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Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)
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Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)

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The lecture has been given on Feb. 12th & 26th, 2011 by Dr. Bakhtyar.

The lecture has been given on Feb. 12th & 26th, 2011 by Dr. Bakhtyar.

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  • 1. Aneurysmal bone cyst
  • 2. Pain Swelling Spine Metaphysis of the long bones Young adult Aneurysmal bone cyst
  • 3. Pathology Cyst contains clotted blood The membrane contains giant cells
  • 4. <ul><li>X-ray </li></ul><ul><li>Metaphysis </li></ul><ul><li>Cystic </li></ul><ul><li>The boundary stops well short of the articular margin </li></ul><ul><li>Expands the bone </li></ul><ul><li>Marked thinning of the cortex </li></ul>
  • 5. Treatment Curettage + Bone graft ( Profuse bleeding) Recurrence is common
  • 6. <ul><li>Giant cell tumour </li></ul><ul><li>Pathology </li></ul><ul><li>Uncertain origin </li></ul><ul><li>After the end of bone growth </li></ul><ul><li>At the rapid growing ends of the long bones </li></ul><ul><li>Reddish fleshy appearance </li></ul><ul><li>Abundant giant cells </li></ul><ul><li>● 1/3 benign </li></ul><ul><li>● 1/3 locally invasive </li></ul><ul><li>● 1/3 metastasize </li></ul>
  • 7. Clinical features Young adult Pain at the end of a long bone ± Slight swelling Pathological # in%15
  • 8. Imaging Eccentric radiolucent at the end of a long bone( soap bubble) Always extends to the articular cartilage CT + MRI = extent
  • 9. 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
  • 10. Primary Malignant Bone Tumours
  • 11. . <ul><li>osteosarcoma </li></ul><ul><li>Pathology </li></ul><ul><li>Highly malignant tumor </li></ul><ul><li>Arises from inside the bone </li></ul><ul><li>Spreads rapidly to the periosteum, surrounding soft tissues </li></ul><ul><li>Contains fibrous, cartilage, osteoid tissue in different amounts </li></ul>
  • 12. <ul><li>Clinical features </li></ul><ul><li>Children and adolescents </li></ul><ul><li>Pain </li></ul><ul><li>(1) Constant </li></ul><ul><li>(2) ↑ at night </li></ul><ul><li>(3) ↑ gradually </li></ul><ul><li>(4)around the knee shoulder ( long bone metaph) </li></ul><ul><li>Lump </li></ul><ul><li>Local tenderness </li></ul><ul><li>The overlying skin looks inflamed </li></ul>
  • 13. Blood exam (1) Anaemia (2) ↑ESR (3) ↑serum alkaline phosphatase
  • 14. Imaging Plain X-ray Alternating osteolytic and osteoblastic areas Margins are poorly defined The cortex is breached Codman’s triangle Sunburst effect
  • 15. 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 Treatment Chemotherapy + Resection OR Amputation + Chemotherapy
  • 16. Diagnosis (1) Imaging (2) Biopsy: Mandatory Treatment Chemotherapy + Resection OR Amputation + Chemotherapy
  • 17. Ewings sarcoma Pathology Arises 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
  • 18. Imaging Middiaphysis Bone destruction Fusiform layers of bone ( onion-peel appearance)
  • 19. Treatment Radiotherapy and chemotherapy have dramatic effect Amputation may be needed
  • 20. Metastatic bone disease Sources Breast Prostate Kidney Lung Thyroid Bladder GIT In 10% no primary is found Commonest sites for bone metastasis Vertebrae Pelvis Proximal ½ of femur and humerus
  • 21. 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)
  • 22. <ul><li>Imaging </li></ul><ul><li>Rarefied areas </li></ul><ul><li>Osteoblastic deposits in late cases of prostatic Ca </li></ul><ul><li>Vertebral collapse </li></ul>
  • 23. 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
  • 24. Special investigations (1)↑ESR (2) ↓Hb (3) ↑Serum alkaline phosphatase (4) ↑Serum acid phosphatase in prostatic Ca
  • 25. 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

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