Primary malignant bone tumours are a scarce entity with limited population-based data from developing countries. The aim of the study is to investigate the frequency and anatomical distribution of primary malignant bone tumours in a local South African population.

This will be an epidemiological retrospective study. Data will be used of patients that were diagnosed with primary malignant bone tumours over a period of nine years spanning from 1 January 2014 to 31 December 2022. This data will be received from private and government laboratories. Data to be considered are type of primary malignant bone tumours diagnosed, incidence of primary malignant bone tumours over a period of nine years and the most common anatomical sites of primary malignant bone tumours. The rationale behind our study is to assess the frequency of different primary malignant bone tumours in another geographic area of South Africa and to compare these findings to local and international literature. With a projected increase in diagnosis of primary malignant bone tumours in developing countries it is important to have more available data about primary malignant bone tumours from these areas to have a better understanding of these conditions and to understand the impact of the burden they impose on healthcare systems so that management of these conditions can also be improved. Preliminary results show that 23.83% of primary malignant bone tumours occurred in the age group 0–24 years of age, 49.22% in the 25–59 age group and 26.95% in the 60+ age group. The most common tumour that occurred was chondrosarcoma (49.21%) followed by osteosarcoma (41.80%) then Ewing's sarcoma (4,69%) and lastly chordoma (4.30%). From the 256 samples that met the inclusion criteria the five most common anatomical sites were distal femur (63), proximal tibia (41), proximal humerus (38), pelvis (34) and proximal femur (20).

In reverse shoulder arthroplasty (RSA), a high complication rate is noted in the international literature (24.7%), and limited local literature is available. The complications in our developing health system, with high HIV, tuberculosis and metabolic syndrome prevalence may be different from that in developed health systems where the literature largely emanates from. The aim of this study is to describe the complications and complication rate following RSA in a South African cohort.

An analytical, cross-sectional study was done where all patients’ who received RSA over an 11 year period at a tertiary hospital were evaluated. One-hundred-and-twenty-six primary RSA patients met the inclusion criteria and a detailed retrospective evaluation of their demographics, clinical variables and complication associated with their shoulder arthroplasty were assessed. All fracture, revision and tumour resection arthroplasties were excluded, and a minimum of 6 months follow up was required.

A primary RSA complication rate of 19.0% (24/126) was noted, with the most complications occurring after 90 days at 54.2% (13/24). Instability was the predominant delayed complication at 61.5% (8/13) and sepsis being the most common in the early days at 45.5% (5/11). Haematoma formation, hardware failure and axillary nerve injury were also noted at 4.2% each (1/24).

Keeping in mind the immense difference in socioeconomical status and patient demographics in a third world country the RSA complication rate in this study correlates with the known international consensus. This also proves that RSA is still a suitable option for rotator cuff arthropathy and glenohumeral osteoarthritis even in an economically constrained environment like South Africa.

This study aims to determine the incidence of surgical site infection leading to reoperation for sepsis following minor hand procedures performed outside the main operating room using field sterility in the South African setting.

The investigators retrospectively reviewed the records of 485 patients who had WALANT-assisted minor hand surgery outside a main operating theatre, a field sterility setting between March 2019 and April 2023. The primary outcome was the presence or absence of deep surgical site infection that required reoperation within four weeks. Cases included where elective WALANT minor hand procedures, a minimum age of 18 with complete clinical records.

The patients were mostly female (54.8%), with a mean age of 56.35 years. The majority of cases were trigger finger and carpal tunnel release. An overall 485 cases were reviewed, the deep surgical site infection rate resulting in reoperation within 4 weeks post-operatively was 1.24% ((95% Confidence Interval (CI) 0.0034 to 0.0237); p = 0.009).

Minor hand procedures performed under field sterility using WALANT have a low surgical site infection rate. The current study's infection rates are comparable to international surgical site infection rates for similar surgeries performed in main operating rooms using standard sterilisation procedures. Field sterility is a safe and acceptable clinical practice that may improve work efficiency in public sector.

Despite numerous advances in the management of chronic osteomyelitis, many questions remain. To date, no evidence-based guidelines exist in the treatment of chronic osteomyelitis. In essence the aim is to improve quality of life through either a curative or a palliative treatment strategy. The choice of treatment strategy is based on the physiological status of the host. This process of host stratification is, however, complicated by the fact that the definition of a C-host has never been standardized.

Purpose of the study:

Improved technology, increasing experience and techniques warrant an analysis of cost effective ways of medical management in general and shoulder decompression specifically. The question raised was whether a less invasive technique is necessarily the most cost effective way or merely the surgeons' preferred technique.

This is a retrospective study of patients at Tertiary Academic Institution who underwent an open or arthroscopic shoulder decompression in the past 3 years.

The aim of the study is to do a cost analysis of shoulder surgery as private health care (medical aid) is demanding more cost effective procedures and we have limited funds in the Government setting.

Low grade chondrosarcoma is currently followed up with the same schedule as all other chondrosarcoma patients. When treated adequately, low grade chondrosarcoma appears to have a very benign follow up course.

Purpose of the study

Fibromatosis is a benign, but locally aggressive tumour. We had a series of patients who had a high rate of recurrence though they had a wide surgical excision. The question raised was whether there are newer treatment modalities with a higher success rate. We did a retrospective study and review of the literature in order to see if there was anything new that can help us reduce recurrences.

The primary purpose of this study was to evaluate the appropriate use of Dual Energy X-ray absorptiometry (DEXA) scanning in the follow-up of osteoporosis. The secondary aim was to ascertain the correlation between body mass index (BMI) and osteoporosis in the study population.

Six hundred and sixty six patients were sent for DEXA scanning from the Osteoporosis clinic at 1-Military Hospital from June 1998 to February 2004. A descriptive expost facto study of primary data was undertaken, consisting of patient records, test results and post treatment test results. Patients were classified according to their World Health Organization (WHO) classification of bone density. Each of the categories was then followed-up to determine an improvement or deterioration in a specific category.

A total number of 307 (46.1%) follow-up DEXA scans were done over a period of five years. The majority of patients’ bone mineral density (BMD) remained in the same WHO category while a significant number improved to a higher category. The biggest improvement was in elevating patients from an osteoporosis category to an osteopenic category. Only a small number of patients’ BMD deteriorated.

A significant positive correlation between BMI and T-scores for all the patients who received DEXA scans was found. It is therefore apparent that it is safe to follow-up patients with osteoporosis by means of DEXA scanning only once every four to five years. The correlation between BMI and bone mineral density, might serve as a useful guide to identify patients qualifying for more frequent follow up scans.

The first purpose of this study was to survey patterns of unusual metastatic spread of soft tissue sarcoma in patients treated at the Musculoskeletal Tumour Unit in Pretoria, and the second to make recommendations regarding the treatment and follow-up of patients.

In 3671 cases of musculoskeletal tumours treated from 1986 to 2003, 346 cases of soft tissue sarcoma were reported. Unusual metastases were present in 11 male and four female patients, ranging in age from 15 to 76 years. The interval between diagnosis and first metastasis ranged from 1 to 56 months. Pulmonary metastases occurred in only six patients, all with metastases in unusual sites. In 10 patients the unusual metastases were diagnosed after the patients themselves had discovered them on self-examination. Meticulous clinical examination combined with radiographs, CT scan and ultrasonographic examinations led to the diagnosis of the other metastases.

This series highlights the importance of referring patients to tumour centres, where the multidisciplinary management approach facilitates the implementation of coordinated surveillance strategies and the early detection and treatment of distant metastases.

The purpose of this study is to compare functional results of hemipelvectomy and internal hemipelvectomy following resection of pelvic tumours. The emotional acceptance of such surgery is also examined.

From 1998 to 2003, 19 male and 13 female patients, aged from 6 to 76 years, underwent hemipelvectomy, and 12 male and seven female patients, aged from 13 to 65 years, underwent internal hemipelvectomy. In the series as a whole, follow-up ranged from 1 to 156 months. Five patients with external hemipelvectomy, six with internal hemipelvectomy and one who underwent internal hemipelvectomy followed by external hemipelvectomy were evaluated functionally, clinically and psychologically.

Patients expressed emotional concern about body image and mobility. Psychosocial adjustment was difficult for all patients, but some were able to overcome their difficulties more easily than others. Patients with internal hemipelvectomy rather than external hemipelvectomy had more difficulty adjusting emotionally.

The site of the tumour and morbidity rates, which remain high when limb-sparing surgery is performed for pelvic tumours, are important considerations when deciding upon the type of surgery. Patients and their families need extensive preoperative psychological preparation and postoperative psychotherapy is imperative.

The purpose of this study was to evaluate functional ability following proximal humeral resection for bone/ soft tissue tumours.

We studied the records of and clinically examined 19 patients with allograft reconstruction following resection of bone/soft tissue tumours.

Although proximal functioning was impaired, all patients could use their arms for activities of daily living. Complications such as sepsis and nonunion occurred in six patients. The tumour recurred in one patient and there were proximal metastases in two. In seven patients there were no complications. Medical, psychological and social concerns were included in the evaluation and in these respects patients expressed satisfaction.

Patient satisfaction and the complication rate were comparable with results in the international literature we surveyed.