A swelling in the leg

A swelling in the leg

1. Anatomy of the thigh

   • Bones
     • Femur
   • Muscles
     • Anterior
     • Medial
     • Posterior
   • Nerve
     • Femoral nerve
     • Obturator nerve
     • Sciatic nerve

2. Ossification

   • Endochondrial
     • most long bones
     • a hyaline cartilaginous model (template) is replaced with bone
   • Intramembranous
     • most flat bones
     • mesenchymal cells directly differentiate to osteoblasts

3. Bone tumors

   • Types
     • Benign
       • Bone forming
         • Osteoma
         • Osteoid osteoma
       • Cartilage forming
         • Osteochondroma
         • Enchondroma
       • Miscellaneous
         • Giant cell tumor
     • Malignant
       • Bone forming
         • Osteosarcoma
       • Cartilage forming
         • Chondrosarcoma
       • Miscellaneous
         • Ewing's sarcoma
   • Differential diagnosis
   • Treatment
     • Above-knee amputation
       • removing the leg from the body by cutting through both the thigh tissue and femoral bone.
     • Limb salvage surgery
       • Surgery to remove a tumor in a limb without removing the whole limb.
     • Chemotherapy
       • to stop the growth of cancer cells and typically begins soon after a child is diagnosed with bone cancer.
       • Used along with AKA and limb salvage surgery

4. Osteosarcoma

   • Sunburst effect
     • Sharpey's fibres stretch out perpendicularly and after ossification produce a sun like pattern
   • Codman's triangle
     • tumor raises the periosteum away from the bone
   • Prognosis
     • depends on site, size, degree of necrosis and distant metastasis
   • Complications
     • Movement problems
     • Amputation
     • Metastasis (to lungs)
     • Osteomyelitis

5. Role of consent

   • Implied consent
   • Expressed Consent

6. Psychological impacts of amputation

   • Decreased self esteem
   • Distorted body image
   • Increased dependency

7. Investigations of tumor

   • X ray
   • MRI
   • Biopsy
     • Incisional
     • Excisional
   • Blood tests

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