Author Archives: Dr. Garin
SICOT 2022
Intra-articular Injection
Just another ordinary day…. stage 2 of our Limb Salvage Surgery in an adult patient with Aggressive GCTB
Burring of Osteoid Osteoma
Osteoid Osteoma
History of an 8y/o patient with a complaint of on and off thigh pain temporarily relieved by NSAID.
Needle Biopsy
Unrelated to Oncology
An 80-year-old male was operated on last 2014 with cemented Total Hip Arthroplasty. He was doing great in the interim period until he accidentally fell from a motorcycle hitting his left hip in 2020. The patient sustained a periprosthetic fracture and was operated on by putting a locking plate screwed distally, wired, and wrapped with bone cement proximally. The fracture line is still present after one year. The patient sought a consult in my clinic, and he was advised to undergo revision. Intraoperatively, the femoral stem was loose, aseptically. The acetabular cup was well-placed and had no loosening. Eventually, we end up revising only the femoral stem. Although, much longer stem should have been inserted. An iatrogenic fracture occurred while inserting the femoral stem. Allograft was used to fill in the gaps and wired the fractured bones.
Conventional Osteosarcoma
This is a case of a 17-year-old male patient with a chief complaint of nagging pain in his left knee. They sought a consult to a physician, and the initial radiograph was read as unremarkable. One month after, despite the intake of the prescribed pain medications, his condition persisted and worsened. Hence, they sought a second opinion from a specialist. He was then immediately scheduled for a needle biopsy and revealed high-grade osteosarcoma. The patient underwent three cycles of neoadjuvant chemotherapy and was subsequently scheduled for limb salvage surgery using a tumor prosthesis. The tumor necrosis for the specimen has less than 90%; hence, a new set of chemotherapy regimens was used for the subsequent three cycles. The latest follow-up revealed an excellent integration and bony ingrowth around the prosthesis.
Low Grade Central Osteosarcoma
A case of an 18-year-old female with a gradually enlarging thigh mass for two years. She was referred to our institution for further evaluation and management, and a needle biopsy was done. The histopathology report revealed atypical spindle cell proliferation, and immunostaining was unremarkable. The multidisciplinary team suggested surgery and because of financial constraints for tumor prosthesis, an extra-articular resection, and a knee fusion using a long intramedullary rod with a non-vascularized fibular graft. The final histopathology report revealed low-grade central osteosarcoma.
Giant Cell Tumor Of Bone
A case of a young adult with a recurrent Giant Cell Tumor of Bone. Previously, the patient underwent an improper intralesional curettage. After one year, he noted a resurgence of pain. He sought a consult with another physician, and he was advised of possible wide resection and an application of tumor prosthesis. However, the patient refused and opted for another procedure knowing the risk of tumor recurrence. Magnetic Resonance Imaging of the lesion revealed a recurrent tumor surrounding the bone cement construct. The tumor extended into the Anterior Cruciate Ligament Tibial attachment. We proceeded then to an extended intralesional curettage, cauterization, and application of hydrogen peroxide. A reconstruction of the tibial plateau roof was done using a tricortical Iliac bone graft, supported by a buttress plate and screws. Below the graft was a Gel-foam and finally, a block of bone cement was used to fill in the gap. Final outcome remains to be seen after a series of follow up.