Orthopedic Care and Consultation
Xray and CT of chondrosarcoma of cuboid of the patient whose clinical photograph is here.
Xray first. AP and oblique views were done. Both suggest that lesion is probably coming from cuboid but a better investigation needed to confirm the origin and other details.
AP and Oblique Views of Foot Showing A Bony Lesion Probably From Cuboid
CT scan confirms the origin as cuboid. [Read more...]
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Cartilage Tumours
Osteochondroma
Chondroma
Chondroblastoma
Chondromyxoid fibroma [Read more...]
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After lung and liver, bone is considered to be third m0st common organ involved by metastases. In breast cancer, the bone is second most common site for metastases.
Metastases in bone need early detection and aggressive management.
Aims of the treatment in metastatic bone disease are
The metastatic spread to the bone is hematogenous and therefore affects vascularised parts especially the axial skeleton.
Presentation
The patient with bony metastases may present by any of the following
Evaluation
Special Investigations
Positron emission tomography is helpful in evaluating response to chemotherapy and treatment guidanc
Angiography is used in vascular or very large tumors or aneurysmal bone cysts to identify the feeder vessel or embolize it preoperatively.
Treatment
There are three approaches to metastases and role of each would depend on type of metastatic tumor, location and extent of metastases.
Systemic Therapy
Radiotherapy
Radiotherapy is done for suppression of tumor growth and pain relief.
Surgery
Surgery is done either for removal of tumor or fixation of pathological fractures or to carry out amputaion in case of unsalvageable limbs. In case of joint is destroyed by tumor or needs to be taken out, endoprosthesis or arthrodesis is considered.
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A study by Prof Gareth J Morgan et al reports that first line treatment with zoledronic acid not only prevents skeletal events but also has antimyeloma effects. The study has been published in Lancet, December issue.
Zoledronic acid is a drug that belongs to bisphosphonates group. Bisphosphonates have been used to reduce the risk of skeletal events in patients with malignant bone disease. The present study was a randomized controlled trial between zoledroninc acid and colodronic acid, another bisphosphonate.
In the study, patients of age 18 years or older with newly diagnosed multiple myeloma were enrolled from 120 centres in the UK. Computer-generated randomisation sequence was used to allocate patients equally, via an automated telephone service, to receive 4 mg zoledronic acid as an infusion every 3–4 weeks or 1600 mg oral clodronic acid daily. 
[Read more...]
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Enchondromas are common tumors of hand.
The xray above is of 17 year old girl who presented with swelling of ring finger for past one year and progressively increasing. There was also complaint of pain which increased on exertion.
The xray showed an expansile lytic lesion with well formed cortical rim in proximal phalanx in most of its distal part.
MRI showed a lesion of low signal intensity.
The patient was provisionally diagnosed as a case of enchondroma and treated by curettage and bone grafting.
Histopathology of the section confirmed it to be an enchondroma.
Patient is on her way to recovery.
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This is clinical photograph of a 24 years old male farmer who presented after 8 months of beginning of pain and 5 months of progressively increasing swelling.
The xray suggested a giant cell tumor like picture involving radius along with breach of the cortices. The diagnosis was confirmed by FNAC and a biopsy was planned.
The patient was explained the disease and the treatment after biopsy which was a choice between limb salvage surgery and amputation owing to advanced stage of disease.
Patient wanted some time to think over the issue and discuss with family. He never reported back.
Popularity: 3% [?]
Osteochondroma are projections of bone with a cartilage cap on top that starts growing in metaphysis and goes toward the diaphysis when the person grows. It is found in growing skeleton and grows only till the time bone growth is there.
There are two types
Sessile osteochondroma of tibia
Osteochondromas especially those which are solitary do not require any treatment until they are causing severe symptoms or a sarcomatous change occurs in the lesion
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Osteochondroma is also called osteocartilaginous exostosis. It is the most common primary benign tumor of bone and constitutes 35% to 50% of benign bone neoplasms.The actual incidence is may be higher as many lesions are never reported because they are asymptomatic.
Osteochondroma can occur as hey may occur as solitary lesions or can be a part of multiple hereditary exostoses, which is most often inherited as an autosomal dominant trait although it can also occur sporadically.
Multiple hereditary exostosis lesions show significant variability in size, number, and distribution.
In true sense, osteochondromas are developmental abnormaility of the cartilage which results in formation of a cartilage capped bony protrusion on the surface of a bone.
They most oftenoccur in the distal femur, proximal tibia, and proximal humerus and ilium. Thy most commonly occur in second and third decade of lif.
Males are affected twice as common as females [Read more...]
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