Tumour_Scenario

Question 1

Tumour_Scenario

Answer 1

1. History
   
   1. Age/Sex
   2. O nset
   3. P osition
   4. Q uality/Quantity
   5. R adiation
   6. S ymptoms associated
      
      1. Neurologic
      2. Mechanical
      3. Constitutional
      4. Local
   7. T iming
   8. AA
   9. PSHX, PMHX, Meds, Allergies
   10. Family Hx, Social Hx (EtOH, tobacco)
   11. Handedness, Occupation, Sports
   12. ADLs
   13. ROS
2. Physical Exam
   
   1. Look
      
      1. Gait
      2. S welling
      3. E rythema
      4. A trophy
      5. D eformity
      6. S kin changes
   2. Feel
   3. Move
   4. NV Exam
   5. Special Tests
3. Imaging
   
   1. Xrays
      
      1. 7 x-ray signs for hole in bone
         
         1. size
         2. site
            
            1. epiphyseal, metaphyseal, diaphyseal
            2. eccentric, central
            3. medullary, cortical
         3. pattern/zone of transition
            
            1. geographic
            2. permeative
            3. moth eaten
         4. matrix
            
            1. osteoid
            2. cartilagninous (popcorn, stippled, arc and rings)
         5. effect on bone
            
            1. endosteal scalloping or erosion
            2. expansion
            3. cortical thinning or breakthough
            4. fracture
         6. reaction of bone to lesion
            
            1. periosteal reaction
               
               1. sunburst
               2. hair on end
               3. onion skin (lamellated)
               4. codman triangle
         7. soft tissue mass
   2. Other modalities
   3. Possible Biopsy
4. Diagnosis or DDx
   
   1. Implications (AVN risk, infection, etc.)
5. Acute Rx and work-up
   
   1. Reduce/splint/traction, ER tests/consults, admit, further imaging, plan OR for trauma
6. Treatment plan
   
   1. Goals
   2. Non-operative Rx (options, follow-up)
   3. Operative Rx
      
      1. Options
   4. Consent
      
      1. Outcome
      2. Risks
         
         1. immediate
         2. late
   5. Pre-op
      
      1. labs (x-match), tests (ECK, CXR), old OR reports, consults
   6. Post the case
      
      1. patient, surgery, implants, adjuncts (teams, consultants, special equipment), table, flouro, monitoring
7. Technique
   
   1. Position, ABX
   2. Incision, approach, fixation
8. Post-op
   
   1. NV exam, compartment check
   2. Xrays
   3. Immobilization
   4. Weight Bearing Status, Physio
9. Disposition and Follow-up
   
   1. F/U plan
10. Complications
    
    1. List potential complications
    2. Prevention
    3. Treatment