OR10.1 | Bone Tumour and Pathological Fracture Assessment — Summary & Reflection

KEY TAKEAWAYS

Bone tumours are age-stratified: osteosarcoma and Ewing's sarcoma in adolescents, GCT in young adults, and metastases as the dominant entity over 40. The three radiological landmarks — Codman's triangle and sunburst pattern (osteosarcoma at the metaphysis), onion-skin layering (Ewing's at the diaphysis), and soap-bubble eccentric epiphyseal lysis (GCT) — define the diagnostic triad. Benign lesions have well-defined sclerotic margins; malignant lesions show ill-defined permeative or moth-eaten destruction. Enneking staging (grade × compartment × metastasis) determines surgical margins and drives the adjuvant therapy decision. The biopsy must be placed along the future resection corridor — a mis-placed biopsy is irreversible. Pathological fractures through metastatic bone are managed with intramedullary nailing and radiotherapy; those through primary sarcomas still require neoadjuvant chemotherapy before definitive resection. The five commonest primaries for bone metastases are breast, prostate, lung, thyroid, and kidney.

REFLECT

Think about a patient in your ward or outpatient clinic with known cancer — or a young person with unexplained bone pain. What would your management pathway look like now versus before this module? Were there assumptions you were carrying that this module has refined? Consider: what would have happened to the 16-year-old at the start of this module if the referring doctor had performed an urgent incisional biopsy through a transverse incision, rather than referring to a specialised centre? How does the biopsy principle change how you will manage bone swellings going forward?