Abstract
The unique opportunity to study the entire appendicular skeleton of a child who died from metastatic angiosarcoma allowed detailed assessment of radiographically evident involvement. Virtually every portion of the appendicular skeleton had evidence of metastatic disease. However, the extent of involvement was extremely variable, especially when contralateral regions were assessed. The most likely region of metastasis, the metaphysis, is normally a fenestrated cortex of woven bone in the young child, rather than a well demarcated cortex formed by osteon (lamellar) bone, as it is in the adult. The pattern of destruction is such that less extensive areas may be involved before becoming radiographically evident, and trabecular bone involvement may be evident even without cortical damage.
The metaphyseal metastatic spread supports the concept of arterial hematogeneous dissemination, comparable to osteomyelitis in the child. Pathologic metaphyseal fractures involved both proximal humeri; the fracture also extended along a portion of the metaphyseal-physeal interface in one humerus. In one distal femur the physis readily separated from the metaphysis; this was a nondisplaced type 1 growth mechanism injury.
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References
Fidler M (1981) Incidence of fracture through metastases in long bones. Acta Orthop Scand 52:623
Green NE, Beauchamp RD, Griffin PP (1981) Primary subacute epiphyseal osteomylelitis. J Bone Joint Surg [Am] 63:107
Harrington KD, Sim FH, Enis JE, Johnston JO, Dick HM, Gristina AG (1976) Methylmethacrylate as an adjunct in internal fixation of pathological fractures. J Bone Joint Surg [Am] 58:1047
Kuettner KE, Benedict UP, Sable L (1978) Morphological studies on the resistance of cartilage to invasion by osteosarcoma cells in vitro and vivo. Cancer Res 38:277
McCarthy SM, Ogden JA (1982) Epiphyseal extension of an aneursymal bone cyst. J Pediatr Orthop 2:171
McKinstry P, Schnitzer JE, Light TR, Ogden JA, Hoffer PB (1982) Relationship of 99mTc-MDP uptake to regional osseous circulation in immature and mature dogs. Skeletal Radiol 8:115
Mickelson MR, Bonfiglio M (1976) Pathological fractures in the proximal part of the femur treated by Zickel-nail fixation. J Bone Joint Surg [Am] 58:1067
Ogden JA (1974) Changing patterns of proximal femoral vascularity. J Bone Joint Surg [Am] 56:941
Ogden JA (1979) Development and growth of the musculo-skeletal system. In: Albright JA, Brand R (eds) The scientific basis of orthopaedics. Appleton-Century-Crofts, New York
Ogden JA (1979) Pediatric osteomyelitis and septic arthritis: The pathology of neonatal disease. Yale J Biol Med 52:423
Ogden JA (1981) Chondro-osseous development and growth. In: Urist M (ed) Fundamental and clinical bone physiology. J B Lippincott, Philadelphia
Ogden JA (1981) Injuries to the growth mechanisms of the immature skeleton. Skeletal Radiol 6:237
Ogden JA (1982) Skeletal injury in the child. Lea and Febiger, Philadelphia
Parrish FF, Murray JA (1970) Surgical treatment for secondary neoplastic fractures. J Bone Joint Surg [Am] 52: 665
Schnitzer JE, McKinstry P, Light TR, Ogden JA (1982) Quantitation of regional osseous circulation in the maturing canine tibia and femur. Am J Physiol 242:H365
Zickel RE, Mourqdian WH (1976) Intramedullary fixation of pathological fractures and lesions of the subtrochanteric region of the femur. J Bone Joint Surg [Am] 58:1061
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Ogden, J.A., Ogden, D.A. Skeletal metastasis: The effect on the immature skeleton. Skeletal Radiol 9, 73–82 (1982). https://doi.org/10.1007/BF00360487
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DOI: https://doi.org/10.1007/BF00360487