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OR46 Orthopedics
Bone Tumours
Toronto Notes 2019
Cobb angle
Figure 55. Cobb angle – used to monitor the progression of the scoliotic curve
Scoliosis screening is not recommended in Canada (Grieg A, et al. 2010; Health Canada, 1994)
In structural or fixed scoliosis, bending forwards makes the curve more obvious
Postural scoliosis can be corrected by correcting the underlying problem
Red Flags
• Persistent skeletal pain
• Localized tenderness
• Spontaneous fracture
• Enlarging mass/soft tissue swelling
X-ray Findings
• Lytic, lucent, sclerotic bone
• Involvement of cortex, medulla, soft tissue • Radiolucent, radiopaque, or calcified matrix • Periosteal reaction
• Permeative margins
• Pathological fracture
• Soft tissue swelling
Treatment
• largelynon-operativeviaPonsetiTechnique(serialmanipulationandcasting) ■ correct deformities in CAVE order
◆ change strapping/cast q1-2wk
◆ surgical release in refractory case (rare)
– delayed until 3-4 mo of age
• 3yrrecurrencerate=5-10%
• mildrecurrencecommon;affectedfootispermanentlysmaller/stifferthannormalfootwithcalfmuscle atrophy
Scoliosis
Definition
• lateralcurvatureofspinewithvertebralrotation • age:10-14yr
• morefrequentandmoresevereinfemales
Etiology
• idiopathic:mostcommon(90%)
• congenital:vertebraefailtoformorsegment
• neuromuscular:UMNorLMNlesion,myopathy
• postural:leglengthdiscrepancy,musclespasm
• other: osteochondrodystrophies, neoplastic, traumatic
Clinical Features
• cosmeticconcern±backpain
• primarycurvewhereseveralvertebraeaffected
• secondarycompensatorycurvesaboveandbelowfixedprimarycurvetotryandmaintainnormal
position of head and pelvis
• asymmetricshoulderheightwhenbentforward
• Adam’stest:ribhumpwhenbentforward
• prominentscapulae,creasedflank,asymmetricpelvis
• associatedposteriormidlineskinlesionsinneuromuscularscoliosis
■ café-au-lait spots, dimples, neurofibromas
■ axillary freckling, hemangiomas, hair patches • associatedpescavusorlegatrophy
• apparentleglengthdiscrepancy
Investigations
• X-ray:3-footstanding,AP,lateral ■ measure curvature: Cobb angle ■ may have associated kyphosis
Treatment
• basedonCobbangle
■ <25°: observe for changes with serial radiographs
■ >25° or progressive: bracing (many types) that halt/slow curve progression but do NOT reverse
deformity
■ >45°, cosmetically unacceptable, or respiratory problems: surgical correction (spinal fusion)
Bone Tumours
• primarybonetumoursarerareafter3rddecade
• metastasestobonearerelativelycommonafter3rddecade
Clinical Features
• malignant(primaryormetastasis):localpainandswelling(wk–mo),worseonexertionandatnight,± soft tissue mass
• benign:usuallyasymptomatic
• minortraumaofteninitiatingeventthatcallsattentiontolesion
© Crista Mason 2005