mylesclough at shaw
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Apr 13, 2008, 10:15 AM
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[Orthopod] Re: bony tumor head fibula
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Planning to do an excisional biopsy before the diagnosis is made goes
against the grain for me. If you think it might be malignant (with
that history) you may need to think of a wide local resection
(leaving at least one barrier between the tumour and the line of
resection) and the opportunities to do this might be compromised by
your biopsy - potential contamination of tissue planes. I would
suggest a needle biopsy first, making sure that the needle track can
be excised if the lesion is malignant. Make sure the needle doesn't
go too deep, into the tibio-fibular joint, as that would also
contaminate a valuable barrier.
Having said that, this is all a bit theoretical for me because I had
the luxury of an orthopaedic oncology service in Vancouver. They were
very clear that they didn't want us to do biopsies in case we messed
up their plans for definitive surgery.
Perhaps other members of the list, more experienced in orthopaedic
oncology, might address the question of what a wide local resection
would look like for this situation. I would assume that it would
include the complete tibio fibular joint with the line of resection
going through the postero-lateral tibia. What about the peroneal
nerve? Would that have to be sacrificed?
Myles Clough MD FRCSC
Orthopaedic Surgeon, Retired
Kamloops, BC
mylesclough@shaw.ca
Clinical Instructor, University of British Columbia
Associate Editor, Orthogate www.orthogate.org
Editor, Orthopaedic Web Links (OWL) www.orthopaedicweblinks.com
On 13-Apr-08, at 1:18 AM, Tamer EL-Sobky wrote:
>
> A 35 years old female patient complaining of upper leg pain since 2
> months. on exam the proximal fibula was tender otherwise no abn
> detected. un fortunately plain xrays are not available now but MRI
> shows abnormal signal intensity in more than one sequence
> occupying the fibular head. If the pateint is to be subjected to
> excision biopsy of fibular head how would we reconstruct the
> lateral ligament of the knee
> --
> best regards
> Tamer ELSobky
> Orthopaedic Surgeon
> >
> <image.jpg><image1.jpg><image2.jpg>
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