orthopedics 5th year, 7th/part two & 8th/part one lectures (dr. bakhtyar)
DESCRIPTION
The lecture has been given on Feb. 12th & 26th, 2011 by Dr. Bakhtyar.TRANSCRIPT
![Page 1: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/1.jpg)
Aneurysmal bone cyst
![Page 2: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/2.jpg)
Pain
Swelling
Spine
Metaphysis of the long bones
Young adult
Aneurysmal bone cyst
![Page 3: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/3.jpg)
Pathology Cyst contains clotted blood
The membrane contains giant cells
![Page 4: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/4.jpg)
X-ray Metaphysis Cystic The boundary stops well short of the articular margin Expands the bone Marked thinning of the cortex
![Page 5: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/5.jpg)
Treatment
Curettage + Bone graft ( Profuse bleeding)
Recurrence is common
![Page 6: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/6.jpg)
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
![Page 7: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/7.jpg)
Clinical features
Young adult
Pain at the end of a long bone
±Slight swelling
Pathological # in%15
![Page 8: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/8.jpg)
Imaging
Eccentric radiolucent at the end of a long bone( soap bubble)
Always extends to the articular cartilage
CT + MRI = extent
![Page 9: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/9.jpg)
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
![Page 10: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/10.jpg)
Primary Malignant Bone Tumours
![Page 11: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/11.jpg)
.
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
![Page 12: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/12.jpg)
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
![Page 13: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/13.jpg)
Blood exam
(1 )Anaemia
(2↑ )ESR
(3↑ )serum alkaline phosphatase
![Page 14: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/14.jpg)
ImagingPlain X-rayAlternating osteolytic and osteoblastic areas
Margins are poorly defined
The cortex is breached
Codman’s triangle
Sunburst effect
![Page 15: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/15.jpg)
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
![Page 16: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/16.jpg)
Diagnosis)1 (Imaging
)2 (Biopsy: Mandatory
Treatment
Chemotherapy + Resection OR Amputation + Chemotherapy
![Page 17: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/17.jpg)
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
![Page 18: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/18.jpg)
Imaging
Middiaphysis
Bone destruction
Fusiform layers of bone ( onion-peel appearance)
![Page 19: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/19.jpg)
Treatment
Radiotherapy and chemotherapy have dramatic effect
Amputation may be needed
![Page 20: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/20.jpg)
Metastatic bone diseaseSourcesBreastProstateKidneyLungThyroidBladderGITIn 10% no primary is found
Commonest sites for bone metastasisVertebraePelvisProximal ½ of femur and humerus
![Page 21: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/21.jpg)
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)
![Page 22: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/22.jpg)
Imaging
Rarefied areas
Osteoblastic deposits in late cases of prostatic Ca
Vertebral collapse
![Page 23: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/23.jpg)
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
![Page 24: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/24.jpg)
Special investigations
)1↑(ESR
)2↓ (Hb
)3↑ (Serum alkaline phosphatase
)4↑ (Serum acid phosphatase in prostatic Ca
![Page 25: Orthopedics 5th year, 7th/part two & 8th/part one lectures (Dr. Bakhtyar)](https://reader035.vdocuments.site/reader035/viewer/2022062702/554b3edeb4c905b5378b49d7/html5/thumbnails/25.jpg)
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