mylesclough at shaw
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Apr 13, 2008, 11:35 AM
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[Orthopod] Re: bony tumor head fibula
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Vinod - your case looks like a Giant Cell Tumour; was that the
diagnosis? Clearly if you have a benign tumour the problem is different.
My comment about wider excision presupposes that the diagnosis in Dr
El-Sobky's case is malignant. I hope it isn't but in that case the
possibility of undetected or micro invasion of the joint through the
very thin layer one can see on the MR scan is present. And you cannot
be sure of this until you have seen a frozen section of the biopsy
margins. By then it is too late; you may have seeded the whole wound
with tumor cells. This concept was the foundation of Enneking's
classification of tumour surgery (incisional biopsy, excisional
biopsy, wide local resection, ablation) which I learned 30 years ago.
Has it been superceded?
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 11:19 AM, vinod naneria wrote:
> Here is just one example for similar situation.
> The jpg file is self explainatory.
> It is not required to temper with tibia in any way. Excision of the
> tumour through the joint, which is an antomical barrier is
> recommonded.
> The Biceps tendon and Lateral collateral ligament need to be
> reattached with the remaining part of the capsule. A plaster
> immobilization of for ligamentous healing is an additional
> precausion to prevent lateral laxity.
> The trick is to isolate the common peroneal nerve ( as we do in
> cases of replacement of lower end of radius by upper end of fibula.
> The nerve has to isolated first from proxymal end and then from
> distal end and lastly for the tumour mass.
> I am not oncologist but have occasion of operating many such cases.
> If there is some more tips and tricks or difference in opinion, I
> will be happy to learn.
> with best wishes,
>
> vinod
>
>
> Vinod Naneria
> Consultant orthopaedic surgeon
> Choithram Hospital & Research Centre,
> Indore,
> India
> http://www.slideshare.net/naneria
> __________________________________________________
> Do You Yahoo!?
> Tired of spam? Yahoo! Mail has the best spam protection around
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> >
> <fibula.jpg>
>
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