Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
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Transcript of Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Aneurysmal bone cyst
Pain
Swelling
Spine
Metaphysis of the long bones
Young adult
Aneurysmal bone cyst
Pathology Cyst contains clotted blood
The membrane contains giant cells
X-ray Metaphysis Cystic The boundary stops well short of the articular margin Expands the bone Marked thinning of the cortex
Treatment
Curettage + Bone graft ( Profuse bleeding)
Recurrence is common
Giant cell tumourPathologyUncertain origin
After the end of bone growth
At the rapid growing ends of the long bones
Reddish fleshy appearance
Abundant giant cells
●1/3 benign●1/3 locally invasive
●1/3 metastasize
Clinical features
Young adult
Pain at the end of a long bone
±Slight swelling
Pathological # in%15
Imaging
Eccentric radiolucent at the end of a long bone( soap bubble)
Always extends to the articular cartilage
CT + MRI = extent
Treatment●Well confined, benign histology
Curettage + stripping with burrs
+ hydrogen peroxide or liquid nitrogen + bone graft
●More aggressive and recurrent lesions Excision
+ bone graft or prosthetic replacement
Primary Malignant Bone Tumours
.
osteosarcomaPathology
Highly malignant tumor
Arises from inside the bone
Spreads rapidly to the periosteum, surrounding soft tissues Contains fibrous, cartilage, osteoid tissue in different amounts
Clinical features
Children and adolescents
Pain (1) Constant(2) ↑ at night(3) ↑ gradually(4)around the knee shoulder ( long bone metaph)
Lump
Local tenderness
The overlying skin looks inflamed
Blood exam
(1 )Anaemia
(2↑ )ESR
(3↑ )serum alkaline phosphatase
ImagingPlain X-rayAlternating osteolytic and osteoblastic areas
Margins are poorly defined
The cortex is breached
Codman’s triangle
Sunburst effect
Radioisotope study : skip lesions
CT and MRI : extent of the lesion
Chest X-ray and CT of the lung: lung metastasis
Diagnosis)1 (Imaging
)2 (Biopsy: Mandatory
TreatmentChemotherapy + Resection OR Amputation + Chemotherapy
Diagnosis)1 (Imaging
)2 (Biopsy: Mandatory
Treatment
Chemotherapy + Resection OR Amputation + Chemotherapy
Ewings sarcomaPathologyArises from endothelial cells in the bone marrow
Clinical features
10-20 years
Throbbing pain in tibia or fibula or clavicle
Swelling
Generalized illness
Pyrexia
Tenderness
↑ESR
Imaging
Middiaphysis
Bone destruction
Fusiform layers of bone ( onion-peel appearance)
Treatment
Radiotherapy and chemotherapy have dramatic effect
Amputation may be needed
Metastatic bone diseaseSourcesBreastProstateKidneyLungThyroidBladderGITIn 10% no primary is found
Commonest sites for bone metastasisVertebraePelvisProximal ½ of femur and humerus
Clinical presentations
Pain
Sudden backache in elderly
Incidentally on Xray
Pathological#
Sudden collapse of a vertebral body
Symptoms of hypercalcaemia( anorexia, nausea, thirst, polyuria, abdominal pain, general weakness)
Imaging
Rarefied areas
Osteoblastic deposits in late cases of prostatic Ca
Vertebral collapse
Radioscintigraphy using 99mTc-HDP is the most
sensitive in detecting silent metastatic deposits
Special investigations)1↑(ESR
)2↓ (Hb)3↑ (Serum alkaline phosphatase
)4↑ (Serum acid phosphatase in prostatic Ca
Special investigations
)1↑(ESR
)2↓ (Hb
)3↑ (Serum alkaline phosphatase
)4↑ (Serum acid phosphatase in prostatic Ca
Treatment
)1 (Primary tumor = Accordingly
)2 (Fracture of the shaft = internal fixation followed by radiotherapy
)3 (Fracture of femoral neck = replacement followed by radiotherapy
)4 (Large deposit may fracture = prophylactic internal fixation
)5 (Stable vertebral # = brace)6(Unstable vertebral # = spinal fusion
)7 (Signs of cord compression = urgent decompression + stabilization
)8 (Terminal stage of the disease = radiotherapy ± steroid ± narcotics