Differential diagnosis of a solitary bone lesion (A very High yielding Table for MD Entrance)
|Giant cell||Simple bone||Aneurysmal||Fibrous|
|20-40 yrs.||< 20 yrs.||10-40 yrs.||20-30 yrs.|
|Lower femur,||Upper humerus||Tibia||Neck of the femur|
|Upper tibia||Upper femur||Humerus||Tibia|
|appearance,||less than width||lesion,||Ground-glass|
|eccentrically||of the growth plate||‘ballooning’ the bone||appearance|
|and bone graft||and bone graft||and bone graft|
- SIMPLE BONE CYST
- This is the only true cystof the bone
- ends of the long bones arc the favourite sites
- commonest site being the upper-end of the humerus (MCQ)
- X-rays show a well-defined, lobulated, radiolucent zone in the metaphysis or diaphysis of a bone
- Maximum width of the lesion is less than the width of the epiphyseal plate (MCQ)
- The cyst is known to undergo spontaneous healing, particularly after a fracture.
- One or two injections of methylprednisolone into the cyst results in healing.
- Some cases need curettage and bone grafting
- Anuerysmal bone cyst
- a benign bone lesion
- consists of a blood-filled space enclosed in a shell, ballooning up the overlying cortex – hence its name.
- common between 10-40 years of age. (MCQ)
- Common sites are the long bones, usually at their ends.
- A gradually increasing swelling is the predominant presentation
- There is little pain(MCQ)
- Often it presents with a pathological fracture
- Typical radiological features (MCQ)
- Eccentric well-defined radiolucent area.
- Expansion of the overlying cortex.
- Trabeculation within the substance of the tumour.
- curettage and bone grafting. (MCQ)
- Recurrence occurs in 25 per cent cases
- Some surgeons prefer to excise the lesion en bloc and fill the gap with bone grafts. (MCQ)