved in driving desiccation tolerance but to explore the feasibility of potential target genes for orphan crop improvement. The work presented herein was aimed at complementing a transcriptomic study using the same leaf tissue from that study to evaluate the changes from RNA to protein and to determine whether there were proteomic signatures that could differentiate the desiccation-tolerant non-senescent (NST) leaves from the desiccation-sensitive senescent (ST) leaves. The data presented here illustrate that several important metabolic pathways are significantly reprogrammed, that only a small subset of proteomic-matching transcripts were translated, and that proteomic differences between the NST and ST were noted despite their being significant similarities between the two in general oxidative and osmotic stress. For instance, the prevention of ferroptosis and accumulation of raffinose synthase and starch synthase in the NST exclusively illustrated that small and subtle increases in protein abundance are likely responsible for enabling resurrection in the NST and not in the ST, which we hypothesise here is likely due to sacrificing of ST upon rehydration as a means to act as a source of nutrition for the NST during resurrection. The study also focussed on functional characterisation of a heat shock 70 protein from E. nindensis as a target for genetic engineering. The selected EnHSP70 was shown to localise to the chloroplast and was able to undergo liquid-liquid phase separation in vitro in a protein concentration and polyethylene glycol dependent manner which could have broad impacts on its role in maintaining proteostasis. In Arabidopsis thaliana, overexpression of EnHSP70 resulted in a stunted germination phenotype whereas expression in BL21 Escherichia coli did not enhance tolerance towards salt or mannitol stress. Furthermore, incubation of EnHSP70 with lactate dehydrogenase did not confer improved thermotolerance. Taken together, the selected HSP70 from E. nindensis did not appear to be involved in stress response and is likely involved with general proteostasis. Lastly, a method for generating embryonic calli from Eragrostis tef is presented with the goal of using this developed protocol for the genetic improvement of the Ethiopian orphan crop
The dynamic processes of the adoption and use of cloud computing by small, medium enterprises in South Africa
Full text linkSmall and Medium Enterprises are vital contributors to economic development in middle-income countries like South Africa. SMEs adopt and use various information and communication technologies, such as cloud computing. This is to compete in the information age characterised by the rapidly changing environment due to ICTs. Cloud computing is a platform where organisations can access a pool of ICT resources through the Internet. Research of CC focusing on the SME sector is generally limited, particularly in middle-income countries. The factors driving the evolution and advancement of the adoption of CC by SMEs in SA have not been adequately articulated within the existing literature. There is a gap in understanding the dynamic processes involved in SMEs' adoption and use of CC in SA. As a result, this research aimed to investigate these dynamic processes, focusing on three aspects. Firstly, the challenges of SMEs' adoption and use of CC. Secondly, the organisational learning processes that lead to the adoption and use of CC. Lastly, the organisational changes experienced by SMEs when adopting and using CC. This research aims to advance the understanding of the African landscape, providing a potential resource for other countries in similar situations to access and utilise this knowledge. A multi-method strategy (induction, abduction and retroduction) was adopted, with three research strategies used to interrogate the phenomenon. Participatory observations and ethnographic interviews were applied research methods. Findings indicated that there may be a limited view of the challenges of adopting and using CC by SMEs in middle-income countries like SA. The challenges not found in the literature encompassed substandard CC provision and financial constraints. Some challenges included insufficient knowledge and skills and a lack of support. The findings associated with OL indicated that SMEs employed OL mechanisms, such as investigative and inquiring activities, training, collaborative learning, and alliances, for the exploration and exploitation learning processes. SMEs faced resource allocation challenges of concurrently managing exploration and exploitation activities in learning. The findings associated with OC revealed that SMEs experienced distinct adoption phases, encompassing pre-adoption, mid-adoption, and post-adoption phases. The transition from pre-adoption to mid-adoption corresponded with OC in communication channels, business processes, human resource management, and a shift in the learning culture and employee mindset. The transition from mid-adoption to post-adoption corresponded with OC in organisational structure and culture
Benefits management and its value to the organisation: a case study in a private organisation
Full text linkThis research evaluates the application of the Benefits Realisation Management (BRM) particularly in the private sector with strategy implementation projects. The key objectives of this study are: to evaluate the alignment of project benefits and the organisations strategic goals, to understand the processes followed to ensure the benefits identified are realised, and to further understand the challenges that the organisation may be facing that influence the adoption of BRM as well as gain insights on potential aiders that can help accelerate the adoption of BRM in the private sector. Ten senior and executive management team members voluntarily participated in the study, and most of the participants completed the interview sessions via face-to-face meetings in the Western Cape, City of Cape Town and others were interviewed online. The analysis of the data has revealed that, the organisation considers project success as the project that has met the triple constraints criteria, delivered on time, on budget and on the agreed scope which is considered to be the project management success as it is still based on the traditional approach to project management even though project success view has shifted overtime and according to literature, the project success is based on the Project Management success as well as the customer satisfaction and the value that the project change has brought about (project benefits). The organisation puts in effort at the pre-initiation phase of the project by identifying the benefits and ensuring it aligns to the strategic objectives of the organisation to obtain funding as this has become a requirement to justify projects and get the board's approval. Whilst this is the first step to the BRM process, the study reveals that the benefits identified at the beginning of the are not tracked or monitored throughout the project or post completion. Also, the findings reveal that the projects that do not require funding from the board do not necessarily have to align to the organisations strategic goals and some do not follow the project governance processes thus, the BRM process is not fully implemented. Another key finding is that the organisation still regards project success based on the traditional approach to project management, which is the project deliverable being met, on time and on budget, they confirm that the benefits realisation should be part of the project measure of success, and the view of project success needs to be based on the project value which includes the realisation of the benefits anticipated. The organisation still does not have a clear understanding of who the benefit accountability should lie with, the study reveals that there is a lack of accountability in the organisation as well as the unclarity of who is or should be accountable for benefit realisation. Although the senior management teams believe that the BRM process should be implemented in the organisation and applied across the divisions, there are gaps within the organisation which mainly includes, the education of the business on the BRM process itself, setting up the BRM process and standardising it across the departments, reinforcement of accountability, stakeholder involvement and gaining Top Management buy-in. The correction of these should then aid the adoption of the BRM process. The limitations of this research are the region and sector in which the study was conducted. The study was conducted in a single private organisation headquarter in the Western Cape region in South Africa. The organisations sector is the retail sector. Only certain departments that implement strategy driven projects were invited to participate to the study. The study can be expanded, and the recommendations are outlined in the report
Evaluation and design of an adapted endobutton fixation system to be used in conjunction with suture and endobutton techniques for the treatment of coronoid process fractures
Full text linkIntroduction: The coronoid process is a critical anatomical structure of the elbow, playing a fundamental role in the joint's stability. Fractures of the coronoid, typically resulting from high-energy impact, can disrupt this stability and compromise the elbow joint posing a significant challenge to the Orthopaedic surgeon. 3D imaging and fracture mapping are becoming the standard practice for visualising the fractured area and a means of planning surgical treatment. Although there is an ongoing debate about the ideal method of treating coronoid fractures, there are several recommended surgical fixation options. One of the available fixation devices is the Endobutton. This dissertation's primary aim is to design an adapted Endobutton using fracture mapping and Q3DCT techniques. The secondary aim is to evaluate the existing Endobutton to establish criteria for comparison and assessment of the newly designed device. Methods and Materials: Sixty-three upper limb computer tomography (CT) scans depicting coronoid fractures were acquired from Groote Schuur Hospital. Q3DCT techniques were used to generate fracture maps from multiple views. This involved editing CT scans to render 3D models of fractures and subsequent in-silico reduction and mapping. These were complimented by the generation of heat maps depicting the fracture line density. Templating and a qualitative assessment, performed by three Orthopaedic surgeons, evaluated the currently used Endobutton, leading to the establishment of evaluation criteria. This was followed by an iterative conceptual and detailed design process that was used to develop the adapted Endobutton. The designed device was verified through rapid prototyping, templating, and comparative qualitative assessment. Subsequent validation of the design was done using simulated surgeries in cadaver limbs, followed by the same comparative qualitative assessment. Results & Discussion: The 3D fracture and heat maps enable comprehensive inspection of the coronoid fractures from multiple views, thus facilitating the identification of the recurring patterns on the anterior surface of the bone. Fracture type specific critical fracture patterns and weak points of the bone's structure are identified. These insights inform the design of an adapted Endobutton. The templating and assessment of the commercially available Endobutton underscore its inefficacy in addressing coronoid fractures, highlighting the limitations that the designed adapted Endobutton aims to mitigate. Verification results indicate that the adapted Endobutton design yields improved qualitative user data, which suggests its enhanced performance as a fixation method compared to the commercially available Endobutton. The validation results reinforce the improved qualitative outcomes for Type 2 and Type 3 coronoid fractures, however the outcomes for Type 1 favour the commercially available device. Overall observations note that a spiked and curved asymmetrical design offer a more congruent fit to the bone, as well as effectively fitting over the majority of the fracture fragments. Conclusion: The commercially available Endobutton leads to unfavourable reduction and fixation qualitative parameters when compared to the newly designed adapted Endobutton. The new design demonstrates promising potential as an effective approach to coronoid fracture fixation as evidence by its effective application to the 3D-printed fractures and cadaver specimens