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DR. NIKHILESH DAS PEERLESS HOSPITAL AND B.K.ROY RESEARCH CENTRE KOLKATA. Pathological Fracture Proximal Tibia In A Case Of Multiple Myeloma - Treated With Curettage & Grafting With Autoclaved Bone & BioGraft HA+ bTCP Granules And ORIF With Locking Plate - a case report. INTRODUCTION.

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DR. NIKHILESH DAS PEERLESS HOSPITAL AND B.K.ROY RESEARCH CENTRE KOLKATA


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dr nikhilesh das peerless hospital and b k roy research centre kolkata
DR. NIKHILESH DAS

PEERLESS HOSPITAL AND B.K.ROY RESEARCH CENTRE

KOLKATA

Pathological Fracture Proximal Tibia In A Case Of Multiple Myeloma - Treated With Curettage & Grafting With Autoclaved Bone & BioGraft HA+ bTCP Granules And ORIF With Locking Plate - a case report

introduction
INTRODUCTION
  • A 60 year old lady presented to us with pain, swelling left proximal tibia and inability to walk – 1 month
  • Being treated elsewhere with a POP slab.
  • On examination she was seen to have a large osteolytic lesion of the left proximal tibia with cortical destruction.
  • She also c/o generalised bone pain and weakness since last few weeks.
other relevant findings
Other Relevant Findings
  • Low Hb%
  • Raised ESR & Sr. ALP
  • IgM in electrophoresis
  • Altered A:G ratio
  • Osteolytic punched out lesions in the skull
  • Pelvis Xray – lesion in the supraacetabular & ischium
whole body t 99 bone scan
Whole body t99 bone ScanMri Scan
  • Increased uptake in the skull shoulders, spine, ribs, pelvis, both tibia and lt. ankle
management
management

Curettage, of the lesion done through a lateral incision, cauterization with distill water and grafting with autoclaved bone mixed with Hydroxyapatite and Tricalcium Phosphate granules. ( REPROBONE). Fixation of the fracture done with a Lateral Tibial Condylar Locking Compression Plate.

Imme. Post op X rays

Histological picture

Chemotherapy : MELPHALAN, THALIDOMIDE, CYCLOPHOSPHAMIDE & PREDNISOLONE.

follow up at one year
Follow up at one year
  • fracture completely united
  • pt. walking full weight bearing
  • knee ROM: 0 - 1150
  • no extensor lag
  • clinically pt. has improved
  • no obvious features of recurrence
conclusion
CONCLUSION
  • The use of autoclaved bone and BioGraftHydoxyapatite& Tricalcium Phosphate granules as a substitute for autologous bone graft is a option to fill in large voids created after removing tumors. This reduces the donor site morbidity.
  • The autoclaved bone provides a scaffold while the BioGraft HA + TCP granules facilitates bony incorporation due to osteoinductive properties.
  • Using a locking plate in this situation provides better fixation in the osteporotic bone and metaphyseal area.