Q. Which of these is the treatment of a case of pathological lesion in proximal tibia (image below) diagnosed as giant cell tumor?
a. Intralesional phenol
b. Curettage and bone cement
c. denosumab therapy
d. Sandwich procedure
Answer -
d
The case here is of a GCT of tibia extending till articular margin proximally.
Sandwich procedure in which the articular part of joint is preserved and seperated from cement filling the cavity after extended currettahe by a layer of morsellised bone graft and gelfoam. Gelfoam acts as protective barrier of articular surface from heat of cement and graft later helps reduce joint destruction (the schematic diagram below).
Denosumab is a RANKL (receptor activator of nuclear kappaB ligand) inhibitor. Giant cells are rich in RANKL that in turn causes osteolysis and destruction, inhibition of which, as done by denosumab, result in improved bone quality and structure.
It has been shown good results in studies but is not an option here for the lesion is larger here and probably in neglected status thus making conservative plan not preferable. The intralesional phenol and currettage with only bone cement is not correct option her for the similar reasons.
a. Intralesional phenol
b. Curettage and bone cement
c. denosumab therapy
d. Sandwich procedure
Answer -
d
The case here is of a GCT of tibia extending till articular margin proximally.
Sandwich procedure in which the articular part of joint is preserved and seperated from cement filling the cavity after extended currettahe by a layer of morsellised bone graft and gelfoam. Gelfoam acts as protective barrier of articular surface from heat of cement and graft later helps reduce joint destruction (the schematic diagram below).
Denosumab is a RANKL (receptor activator of nuclear kappaB ligand) inhibitor. Giant cells are rich in RANKL that in turn causes osteolysis and destruction, inhibition of which, as done by denosumab, result in improved bone quality and structure.
It has been shown good results in studies but is not an option here for the lesion is larger here and probably in neglected status thus making conservative plan not preferable. The intralesional phenol and currettage with only bone cement is not correct option her for the similar reasons.
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