Osteolytic lesion in calcaneum

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hi,

38 yrs female, has pain over left heel for 6 months duration.
clinical examinations shows no swelling.tenderness present.
x ray-large aggressive lytic lesion calcaneum,breech of anterior and inferior
cortex, soap bubble appearance.

we have done needle biopsy, few giant cells and not much conclusive.

awaiting MRI report.

our plan to through lateral approach, curettage and bone cementation and
stage 2 cement removal and iliac bone grafting

any suggestion from forum


suresh

 

Great xray.

IF you have aspirated only a few giant cells with few symptoms, heat, swelling, other clinical signs; then I would make a preliminary diagnosis of (a nonossifying) Fibrocortical defect, although she is a bit old for this.

It is interesting that the plantar cortex seems to have been violated. I would assume this is what is causing her pain.

Please let us know how this case progresses.

Thanks

Steve

 

dear Steve,

how will you proceed if you treat this lesion.

suresh

 

biopsy report as benign fibrous histiocytoma (BFH) ,

anyone have related articles related BFH and mangement.


suresh
Chennai,
India.

 

3 weeks post op

patient is comfortable ,walking with minimal limp.

pain reduced. wound healed well.

suresh

 

Hi Suresh:

Histiocytoma and fibrocortical defect are interchangeable as far as I know.

Can you supply any further information? Was the cortex violated? What volume did you need to pack? Any post op scans. Partial weight bearing?

Steve

 

yes, cortex was violated on the medial and inferior calcaneum. two packs of bone cement was used.started partial weight bearing on follow up. will send the post op pic.

 

Suresh,

Great case Suresh, would also love to see the post op x-rays. Good job.

Steven