Topic: Fractures of spine, Colles’ fracture and bone tumors.
Question: Write short notes on 1. Crush syndrome 2. Giant Cell Tumor of bone.
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- Crush Syndrome
- Definition: Severe systemic manifestation of trauma and ischemia involving skeletal muscle compression.
- Pathophysiology:
- Prolonged pressure on skeletal muscles leads to cellular anoxia, ATP depletion, cell membrane disruption.
- Leakage of intracellular contents (myoglobin, K+, phosphates, urate) into circulation.
- Myoglobin deposit in renal tubules precipitates acute kidney injury.
- Hyperkalemia from cellular K+ release can cause fatal arrhythmias.
- Metabolic acidosis from tissue necrosis.
- Causes:
- Prolonged entrapment of limbs (e.g. earthquakes, building collapse)
- Tight casts or dressings
- Pressure during surgery under anesthesia
- Snake or insect envenomation
- Drug overdose coma
- Clinical Features:
- Severe pain, tense muscle swelling at compression site
- Tea-colored urine
- Systemic hypotension, shock
- Cardiac arrhythmias
- Acute kidney injury
- Metabolic acidosis
- Disseminated intravascular coagulation
- Diagnosis:
- Creatinine phosphokinase, myoglobin, K+, creatinine
- Urinalysis: myoglobinuria, hemoglobinuria
- ECG, chest x-ray
- Treatment:
- Rapid rescue and limb reperfusion
- Aggressive IV hydration with saline
- Alkalinize urine
- Dialysis if severe kidney injury
- Treat hyperkalemia, metabolic acidosis
- Fasciotomy for compartment syndrome
- Supportive care
- Prognosis: High mortality if untreated. Survivors at risk of renal failure.
- Giant Cell Tumor of Bone
- Locally aggressive benign bone tumor representing around 5% of primary bone tumors
- Usually affects epiphysis of long bones (distal femur, proximal tibia, distal radius)
- Peak incidence age 20-40 years
- No clear risk factors; slightly more common in females
- Pathology:
- Solid mass containing osteoclast-like giant cells, mononuclear cells, inflammatory cells
- Variable degrees of mitotic activity
- Can extend through cortex and involve soft tissues
- Older lesions show more fibrosis
- Radiographs: Eccentric lytic lesion in epiphysis with no matrix mineralization
- Clinical Features:
- Dull, aching pain
- Swelling
- Pathologic fracture in 20%
- Rarely spreads to lungs (benign metastases)
- Treatment:
- Intralesional curettage with bone grafting
- Wide resection for lesions with joint involvement
- Radiation controversial due to risk of sarcoma
- Bisphosphonates, denosumab may reduce recurrence
- Prognosis:
- 10-20% local recurrence rate
- <5% undergo malignant transformation
- Lung lesions regress spontaneously
- Overall 5 year survival >90%
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