Physiotherapeutic Approach for Osteochondroma of 4th And 5th Ribs - A Case Report

The most frequent benign bone tumor is osteochondroma, which account for 45 percent of all benign bone tumours. Although not a real neoplasm, osteochondroma (exostosis) is the most common lesion and is often classed as a tumour. The majority of them develop in the metaphyseal region of long bones like the femur and tibia. A 21-year-old female presented to the orthopedic OPD with complaints of pain and swelling over dorsal spine since 2 years with left upper limb radiculopathy since 1 month. Pain was insidious in onset which started 1 month back and it aggravated ever since. On inspection swelling present over paraspinal region of approximately 5cm in length and 4cm in width. On palpation swelling was not adherent to skin, immobile and firm in consistency. Osteochondroma represent the most common bone tumor accounting for 20 to 50% of all benign osseous tumors. In osteochondroma maintaining mobility is important for activities of daily living and to maintain the quality of life. Physiotherapy plays a significant role in maintaining the mobility and improving the quality of life.

Rare right acetabulum aneurysmal bone cyst treated with curettage and local adjuvants in a 4-year-old girl

Aneurysmal bone cysts are locally aggressive benign bone tumours with a high risk of recurrence. We describe a case in a 4-year-old girl, involving the right acetabulum. A direct posterior approach was used and the lesion ablated with curettage and local adjuvants with bone grafting. The cyst resolved swiftly with an uncomplicated recovery.

Outcomes of Surgery for Enchondromas within the Hand

Background. Enchondromas are the most common benign bone tumours found in the hand. They are usually accidentally diagnosed on an X-ray, because they grow asymptomatically. In some cases, a pathological fracture of the involved phalanx may be the first sign. The objective of this study was to assess the results of operative treatment of enchondromas involving hand phalanges and metacarpals. Material and methods. The study group consisted of 24 patients, 16 women (67%) and 8 men, (33%), aged a mean of 31 years, who were operated on at our centre. The surgery consisted in curettage, and - in most cases - filling the bone defect with either a bone graft or a bone substitute. Follow-up assessment was performed over the telephone in 17 patients (79% of the group) at a mean of 2 years after surgery. Results. Half of the patients were asymptomatic and fully recovered functionally, whereas the other half complained of some not troublesome symptoms such as scar discomfort, limitation of finger movement or cold sensitivity. No differences were observed with regard to the material used for filling of the bone defect following curettage. Two cases of recurrence were noted after surgery: one in the bone substitute group and one in the bone graft group. Conclusions. 1. Enchondromas are the most common benign bone tumours encountered in bones of the hand. 2. The first line treatment in these lesions is curettage and filling of the bone defect with a bone sub­stitute or cancellous bone graft. 3. Both the results of the present study and literature data show that the approach to managing the tu­mour cavity after curettage has no significant effect on outcomes, which are essentially satisfactory.

Tumours

This chapter contains practice questions based on a broad range of orthopaedic topics that may be encountered within the ‘Adult Pathology’ station of the FRCS (Trauma and Orthopaedics) viva examination. The topics covered malignant and benign bone tumours including osteosarcoma and osteochondroma among other conditions.

The Innermore Ossein- Enchondroma

Preface Frequently, benign bone tumours are an incidental discovery wherein clinical symptoms are contingent to tumour location and magnitude and manifest as localized pain, swelling, skeletal deformities or pathologic fracture. Radiographic imaging is a cogent methodology of discerning the neoplasms.

Role of in-phase and out-of-phase chemical shift MRI in differentiation of non-neoplastic versus neoplastic benign and malignant marrow lesions

Objective: To determine its ability of in-phase (IP) and out-of-phase (OOP) chemical shift imaging (CSI) to distinguish non-neoplastic marrow lesions, benign bone tumours and malignant bone tumours. Methods: CSI was introduced into our musculoskeletal tumour protocol in May 2018 to aid in characterisation of suspected bone tumours. The % signal intensity (SI) drop between IP and OOP sequences was calculated and compared to the final lesion diagnosis, which was classified as non-neoplastic (NN), benign neoplastic (BN) or malignant neoplastic (MN). Results: The study included 174 patients (84 males; 90 females: mean age 44.2 years, range 2–87 years). Based on either imaging features (n = 105) or histology (n = 69), 44 lesions (25.3%) were classified as NN, 66 (37.9%) as BN and 64 (36.8%) as MN. Mean % SI drop on OOP for NN lesions was 36.6%, for BN 3.19% and for MN 3.24% (p < 0.001). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of CSI for differentiating NN from neoplastic lesions were 65.9%, 94.6%, 80.6%, 89.1%% and 87.4% respectively, and for differentiating BN from MN were 9.1%, 98.4%, 85.7%, 51.2 and 53.1% respectively. Conclusion: CSI is accurate for differentiating non-neoplastic and neoplastic marrow lesions, but is of no value in differentiating malignant bone tumours from non-fat containing benign bone tumours. Advances in knowledge: CSI is of value for differentiating non-neoplastic marrow lesions from neoplastic lesions, but not for differentiating benign bone tumours from malignant bone tumours as has been previously reported.

‘Umbrella construct’ – an innovative technique for reconstruction of the proximal humerus after curettage in locally aggressive benign bone tumours

Aim Reconstructing locally aggressive benign bone tumours of the proximal humerus after intralesional curettage is a challenge. We present a novel reconstruction technique ‘ Umbrella construct’ where a femoral head and a strut allograft are combined to reconstruct the cavity. Complications, graft incorporation time, functional (Musculoskeletal Tumor Society score [MSTS]) and oncological outcomes were evaluated. Methods Between January 2006 and June 2017, 11 cases (10 giant cell tumours, 1 chondroblastoma) underwent curettage followed by reconstruction with Umbrella construct. There were six females and five males with a mean age of 23 years (range 14–36 years). The maximum longitudinal extent of disease was 9 cm (range 5–9 cm). Results The median follow-up was 54 months (range 34–122 months). The mean allograft incorporation time was 7 months (5–8 months). One patient had a graft fracture which was managed conservatively. Two cases developed local recurrence and the construct was revised to a prosthesis in both. The mean MSTS score for the nine cases with retained graft was 27 (23–29). Conclusions Umbrella construct is an effective reconstruction modality which helps to maintain joint congruity and limb length. It has acceptable oncological outcomes with good function.