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
<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...
Treatment Curettage + Bone graft ( Profuse bleeding) Recurrence is common
<ul><li>Giant cell tumour </li></ul><ul><li>Pathology </li></ul><ul><li>Uncertain origin </li></ul><ul><li>After the end o...
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 =...
Treatment ● Well confined, benign histology  Curettage  +  stripping with burrs  +  hydrogen peroxide or liquid nitrogen +...
Primary Malignant Bone Tumours
.  <ul><li>osteosarcoma </li></ul><ul><li>Pathology </li></ul><ul><li>Highly malignant tumor </li></ul><ul><li>Arises from...
<ul><li>Clinical features </li></ul><ul><li>Children and adolescents </li></ul><ul><li>Pain  </li></ul><ul><li>(1) Constan...
Blood exam (1) Anaemia (2) ↑ESR (3) ↑serum alkaline phosphatase
Imaging Plain X-ray Alternating osteolytic and osteoblastic areas Margins are poorly defined The cortex is breached Codman...
Radioisotope study  : skip lesions CT and MRI  : extent of the lesion Chest X-ray and CT of the lung : lung metastasis Dia...
Diagnosis (1) Imaging (2) Biopsy: Mandatory Treatment Chemotherapy + Resection OR Amputation + Chemotherapy
Ewings sarcoma Pathology Arises from endothelial cells in the bone marrow Clinical features 10-20 years Throbbing pain in ...
Imaging Middiaphysis Bone destruction Fusiform layers of bone ( onion-peel appearance)
Treatment Radiotherapy and chemotherapy have dramatic effect Amputation may be needed
Metastatic bone disease Sources Breast Prostate Kidney Lung Thyroid Bladder GIT In 10% no primary is found Commonest sites...
Clinical presentations Pain Sudden backache in elderly Incidentally on Xray Pathological # Sudden collapse of a vertebral ...
<ul><li>Imaging </li></ul><ul><li>Rarefied areas </li></ul><ul><li>Osteoblastic deposits in late cases of prostatic Ca </l...
Radioscintigraphy using 99mTc-HDP is the most sensitive in detecting silent metastatic  deposits Special investigations (1...
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) Fract...
Upcoming SlideShare
Loading in …5
×

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

1,293 views

Published on

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

Published in: Health & Medicine
1 Comment
1 Like
Statistics
Notes
  • Please sent power points for me
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Views
Total views
1,293
On SlideShare
0
From Embeds
0
Number of Embeds
11
Actions
Shares
0
Downloads
94
Comments
1
Likes
1
Embeds 0
No embeds

No notes for slide

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

  1. 1. Aneurysmal bone cyst
  2. 2. Pain Swelling Spine Metaphysis of the long bones Young adult Aneurysmal bone cyst
  3. 3. Pathology Cyst contains clotted blood The membrane contains giant cells
  4. 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. 5. Treatment Curettage + Bone graft ( Profuse bleeding) Recurrence is common
  6. 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. 7. Clinical features Young adult Pain at the end of a long bone ± Slight swelling Pathological # in%15
  8. 8. Imaging Eccentric radiolucent at the end of a long bone( soap bubble) Always extends to the articular cartilage CT + MRI = extent
  9. 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. 10. Primary Malignant Bone Tumours
  11. 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. 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. 13. Blood exam (1) Anaemia (2) ↑ESR (3) ↑serum alkaline phosphatase
  14. 14. Imaging Plain X-ray Alternating osteolytic and osteoblastic areas Margins are poorly defined The cortex is breached Codman’s triangle Sunburst effect
  15. 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. 16. Diagnosis (1) Imaging (2) Biopsy: Mandatory Treatment Chemotherapy + Resection OR Amputation + Chemotherapy
  17. 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. 18. Imaging Middiaphysis Bone destruction Fusiform layers of bone ( onion-peel appearance)
  19. 19. Treatment Radiotherapy and chemotherapy have dramatic effect Amputation may be needed
  20. 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. 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. 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. 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. 24. Special investigations (1)↑ESR (2) ↓Hb (3) ↑Serum alkaline phosphatase (4) ↑Serum acid phosphatase in prostatic Ca
  25. 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

×