GIANT CELL TUMOR OF DISTAL FEMUR WITH PATHOLOGICAL.pptx

GIANT CELL TUMOR OF DISTAL FEMUR WITH PATHOLOGICAL.pptx

1. GIANT CELL TUMOR OF DISTAL FEMUR WITH PATHOLOGICAL FRACTURE Dr K Goutham ,Department of orthopaedics , Thrissur Govt Medical College , Kerala.

2. INTRODUCTION: •A 48 year old male patient presented with history of slip and fall while walking and sustained injury to the right knee and Unable to bear weight over the affected limb. •On examination, there was swelling and tenderness over right knee with restriction of range of motion at the knee joint. Hence splint applied .

3. INVESTIGATIONS : On preliminary imaging with x-rays: Lateral condyle fracture of the femur along with an incidental finding of a lytic lesion in the distal femur. CT scan of the right knee done -pathological comminuted fracture of the lateral condyle with expansile lytic soft tissue density in the epiphysio metaphyseal region of right distal femur MRI right knee - suggestive of well defined lytic lesion at the epimetaphysial region with findings favouring of Giant cell tumor , along with a pathological fracture of the lateral condyle of the femur.

4. Needle biopsy done : necrotic material,granulation tissues and giant cell IHC : Positive for CD68, Negative for CK &CD10 Correlating with clinical and radiological findings , GCT is considered

5. INTRA OPERATIVE FINDINGS : The distal femur along with the tumor has been resected and Megaprosthesis has been applied, intraoperative uneventful, post-op xray is acceptable

6. ANALYSIS: Giant cell tumor (GCT) is a locally aggressive benign tumors arises from epiphysio metaphyseal region and accounts for 4-10% of all bone tumors 50% of GCTs are located around the knee.Pain is the most common presenting complaint. Swelling and deformity are associated with larger lesions. Soft-tissue extension is common.The incidence of pathologic fracture at presentation is 11-37%. Following resection and megaprosthesis application ,the patient has been referred to radiotherapy for expert management from therir side and followed up to ruleout surgical site infection. Now the patient is ambulatory with adequate range of movement to do daily activities without difficulty