See Full Case | A 37-year-old male presents to the emergency room with acute left knee pain after low energy trauma. He has a history of curettage for a Giant Cell Tumor in the distal femur 3 years ago. Physical exam shows diffuse knee swelling and decreased motion. Pain limits weight-bearing or motion. There is a well-healed scar on the lateral side with no evidence of erythema or exudate.
Would you perform a needle biopsy in this patient prior to surgical intervention to confirm the diagnosis? Prior to surgical intervention of the GCT, would you attempt a trial of nonoperative treatment (brace or knee) to allow the fracture to heal before the currettage? If performing extensive curettage, what would you use to fill the void and provide subchondral support? | Cement | | allograft cancellous bone chips | | allograft cortical bone chips | | | allograft cortical-cancellous bone chips | | | allograft bone block | | | autograft fibula strut graft | | | Other | |
Would you use adjuvant therapy? | No | | Yes, phenol | | Yes, hydrogen peroxide | | Yes, argon beam | | Other |
If you performed the operation below, what would be your postoperative weight-bearing instructions? | NWB for 2 weeks followed by PWB | | NWB for 4 weeks followed by PWB | | NWB for 6 (or more) weeks followed by PWB | | TTWB for 2 weeks followed by PWB | | TTWB for 4 weeks followed by PrWB | | NWB for 6 (or more) weeks followed by PrWB | | PWB for 2 weeks followed by PWB | | PWB for 4 weeks followed by PWB | | NWB for 6 (or more) weeks followed by PrWB | | NFWB postop | | Other |
What additional imaging studies would you do as part of the preoperative evaluation? | CT Chest | | CT Chest/Abd/Pelvis | | Bone Scan | | Bone Scan AND CT Chest | | TTWB for 4 weeks followed by PrWB | | Bone Scan AND CT Chest/Abd/Pelvis | | Other |
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