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

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

5. Treatment Curettage + Bone graft ( Profuse bleeding) Recurrence is common

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

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)

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