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Allografts & Bone Banking
Bone allografts used for structural reconstruction after tumor resection. Sources: cadaveric donors; stored in bone banks (fresh-frozen, freeze-dried). Indications: intercalary defects, osteoarticular reconstruction. Complications: nonunion, fracture, infection, resorption. Alternatives: endoprosthesis, autograft, vascularized fibula.
Open topicAneurysmal Bone Cyst
Expansile blood-filled benign tumor in children/young adults. Common sites: metaphysis of long bones, spine posterior elements. X-ray: blow-out lesion with thin shell, septations. MRI: multiple fluid–fluid levels. Treatment: curettage + graft/cement, sclerotherapy, embolization.
Open topicBiopsy Principles in MSK Oncology
Biopsy is critical for diagnosis but must follow strict oncological principles. Plan biopsy with final surgery in mind; incision should be longitudinal and in line with resection. Avoid contamination of uninvolved compartments and neurovascular structures. Prefer core needle/incisional biopsy; excisional only for small superficial masses. Send adequate tissue for histopathology, culture, cytogenetics.
Open topicBone Tumor Biopsy Principles
Biopsy should be performed only by definitive surgical team at referral center. Types: core needle (preferred), incisional, excisional. Incision along surgical approach, longitudinal not transverse. Biopsy tract must be excised en bloc at definitive surgery. Complications: contamination, hematoma, infection, inadequate sample.
Open topicBone Tumor Imaging — Lodwick
Lodwick classification describes patterns of bone destruction on radiographs. Type I: geographic (IA sclerotic rim, IB sharp margin, IC ill-defined). Type II: moth-eaten destruction. Type III: permeative pattern. Helps differentiate benign vs malignant and plan biopsy/management.
Open topicChondrosarcoma
Second most common primary malignant bone tumor in adults. Occurs age 40–70 yrs; M > F. Common sites: pelvis, femur, shoulder girdle, ribs. Variants: conventional, clear cell, mesenchymal, dedifferentiated. Chemo/RT ineffective except mesenchymal type. Treatment: wide surgical excision.
Open topicChondrosarcoma — Grades & Surgery
Second most common primary malignant bone tumor after osteosarcoma, usually >40 years. Common sites: pelvis, femur, humerus, ribs. Graded histologically (I–III); dedifferentiated and mesenchymal subtypes more aggressive. X‑ray: rings‑and‑arcs calcification, endosteal scalloping, cortical breach. Treatment: Wide surgical resection is mainstay; chemo/radiotherapy are ineffective.
Open topicEnchondroma vs Osteochondroma
Enchondroma: intramedullary cartilage tumor, common in hand phalanges. Osteochondroma: cartilage-capped exophytic lesion from metaphysis. Syndromes: Ollier, Maffucci (enchondroma); Multiple Hereditary Exostoses (osteochondroma). Malignant transformation rare in solitary lesions, higher in syndromic cases. Treatment: observation, excision if symptomatic or suspicious.
Open topicEwing’s Sarcoma — Protocols
Second most common malignant bone tumor in children/adolescents after osteosarcoma. Characterized by t(11;22) → EWS-FLI1 translocation. Common sites: diaphysis of long bones, pelvis, ribs. Onion-skin periosteal reaction on X-ray is classical. Treatment: multi-agent chemotherapy (VDC/IE), surgical resection ± radiotherapy. Overall survival ~70% in localized disease,
Open topicExpandable Prosthesis in Paediatric Oncology
Indicated for skeletally immature patients undergoing limb-salvage near a growth plate (e.g., distal femur/proximal tibia). Designs: minimally invasive magnetically driven expanders vs older surgical-lengthening types. Aims to maintain limb length equality during growth while preserving function and oncologic safety. Complications: infection, mechanical failure, soft-tissue problems, stiffness; multiple lengthenings required. Requires multidisciplinary follow-up through growth until maturity.
Open topicFibrous Dysplasia — Shepherd’s Crook
Developmental fibro‑osseous lesion replacing normal bone with fibrous tissue. Types: monostotic (70%), polyostotic; associated with McCune–Albright (café‑au‑lait, endocrine). X‑ray: ground‑glass appearance, expansion, cortical thinning; Shepherd’s crook deformity of proximal femur. Histology: irregular woven bone trabeculae (‘Chinese letters’) in fibrous stroma. Treatment: bisphosphonates for pain, corrective osteotomies, internal fixation for deformity.
Open topicGiant Cell Tumor — Campanacci Classification
Locally aggressive benign tumor in skeletally mature adults (20–40 yrs). Campanacci classification: Grade I (latent), II (active), III (aggressive with soft tissue extension). X-ray: eccentric lytic lesion, soap-bubble appearance. Treatment: extended curettage with adjuvants, PMMA, or wide excision. Denosumab indicated in sacral/spinal or unresectable lesions.
Open topicLimb Salvage — Endoprostheses
Limb salvage is preferred over amputation when margins can be obtained and function preserved. Endoprostheses replace resected bone segment, especially around knee and proximal humerus. Types: modular, custom‑made, expandable (pediatric). Complications: infection, aseptic loosening, mechanical failure, soft tissue problems. Survival: 70–80% implant survival at 10 years; improves quality of life over amputation.
Open topicLimb Salvage Surgery in Bone Tumors
Oncologic principles: accurate diagnosis, staging (MRI, PET/CT), biopsy planning, and **wide margins**. Indications: resectable tumors with adequate soft-tissue coverage and neurovascular preservation; good chemo response when applicable. Reconstruction options: endoprosthesis (modular/mega), biological (intercalary grafts, vascularized fibula, allograft), arthrodesis. Complications: infection, flap failure, nonunion, prosthetic loosening, local recurrence. Multidisciplinary planning is essentia...
Open topicMega Prosthesis — Indications & Complications
Used for segmental bone loss after tumor resection or non-oncologic massive defects (failed revision arthroplasty, periprosthetic fractures). Common sites: distal femur replacement (DFR), proximal tibia, proximal femur replacement (PFR), proximal humerus. Advantages: immediate stability, early mobilization; modular designs allow intra-op flexibility. Complications: infection, aseptic loosening, soft tissue failure (extensor mechanism in proximal tibia), mechanical breakage. Long-term survivorshi...
Open topicMetastatic Bone Disease
Most common malignant tumor of bone overall. Primary sources: breast, prostate, lung, kidney, thyroid. Lesions: breast (mixed), prostate (blastic), lung/kidney/thyroid (lytic). Sites: spine, pelvis, proximal femur/humerus. Investigations: X-ray, MRI, CT chest/abdomen, bone scan/PET. Management: systemic therapy, bisphosphonates/denosumab, prophylactic fixation (Mirel’s >8), radiotherapy, spinal stabilization.
Open topicModular Mega-prosthesis — Knee
Used after wide resection of distal femur/proximal tibia tumors. Modular systems allow intraoperative flexibility and immediate stability. Expandable designs used in children to accommodate growth. Advantages: early mobilization, good function; Disadvantages: high cost, infection risk. Survival: 70–80% implant survival at 10 years; complications include loosening, mechanical failure.
Open topicMultiple Myeloma — Orthopaedic View
Most common primary malignant bone tumor in adults (median age ~65 yrs). Neoplastic proliferation of plasma cells → monoclonal immunoglobulin production. Classical CRAB features: hyperCalcemia, Renal failure, Anemia, Bone lesions. Radiology: multiple punched-out lytic lesions, diffuse osteopenia. Diagnosis: SPEP/UPEP (M protein, Bence-Jones), bone marrow biopsy (>10% plasma cells). Ortho role: prophylactic fixation of impending fractures (Mirel’s >8), spinal decompression, bisphosphonates, verte...
Open topicMultiple Myeloma & Plasmacytoma
Most common primary malignant tumor of bone (plasma cell dyscrasia). CRAB features: hyperCalcemia, Renal failure, Anemia, Bone lesions (lytic). X‑ray: punched‑out lytic lesions, diffuse osteopenia, vertebral collapse. Diagnosis: serum/urine electrophoresis (M‑protein), bone marrow plasma cells >10%. Treatment: systemic chemotherapy (bortezomib, lenalidomide, dexamethasone), bisphosphonates, SCT in eligible patients.
Open topicNuclear Medicine — Bone Scan & PET Basics
Bone scan = radionuclide (Tc-99m MDP) uptake proportional to osteoblastic activity. Highly sensitive for metastasis, stress fractures, infection, AVN. PET (FDG-PET): measures metabolic activity (glucose uptake). PET superior for staging malignancy, differentiating benign vs malignant lesions. Limitations: false positives (arthritis, trauma, infection).
Open topicOsteoid Osteoma — Night Pain & RFA
Benign osteoblastic tumor
Open topicOsteosarcoma — Diagnosis & Treatment
Most common primary malignant bone tumor in adolescents (after myeloma overall). Sites: metaphysis of long bones—distal femur, proximal tibia, proximal humerus. X‑ray: sunburst periosteal reaction, Codman triangle, mixed lytic–sclerotic lesion. Work‑up: MRI for local staging, CT chest for metastasis, bone scan for skip lesions. Treatment: neoadjuvant chemotherapy → wide resection/limb salvage/rotationplasty → adjuvant chemotherapy.
Open topicOsteosarcoma — Workup & Management
High‑grade intramedullary osteosarcoma affects metaphyses of long bones in adolescents (distal femur, proximal tibia, proximal humerus). Workup: **X‑rays**, **MRI with contrast** of entire bone, **CT chest**, and **bone scan/PET‑CT**; labs (ALP, LDH). Biopsy: **planned by treating team** along resection plane to avoid contaminating compartments. Standard treatment: **neoadjuvant chemotherapy (MAP)** → **wide resection** with limb‑salvage reconstruction where feasible → **adjuvant chemotherapy**....
Open topicPathological 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...
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