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DR. NIKHILESH DAS PEERLESS HOSPITAL AND B.K.ROY RESEARCH CENTRE KOLKATA

DR. NIKHILESH DAS PEERLESS HOSPITAL AND B.K.ROY RESEARCH CENTRE KOLKATA. Pathological Fracture Proximal Tibia In A Case Of Multiple Myeloma - Treated With Curettage & Grafting With Autoclaved Bone & BioGraft HA+ bTCP Granules And ORIF With Locking Plate - a case report. INTRODUCTION.

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DR. NIKHILESH DAS PEERLESS HOSPITAL AND B.K.ROY RESEARCH CENTRE KOLKATA

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  1. DR. NIKHILESH DAS PEERLESS HOSPITAL AND B.K.ROY RESEARCH CENTRE KOLKATA Pathological Fracture Proximal Tibia In A Case Of Multiple Myeloma - Treated With Curettage & Grafting With Autoclaved Bone & BioGraft HA+ bTCP Granules And ORIF With Locking Plate - a case report

  2. INTRODUCTION • 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.

  3. Other Relevant Findings • 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

  4. Whole body t99 bone Scan Mri Scan • Increased uptake in the skull shoulders, spine, ribs, pelvis, both tibia and lt. ankle

  5. management 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.

  6. Follow up at one year • fracture completely united • pt. walking full weight bearing • knee ROM: 0 - 1150 • no extensor lag • clinically pt. has improved • no obvious features of recurrence

  7. CONCLUSION • The use of autoclaved bone and BioGraftHydoxyapatite& 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.

  8. THANK YOU

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