Bone Disease Flashcards
You are the orthopaedic registrar in the fracture clinic. An 8 year old girl has been referred from A&E with a fracture to her right clavicle. She dis this when she fell from a swing onto her outstretched hand. She’s comfortable in the broad arm sling she has been given and she’s neurovasularly intact in the right arm. She had no preceding symptoms, such as pain, in the shoulder or collar bone prior to the accident. She is fit and well.
On examination, there is a mild deformity in the middle 1/3 of the clavicle at the site of the fracture but the skin is intact.
So far, there is nothing atypical about this girl’s story or injury. However, when you look at the x-ray, you notice that the bone at the fracture site isn’t completely normal. There is a lucent lesion in the middle 1/3 of the clavicle with a smooth edge where it meets the more normal looking bone. There is mild expansion of the cortex.
What do you suspect has caused this pathological fracture?
Simple Bone Cyst
Likely a defect in physis (growth plate) and found in metaphyseal region of long bones (usually proximal humerus & femur) although they can occur in talus & calcaneus.
Often asymptomatic, found incindentally. Can cause a fracture which is often the presentation. After the fracture heals the bone cyst will be filled with bone and therefore stronger.
A single lucent lesion, often an incidental finding, found most commonly within metaphyseal regions.
What is this bony lesion?
A simple bone cyst.
A tumour extensively involving the proximal femur with cortical thinning and a ‘Shepherd’s crook’ deformity.
What is this bony lesion?
Fibrous Dysplasia
Tumour often occuring arround the knee and distal radius with a ‘soap bubble’ appearance
Giant Cell Tumour
A lucent, multi-loculated cyst found within the medulla of many different bones, often with associated cortical expansion.
What is this bony lesion?
Aneurysmal bone cyst
A mostly lucent lesion, with a patchy sclerosis, found within the metaphyseal region of short tubular bones.
What lesion is this?
Enchondroma
A bony spur, originating the in metaphyseal regions of long bones, growing away from the epiphysis.
What lesion is this?
Osteochondroma
Usually doesn’t produce any problems but localised pain. There is a 1% chance of malignant transformation into osteosarcoma.
A malignant tumour that only rarely occurs in bone and usually only if the bone is abnormal (Paget’s etc.).
Which malignant bone tumour is this?
Fibrosarcoma
A malignant tumour of unknown histogenesis characterised by the t(11;22) translocation.
Which malignant bone tumour is this?
Ewing’s Sarcoma
The most common form of primary bone tumour, producing abnormal bone. Most cases are seen in younger age groups (adolescence and early adulthood) with 60% involving the bones around the knee.
What malignant bone tumour is this?
Osteosarcoma
Which cancers metastasise readily to bone? (5)
Breast, prostate, lung, renal, thyroid.
