Explore the vast range of titles available.

Giant cell tumours of bone (GCTB) are rare benign, locally aggressive bone tumours that are characterised by mononucleated mesenchymal stromal cells that overexpress receptor activator nuclear factor kappa B (RANK) ligand and multinucleated osteoclast-like giant cells that express RANK. Surgery is the primary management option for operable disease but may cause significant functional morbidity in cervical vertebral GCTB. Case series of denosumab use in irresectable GCTB have reported good long term local control and downgrading of surgical extent. Concerns exist about the increased risk of local recurrence when neoadjuvant denosumab is followed by intralesional surgery, and when treatment is discontinued in cases of advanced disease.Contribution: We describe the management of a 21-year-old female with cervical vertebral GCTB with long-term adjuvant denosumab after partial resection who continues to show good clinical and radiologic control.

The healthcare landscape in South Africa is challenging with a complex patient population and a stressed healthcare system. Negative pressure therapy‐based systems such as negative pressure wound therapy with instillation and dwell (NPWTi‐d) and closed incision negative pressure therapy (ciNPT) can help manage wounds or incisions. However, guidelines for South Africa‐specific use are limited. An in‐person meeting was held with 10 experts to develop South Africa‐specific therapy use recommendations for NPWTi‐d and ciNPT. Panel members recommended NPWTi‐d use for wounds in need of cleansing. Normal saline and a 10‐min dwell time were recommended with the caveat that the instillation solutions and dwell times can be changed based on the wound bed condition and the features of the instillation solution. A negative pressure cycle of 2–3 h and a negative pressure of −125 mmHg were also recommended for NPWTi‐d. In patients, incisions, and surgical procedures at high risk of developing surgical site complications, ciNPT use was recommended. These general recommendations serve as a framework for NPWTi‐d and/or ciNPT use in South Africa and should be updated as more region‐specific evidence becomes available.

Background: Spinal pathology in the Western Cape is managed at three tertiary level hospitals, including Tygerberg Hospital. The Tygerberg Hospital Orthopaedic Spinal Unit is responsible for the management of spinal pathology for the 3.4 million people in the hospital’s catchment area. However, the unit’s overall burden of disease and associated resource use is currently unclear. Aim: The first aim was to investigate the overall burden and clinical profile of spinal pathology presenting to the Tygerberg Hospital Spinal Unit over a one-year period. The second aim was to determine resource use associated with spine pathology admissions. Methods: Overall burden was investigated by performing a retrospective review of all patients admitted to the Spine Unit between 1 October 2016 and 30 September 2017. Demographic and clinical data was collected, and patients were assigned to one of five spinal pathology sub-groups. Resource use was determined by length of hospital stay, waiting times, advanced imaging and theatre usage. Results: Overall burden comprised 349 individual patients and 376 admissions, including readmissions. Trauma (51%) and infection (24%) accounted for the majority of admitted pathology with degenerative (10%), deformity (7%) and malignancy (7%) representing fewer admissions. Motor vehicle accidents were the primary mechanism of injury, accounting for 48% of spine trauma. Tuberculosis was the causative organism in 87% of spinal infections with 44% HIV co-infection. Hospital resource use was considerable with 92% of spine patients requiring advanced imaging, a median operating time of 3 h 36 min and a median hospital stay of 19 days. Infection and malignancy sub-groups had the longest waiting times for advanced imaging and theatre with a median wait of 14–16 days, accounting for approximately 62% of the typical total hospital stay. Conclusions: The Spine Unit experienced a substantial patient burden requiring significant hospital resources. Reduced in-patient waiting times and upskilling of orthopaedic services at secondary hospitals represent key areas for health system strengthening. However, multi-sectoral strategies would be required to effectively address our high burden of largely preventable spinal pathology. Level of evidence: Level 4