4th Edition

Chapter 36: The council worker who slipped

A 58-year old, who worked for the council slipped on a loose paving stone. He was in a lot of pain and went to the ED. His right thigh was almost twice the size of the left one and he said that that had preceded the fall.

He had an X-ray of his right femur.

  • 1. What does the X-ray show?

    Correct answer:

    Plain X-ray showed:
    Codman triangle (periosteal elevation)
    Pathological fracture
    Extensive soft tissue mass
    Sunburst spiculation
    Cortical bone destruction

Both a CT scan and an MRI scan confirmed these findings.

In view of the high suspicion of sarcoma, he was referred to the supra-regional sarcoma unit where he had an open biopsy that confirmed the diagnosis of osteosarcoma. About 60% of osteosarcomas affect the knee region, 15% the hip, 10% the shoulder and 8% the jaw.

As there was no evidence of metastatic spread, he was treated with neoadjuvant chemotherapy, followed by limb salvage surgery and further adjuvant chemotherapy. Both the surgery and chemotherapy are complex and highly specialized, requiring immense technical skill and input from multiple healthcare professionals.

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