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Osteoid osteoma
 Commonest true benign tumour
 Nidus of tangled arrays of partially mineralized osteoid elements
surrounded by dense sclerotic bone
 Age – 5-25 years
 Lower extremity bones , tibia and femur
 Site – diaphysis of long bone,posterior elements of vertebrae
 Clinically - nagging pain, worse atnight , relieved by salicylates
tenderness at site of lesion minimal /no swelling
 Investigation – X ray – zone of sclerosisaround radioluscent
nidus< 1cm - CT scan - diagnostic
Osteochondroma Also known as EXOSTOSIS
 Most common benign tumor of bone
 Hamartomatous proliferation of bone and cartilage
 Consists of a bony outgrowth from metaphyseal surface
surrounded by a cartilage cap
 Not a true neoplasm – growth stops after skeletal maturity
 Pathology
- abberation of growth plate-cells of growth plate left out in
metaphysis as growth occurs herniation of growth plate in metaphysis
 Parts - bone stalk with its head AND cartilaginous cap
 Age – adolescent(10 to 20 years),duringgrowth period
Site – metaphysis OF TIMUR flat bones (scapula , pelvis)
Types – sessile(without a stalk) / pedunculated(with a stalk)
- solitary / multiple
 Most are asymptomatic and pain less
 Hard mass of long standing duration
 May present with mechanical problems
 Symptoms related to size and location
 Pain occurs in case of development of complications
 Investigation-X ray –
 bony growth(cartilage cap not visible )
 cortex and medullary cavity extend to the growth
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 Sessile tumours blend with metaphysis

 Pedunculated ones moves towads diaphysis
 Cartilage cap is thin and its thickness decreases with age
 cartilage cap thickness > 2cm suggestive of maligtransformation
Treatment
 Excision of tumour along with its periosteum
 Indication of surgery- symptomatic OR cosmesis
 Complications of osteochondroma –
1) bursitis 2) pathological fracture 3) neurovascular symptoms
(due to compression) 4) restriction of joint movement
5) malignant transformation(chondrosarcoma,osteosarcoma)

EWING’S SARCOMA
 Highly malignant bone tumor Males > females Diaphysis of long
 Bones : timur, Hum ,Radius &Ulna ,Flat bones ,Ribs & Spine(Rare)
Gross : tumor mass large- involves entire medullary cavity-multiple
layers of bone parallel with shaft -subperiosteal new boneformation
in layers - tumor ruptures through cortex and extends to soft tissue
 Microscopy :
- sheets of monomorphic small,round,blue cells
- pseudo rosette formation(tumor cells surround a central clear area)
Signs : Swelling in diaphysis- Local warmth- Dilated veins - Tenderness
X ray : - Cortico-Medullary destruction- Soft tissue shadow
- Periosteal reaction andnew bone formation- Onion peel appearance
(concentric layers of new bone formation)
 Chest x ray CT Scan MRI Bone scanFNAC / Biopsy
 Radiotherapy
- highly radio sensitive(melts like snow) - control of local tumor
- disappears with radiation but only to recur - high dose radiotherapy
Chemotherapy for control of metastasis
- multidrug therapy (cyclophosphamide adriamycin vincristine )
 Surgery- amputation- debulking of tumor- limb saving surgery
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 Prognosis- poor- bone to bone secondaries common- metastasis

to lungs- 5 year survival rate 30 – 40 %

OSTEOSARCOMA Also known as “ OSTEOGENIC SARCOMA”

 Highly malignant bone tumor Characterized by formation of
osteoid or bone by malignant mesenchymal cells
 Primary osteosarcoma (15-25 years)etiology unknown
 Secondary osteosarcoma (>50 yearsprevious radiation exposure
pagets disease multiple exostosis fibrous dysplasia
 According to site of affection- medullary periosteal parosteal
 histologic types - osteoblastic- chondroblastic- fibroblastic
 Grossly- metaphyseal end of long bone- large mass with
destruction of inner cortex- osteoblastic – yellowish white
- chondroid - bluish white- fibroblastic – white
 Stony hard to soft gritty Large vascular channels with
haemorrhage-Necrotic foci and areas of disintegration
- Sarcomatous stroma Spindle cell- Direct formation of
tumor osteoid and bone by malignant connective tissue
Symptoms - pain ( constant , boring, progressive ,increase intensity as
swelling increases)- swelling (rapid increase in size)
 Signs– metaphyseal swelling - skin over swelling : shiny ,glossy,
stretched dilated veins warm and tender- variegated consistency
- ill defined margins restricted joint movement
X ray - lesion in metaphysis- irregular cortico-medullary
destruction - new bone formationin form of- periosteal reaction-
codman’s triangle - sunray /sunburst appearance
CODMAN’S TRIANGLE : triangular area ofsub periosteal new bone
at tumor and host cortex junction- seen at the ends of tumor
 SUN RAY APPEARANCE : - growth of tumor to overlying soft
tissue- laying of new bone along the blood vessels within tumor
centrifugally at right angles to shaft
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 X ray chest and CT chest- to look for pulmonary metastasis

 Biochemical :- serum alk phosph and LDH - elevated
 BIOPSY: (FNAC) BONE SCAN:to know bony mets MRI,Angiography
 Aims- confirmation of the diagnosis- evaluation of the spread of
tumor- treatment of tumor

1) Surgery – amputation- according to site of affected- carried out

when limb salvage not possible- ensure complete removal of tumor-
usually 10 cms from tumor margin( to prevent stump recurrence )
- limb salvage surgeriesa) radical excision and reconstruction with
megaprosthesis b) radical excision with rotationplasty
2) Chemotherapy ( multi drug regimen )- drugs used –methotrexate
+ folinic acid- adriamycin /doxorubicin- cisplatin, ifosfamide
3) Radiotherapy ( mega voltage ) 4) Immunotherapy

OSTEOCLASTOMA (GCT)
 Bone tumor of variable growth potential
 Arises from non bone forming supporting C TISSUE of
marrow with networks of stromal cells interspersed with giant
cells
 Benign tumor but locally aggressive in nature
 Tends to recur after surgical treatment
 1/3 rd benign , 1/3rd locally malignant , 1/3 rd frankly
malignant
 Age of presentation : 20 – 40 years Females > males – 2 : 1
 Site of affection : epiphysis but extends to metaphysis
 Bones affected : long bones (commonly around knee)
lower end of femur ,upper end of tibia lower end of radius
Gross : fleshy, dark brown, friable mass: cut section cystic spaces
: expanded ends of long bones : eccentric lesion in epiphysio
metaphyseal end thinned out periosteum
 Symptoms : - swelling - pain (variable severity) restriction of
joint movement - h/o trauma , pathological fracture
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 Signs : swelling epiphyseal, eccentrically placed consistency

- firm in nature, fixed to bone margin – well defined surface –
smooth regular, skin free from swelling
: tenderness on firm palpation : characterestic – EGG SHELL
CRACKLING : in case of pathological fracture – deformity
X ray - epiphyseal-eccentric- expansile
- Soap bubble appearance- cortex – thinned out / breached in
 CT scan - MRI
Surgical options : 1) Curettage2) Curettage with bone grafting3)
Curettage with bone cementation4) Curettage with cryosurgery5)
Curettage with cauterization 6) Resection 7) Resection with
reconstruction8) Radiotherapy9) Tumor embolization
OSTEOARTHRITIS Osteoarthrosis / Degenerative joint disease
It is defined as a non-inflammatory idiopathic degenerative slow
progressive disease of the joints (mostly in weight bearing joints)
characterized by focal degeneration of articular cartilage and
subchondral bone sclerosis
Risk factors : Age (most important ) >45 yearsFemale sexObesity
Habitual cross leg sitting ,squattingOveruse (high impact activity)
PRIMARY OSTEOARTHRITIS- occurs de novo / no attributable cause
- usually in old age- usually bilateral
2) SECONDARY OSTEOARTHRITIS- underlying primary
disease/fracture- can occur in any age-unilateral / bilateral
Knee hip , ankle , shoulder , wrist , 1st CMC joint
• Pain : earliest and most common insidious , progressive ,
intermittent (early stages ) , constant ( late stages ) Initially dull
aching on starting of activity, later cramping like after activity
 Coarse crepitus . Swelling of joint in later stages due to effusion
 Stiffness : early due to spasm ,late due to capsular contracture
 Instability , locking ( loose bodies , frayed meniscus )
 Joint line tenderness, irregular and enlarged looking joint
 Deformity : varus of knee , flexion, adduction and external
rotation of hip Effusion Wasting of quadriceps
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 Limitation of terminal range of motion with tenderness

• Bouchard’s nodes : swelling of proximal IP joint
• Heberden’s nodes : swelling of distal IP joint
X rays : joint space narrowing ( early – medial , late stages –
lateral ) subchondral sclerosis subchondral cysts osteophyte
formation loose bodies in joint deformity of joint
Other investigations : ESR, CRP and RA factor – usually normal
• Serum Uric acid – to rule out gouty arthritis
• Arthroscopy :for staging osteoarthritis - look for osteophytes
Principles of treatment :a) delay occurrence of disease b) halt the
progress of the disease c ) rehabilitation of established late stage
cases
a) Supportive therapy : weight reduction avoidance of stress and
strain , local heat application physiotherapy exercises for improving
muscle power local application of counter irritants to relief pain
b) Drugs : analgesics ( NSAIDS ) c) Chondroprotective agents
( DMOAD ): Glucosamine, Chondroitin sulphate, Diacerein,
glycosaminoglycan peptide complex d) Viscosupplementation :
Sodium hyaluronate ( 3 – 5 times weekly interval )e) Intraarticular
steroid injection

High tibial osteotomy for OA with varus knee

Subtrochanteric osteotomy for OA hip
REPLACEMENT ARTHROPLASTY-For end stage OA with
deformities