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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_15 | Pages 37 - 37
7 Nov 2023
du Preez J le Roux T Meijer J
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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).


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_15 | Pages 2 - 2
7 Nov 2023
du Plessis JG Koch O le Roux T O'Connor M
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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.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_19 | Pages 60 - 60
1 Dec 2014
Marais L Ferreira N Aldous C Sartorius B Le Roux T
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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;

The aim of the study was to investigate the short term outcome of the treatment of chronic osteomyelitis in adult patients where selection of a management strategy was based on a refined host stratification system.

Methods;

A retrospective review was performed of adult patients with chronic osteomyelitis seen over a one year period. In total 116 patients were included in the study. A modified host stratification system was applied, incorporating predefined major and minor criteria, to determine each patient's host status.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_29 | Pages 81 - 81
1 Aug 2013
du Plessis L le Roux T Becker P
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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.

Methods:

We focused on the following: the surgeon; the procedure; operating time; inpatient time; intraoperative block; physiotherapy costs, time off work and the cost of instrumentation used. Patients had to comply with specific inclusion and exclusion criteria.

Inclusion: All patients that had shoulder decompression surgery in the past three years by a qualified orthopaedic surgeon; Exclusion: sepsis, tumours, rotator cuff tears, conversion of an arthroscopic procedure to an open procedure intraoperatively, inadequate notes, multiple surgical procedure under the same anaesthetic (e.g. scope with a trapezium excision).


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_29 | Pages 13 - 13
1 Aug 2013
Steyn C le Roux T
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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.

Patients and Methods:

A retrospective study of follow ups was done on fifty six patients treated for chondrosarcoma at the Pretoria musculoskeletal tumour unit from 1987–2009, evaluating the outcome and presence of local recurrence. The lesions were divided into four histological grades; atypical enchondroma (grade 0), low grade chondrosarcoma (grade 1), intermediate grade chondrosarcoma (grade 2), and high grade chondrosarcoma (grade3).

Results:

Biopsy revealed forty-six patients with low grade chondrosarcoma (82%), nine cases of grade 2 chondrosarcoma (16%), and one patient with a metastatic mesenchymal chondrosarcoma. The femur and humerus were the commonest sites involved, while the axial skeleton was only affected in three cases, all of whom had more aggressive lesions. Forty-nine patients had no recurrence after a mean period of 57.5 months follow up. Forty- two of those had low grade lesions, and seven patients had grade 2 lesions. Two patients with low grade lesions were lost to follow up. Three patients involved in the study presented with local recurrence, but no metastases were detected radiographically. Two patients died, one with metastatic mesenchymal chondrosarcoma involving the scapula, and the other with a grade 2 lesion of the pelvis.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_14 | Pages 13 - 13
1 Mar 2013
du Plessis L Le Roux T Greyling P
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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.

Materials and Methods

A retrospective study of all patients who presented with histologically confirmed fibromatosis at an orthopaedic practice in the past 19 years was conducted. Age of the patient at first presentation; sex; tumour site; surgery performed; histological results; first line of treatment and recurrence rate were reviewed. Patients were also contacted telephonically in order to know if they had any recurrence that was managed by another orthopaedic surgeon.