Principles of management of patients with metastatic bone disease in terms of investigation, prophylactic and definitive fixation of pathological fractures and oncological management

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QUESTION 1 OF 2

A 60-year-old man with previous history of prostate cancer presents with a midshaft femoral fracture through a lytic lesion. X-rays show bone destruction and wide zone of transition at the lesion. CT chest, abdomen and pelvis did not reveal evidence of tumours.
What would be the most appropriate next step in the management?

QUESTION ID: 1283

1. External fixator stabilisation of the fracture
2. Intramedullary nailing of femur with reaming’s sent for histology
3. Open biopsy of the lesion
4. Plating and cement augmentation of the pathological fracture
5. Wide excision and endoprosthesis placement
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QUESTION 2 OF 2

A 10-year-old boy presents with a painful swelling in the index finger of the right hand. This has grown slowly over 6 months. Plain x-rays show multiple osteolytic lesions in the small bones of the hand, with expansion of the middle phalanx of the index finger.
Which of the following statements is true?

QUESTION ID: 1284

1. Maffucci syndrome presents with multiple osteochondromas and haemangiomas
2. Ollier disease presents with multiple osteochondromas and haemangiomas
3. Ollier disease shows autosomal dominant Inheritance
4. Persistent pain of an enchondroma raises the possibility of malignant transformation
5. The risk of malignant transformation in Ollier disease is close to 100%
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