Describe an X-ray

 


AP radiograph of a skeletally immature child showing a loculated lytic lesion in proximal metaphysis of femur.

The lesion is lying centrally. The zone of transition is sharp. Cortices look normal with no any periosteal reaction.

This is suggestive of a benign lesion.

  D/D 

    1. Simple Bone Cyst 

    2. Aneurysmal Bone Cyst 

    3. Infection 


Patient presents with new onset of pain on thigh.What you think is the cause ?

    Pathological Fracture due to weakened bone. 

    A fallen fragment sign is diagnostic of unicameral bone cyst.

    How to manage such cases ?

        Thorough history

        Examination

         Manage expectantly - fracture stimulates new bone formation

        Patient treated expectantly  but lesion persists. How to manage ?

         Aspirate cyst.

         Inject steroid or bone graft, marrow to try and stimulate new bone formation.

        If it fails ,repeated attempt is worthwhile.

        Surgery - Curette out lining of cyst through a cortical window and stabilize bone to prevent                     fracture.

         Plating or Nailing in long bones across lytic area. 

            If cavity lies adjacent to growth plate, its important not to damage physis.

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