Pathological Fracture Proximal Tibia In A Case Of Multiple Myeloma

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PEERLESS HOSPITAL AND B.K.ROY RESEARCH CENTRE
KOLKATA
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.

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


Increased uptake in the skull
shoulders, spine, ribs, pelvis, both
tibia and lt. ankle
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.
fracture completely united
pt. walking full weight bearing
knee ROM: 0 - 1150
no extensor lag
clinically pt. has improved
no obvious features of recurrence
The use of autoclaved bone and BioGraft Hydoxyapatite &
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.
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