PMC7676968_01
Preoperative radiograph ((a) anteroposterior, (b) lateral) of the left knee, depicting the existence of a large lytic lesion (white arrows) at the proximal tibia, extending into the popliteal cavity.
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The patient underwent further examination with plain radiographs (Figure 1), a CT- and a MRI-scan (Figure 2), which showed the existence of a lytic lesion at the proximal tibia, extending into the popliteal cavity, due to the complete destruction of the posterior tibial cortex.
Preoperative axial CT-scan showing the destruction of the posterior cortex at the proximal part of the tibia (white arrows).
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The patient underwent further examination with plain radiographs (Figure 1), a CT- and a MRI-scan (Figure 2), which showed the existence of a lytic lesion at the proximal tibia, extending into the popliteal cavity, due to the complete destruction of the posterior tibial cortex.
Intraoperative photos. (a) Through a typical posteromedial approach to the tibia, a cortical fenestration of approximately 3 x 3 cm was made to the proximal tibia (white dotted line). The lesion underwent extensive curettage under direct vision. (b) The polytetrafluoroethylene felt (black dotted line) was put in place in order to internally line the walls of the lytic cavity (black arrows point at the retracted pes anserinus). (c) Photograph taken immediately after the instillation of PMMA bone cement into the lytic cavity. PMMA bone cement filled the cavity and restored the medial tibial cortex continuity (black dotted line). Black arrows point at the retracted pes anserinus and grey arrows at the retracted gastrocnemius.
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Third Street Tempe, AZ 85281, USA). The lesional bone cavity was then completely filled with PMMA bone cement (Figure 3).
Immediate postoperative radiograph ((a) anteroposterior, (b) lateral) showing the complete containment of the PMMA bone cement within the lytic cavity.
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The drain was removed on the 2nd postoperative day, and the patient has begun to bear weight to pain tolerance with the use of a walker soon after that (Figure 4).
CT-scan ((a) axial, (b) 3-D reconstruction) at six months postoperatively, showing the containment of the PMMA bone cement within the lytic cavity, enabling the patient full weight-bearing.
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The patient was followed-up at six (Figure 5) and 12 months postoperatively (Figure 6).
Plain radiograph ((a) anteroposterior, (b) lateral) at 12 months postoperatively showing containment of the PMMA bone cement and intact proximal tibia.
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The patient was followed-up at six (Figure 5) and 12 months postoperatively (Figure 6).
Axial CT-scan at 14 months postoperatively, moving from distal (a) to proximal (c). The PMMA bone cement is still contained; however, the proximal tibia of the patient sustained a pathological fracture (black arrows) after a fall.
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Unfortunately, at 14 months postoperatively, the patient fell and sustained a pathological fracture at the proximal left tibia, at an area adjacent to the operatively treated lytic lesion (Figures 7 and 8), together with a pathological peritrochanteric fracture at the contralateral hip and a pathological fracture at the right proximal humerus (Figure 9).
Plain radiograph ((a) anteroposterior, (b) lateral) at 14 months postoperatively showing the pathological proximal tibia fracture (black arrows). The PMMA bone cement is still contained.
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Unfortunately, at 14 months postoperatively, the patient fell and sustained a pathological fracture at the proximal left tibia, at an area adjacent to the operatively treated lytic lesion (Figures 7 and 8), together with a pathological peritrochanteric fracture at the contralateral hip and a pathological fracture at the right proximal humerus (Figure 9).
Plain radiographs ((a) anteroposterior of the right hip, (b) anteroposterior of the right shoulder and humerus) at 14 months postoperatively showing the pathological peritrochanteric and proximal humerus fractures the patient sustained following a fall.
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Unfortunately, at 14 months postoperatively, the patient fell and sustained a pathological fracture at the proximal left tibia, at an area adjacent to the operatively treated lytic lesion (Figures 7 and 8), together with a pathological peritrochanteric fracture at the contralateral hip and a pathological fracture at the right proximal humerus (Figure 9).