43: Surgical Management of Bone Tumors - Bennett Flashcards Preview

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Flashcards in 43: Surgical Management of Bone Tumors - Bennett Deck (8)
1

describe this picture

permeative (ill-defined)

- also know what geographic (well-defined) and moth eaten look like

2

narrow margin

0.1-1.0 mm: tumor and surround normal bone are touching, and you see a small distance b/w them

 

wide = 2-10 mm: indistinct area that looks like it might be partially damaged in betweed tumor and undamaged bone

poorly defined = several centimeter or impossible to measure

3

periosteal reaction = indicator of biologic activity of bone lesion

less --> more aggressive

If growth is very rapid, two patterns may develop:

  1. “sun-burst” or “hair-on-end” appearance-periosteum has no time to lay down bone, but Sharpey’s fibers become stretched out perpendicular to the bone, and then ossify
  2. Codman’s “triangle”- only the edges of the raised periosteum will ossify-this little bit of ossification forms a small angle with the surface of the bone, but not a complete triangle

4

benign lesion staging

Stage 1:  lesions that are static or tend to heal spontaneously.

Stage 2:  lesions that present with a more aggressive radiographic presentation, and evidence of continued growth.

Stage 3:  locally aggressive lesions, and show progressive growth not limited by barriers.

Stage 2 and 3 are histologically immature

5

treatment based on staging of benign lesion

Benign stage 1 & 2: 

  • intra lesional currettage
  • reconstructed with cancellous bone grafting,  methyl methacrylate augmentation

Benign stage 2 & 3:

  • over treat with marginal excision that removes the intra articular surface with associated fusion  

adj tx: cryotherapy, phenol, polymethacrylate

6

staging malignant lesions

Stage 1: low grade lesions

Stage 2 :  high grade lesions

Stage 3: presence of metastasis

7

treatment based on staginf of malignant lesion

Malignant stage 1 lesions:  require a wide marginal excision, may require a partial or complete amputation at the appropriate level.

Malignant stage 1B and 2 lesions:  result in reconstruction by Malignant stage 1B and 2 lesions:  result in reconstruction, amputation

8

principles of biopsy

  • Incision placement and orientation
    • longitudinal and based on the anticipated area of resection
    • performed without the formation of tissue planes
    • hemostasis
  • Dissection should be carried out sharply to the level of bone and remain within one fascial compartment
  • Soft tissue mass sent if present
  • Cortical window created
  • Closed in layers

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