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Pathological Fractures — Workup
Stage before biopsy: define lesion (X‑ray/MRI) and search for primaries (CT CAP, bone scan/PET). Adult common cause is metastasis (BLT KP) or myeloma; in children, benign lesions (UBC/ABC, fibrous dysplasia). Biopsy tract must align with planned incision; core biopsy preferred; avoid contaminating compartments. Stabilize impending/complete fractures with nails/plates ± cement; endoprosthesis for major destruction. Adjuvant systemic therapy and radiotherapy per histology; bisphosphonates/denosuma...
Open topicPeriosteal Reaction
Periosteal reactions are one of the most underrated signs on a plain X-ray. One look at the pattern tells you whether you're dealing with something benign and slow — or aggressive and urgent.
Open topicPigmented Villonodular Synovitis (PVNS) / Tenosynovial Giant Cell Tumor (TGCT)
Benign proliferative synovial lesion; localized or diffuse type. Common in knee (80%) and hip; presents with pain, swelling, recurrent effusion. MRI: low-signal intensity on T2 due to hemosiderin deposition. Treatment: synovectomy (arthroscopic/open); recurrence common in diffuse type. Targeted therapy: CSF1R inhibitors (pexidartinib) for unresectable cases.
Open topicSoft Tissue Sarcoma — Enneking
Malignant tumors of mesenchymal origin; >50 histological subtypes. Enneking staging: based on grade (low/high), compartment (intra/extra), metastasis (I–III). Presentation: painless enlarging mass, often deep to fascia. MRI is imaging of choice; biopsy planned along resection line. Treatment: wide surgical excision ± radiotherapy; chemo for select subtypes.
Open topicSolitary Plasmacytoma
Localized malignant proliferation of plasma cells in bone or soft tissue without systemic myeloma. Common in vertebrae, pelvis, ribs, femur. Symptoms: pain, swelling, pathological fracture, neuro deficits if spine involved. Diagnosis: biopsy + immunohistochemistry, normal marrow (
Open topicSynovial Sarcoma
High-grade soft tissue sarcoma, often near large joints of extremities (knee, ankle). Affects adolescents and young adults (15–40 years). Histology: biphasic (epithelial + spindle cells) or monophasic; SYT-SSX fusion gene (t[X;18]). Imaging: calcification may be seen on X-ray; MRI shows heterogeneous mass. Treatment: wide excision with radiotherapy; chemotherapy (ifosfamide, doxorubicin) improves survival in advanced cases.
Open topicTumour Biology — Benign vs Malignant
Benign: slow, well circumscribed, no metastasis. Malignant: rapid, infiltrative, metastasis. Histology: benign differentiated; malignant atypia, mitoses, necrosis. Radiology: benign geographic margins; malignant permeative with periosteal reactions.
Open topicUnhappy Triad of O'Donoghue
The unhappy triad (O'Donoghue triad) is a combined knee injury involving the ACL, MCL, and medial meniscus, classically caused by a valgus contact force on a planted foot. Modern evidence has revised the original description — the lateral meniscus is now recognised as the more commonly injured meniscus in this injury pattern.
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