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Aug 1, 2006, 8:50 PM
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Re: [ORT-L] femoral neck lesion - nail or not
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This patient dyes sufficient problems, to add one yatrogenia to him.
Evidently this patient benefits from a treatment based on the principle
of -minimum but not insufficient treatment-
Touch prophylactically a bone, in which there is a metastasica injury,
that is not the center of the problem, have an effect ?Domino?, that
has a disastrous end.
My recommendation: Observation and don?t touch
----- Original message -----
From: "Bruce Sangeorzan" <bsangeor@u.washington.edu>
To: ORT-L@www2.aaos.org
Date: Tue, 1 Aug 2006 19:14:11 -0700
Subject: Re: [ORT-L] femoral neck lesion - nail or not
femoral neck lesion - nail or notwithout any pain and without erosion of
the cortex, it would be hard to make an argument for surgery. But at the
earliest sign of mechaincal stress, A recon nail before irradiation with
immediate post op weightbearing saves the patient a lot of misery. after
fracture and irradiation , you will not get healing. some idea of the
activity level of the lesion, (bone scan etc) may provide guidance
Bruce Sangeorzan, MD
Professor Orthopedics and Sports Medicine University of Washington
Chief of Orthopedics, Harborview Medical Center
Patient Care 206 731-4830
Academic office 206 731-4631
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----- Original Message -----
From: Douglas Duncan
To: ORT-L@www2.aaos.org
Sent: Tuesday, August 01, 2006 3:47 PM
Subject: [ORT-L] femoral neck lesion - nail or not
Attached are x-ray images of a lesion in the left hip of a 71 y/o lady
with numerous breast CA blastic metastases to in the spine, pelvis and
many other bones. This lesion in the left femoral neck was found on a
total body bone scan ordered by her oncologist to assess the extent of
her metastases. She was not, and is not, symptomatic in the hip area.
Her oncologist sent her to an orthopedist in town and he recommended
surgery (I don't know if a hip nail or prosthesis was recommended.)
Since she is fully ambulatory with full weight bearing and without
pain and asymptomatic in the hip, she was reluctant to proceed with
his recommendation and came to me for another opinion.
There doesn't appear to be any lytic destruction of her cortex on CT
scan in all 3 planes.
The radiation oncologist wants to do radiation of the hip but not
until after any recommended surgery.
I have difficulty making a case for prophylactic surgery on the basis
of her x-ray findings and in light of the fact she is not having pain
that can be attributed to her hip.
Any of your thoughts would be appreciated.
<<AP1.jpg>> <<CORONAL1.jpg>> <<CROSS NECK1.jpg>> <<CROSS NECK2.jpg>>
<<LAT2.jpg>> <<SAGITAL1.jpg>>
Doug Duncan
Douglas.Duncan@coxhealth.com
dmdunc@mhcsi.com
---
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(This post was edited by christian on Jan 24, 2007, 3:13 PM)
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