presentation:
Painful distal thigh ?prox. leg swelling/mass.

Examination:
-mass examination:
-site
-shape
-size
-tenderness
-temperature changes
-surface
-consistency
-border
-?sinus,ulceration,discharge
-special features
-pulsatile/expansile
-translumination test
-bruit
-relation to adjacent structures
-attachment to skin and underlying muscles
-mobility
-compression effects to neurovascular structure
-knee joint ROM

Common Qs:
1.Differential diagnosis:
-tumor
-osteosarcoma
-infection
-chronic OMof prox tibia
-TB
-TB arthritis - usually the sweeling is diffuse and ROMknee is usually present.

2.Investigations
-Blood:
-Hb - anemia - nonspecific
-TWDC -elevated in infection
-ESR -non specific
-LFT -elevated ALP - suggestive of bone tumor
-Radiological:(Radiological staging)
-Plain x-ray of the affected limb
-osteolytic changes, cortical destruction,periosteal elevation(Codman's triangle), narrow
zone of transistion (both present in tumor and Chronic OM)
-calcification/new bone formation - more toward sbone forming tumor eg osteosarcoma.
-look for joint involvement, skip lesion into femur
-pathological fracture
-Chest x ray - look for secondary
-Other investigation:
-MRI - soft tissue involvement - marrow extension, muscles and neurovascular

involvement
-CT scan - the affected site (for cortical destruction)
- chest especially if plain chest x ray is normal - TRO secondaries
-Bone scan - to detect secondaries
-angiogram if necessary

3.What is next?
-Biopsy.(histological staging)

4.What is tumor staging
- Full radiological staging & biopsy .
-for diagnosis and localization of tumor

5.How do you stage tumor?
-Enneking classification:
-Stage 1 (tumor grade- histology)
a-low grade
b-high grade
-Stage 2 (anatomical extension - radiography)
a-intracompartmental
b-extracompartmental
-Stage 3 -with secondaries elsewhere (radiolography)

6.How do you treat the tumor?
generally depends on:
- histological diagnosis
-tumor grading
Options:general principles
-surgical resection - localized tumor without mets.
-chemotherapy- tumor with mets. /certain tumor eg Ewing's sarcoma
-radiotherapy- surgically inaccesible tumor eg.pelvis, spine
#sometimes used in combination

Labels: Short cases in orthopaedics