Cysts and Tumors

Unicameral bone cysts - painless, causes pathological fractures. Cyst contains high level of cytokines, which resorb bone. Intraosseous injection of methylprednisolone = tx for young kids. Adults = curettage and bone grafting

MC bone tumor mets from breast

ORIF with bone tumor and impending fracture (>50% cortical involvement), then XRT

MC primary malignant bone tumor  Multiple myeloma

MC bony tumor overall – osteochondroma

MC malignant bone tumor in adults  osteosarcoma

• MC around knee, MC 80% young < 20
• Codman triangle
• Tx: Limb sparing resection, consider pre-op chemo-XRT

Ewing sarcoma – MC in adolescents

• Painful, swelling, Onion skin appearance on X-ray

  

• MC location: pelvis (iliac wing)

  • Pelvis 25%
  • Diaphysis of femur 16.4%
  • Ribs 12%
  • Tibia 7.6%

• Chemo-RAD is mainstay of tx, +/- resection

Thoracodorsal Neurovascular Bundle

• Runs in the mid axilla just inferior to the axillary vein
• Includes thoracodorsal nerve and thoracoepigastric vein
• Latissimus dorsi - arm ADduction, arm extension, internal rotation
• Serratus anterior - long thoracic nerve, runs parallel to the chest wall, mor proximal int he axilla than the thoracodorsal nerve