Schlatter's disease (Osgood-Schlatter disease, osteochondropathy of the tibial tuberosity)

Causes of the disease

Schlatter's disease is a non-inflammatory disease accompanied by necrosis of bone tissue.
This pathology most often develops on one leg, although there are cases of it occurring on both. It is usually observed in children and adolescents aged ten to eighteen years, when bones are at their most intense stage of growth. It can be found much more often in boys. The disease often develops for no apparent reason (in some cases it is possible to trace a connection with bruises and injuries).

The causes of the development of the disease are often the following factors:

• direct injuries: fractures and dislocations of the patella or tibia, damage to the knee joint;
• permanent microtraumas of the knee associated with sports.

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According to medical statistics, Osgood Schlatter disease affects about 20% of teenagers actively involved in sports and only 5% of those who are not involved in sports.

The risk group includes children who engage in the following sports:

• basketball;
• volleyball;
• hockey;
• football;
• gymnastics;
• acrobatics;
• figure skating;
• ballet;
• struggle;
• weightlifting.

As a result of overloads, constant microtraumas of the knees, as well as excessive tension of the patellar ligaments that occur during contractions of the quadriceps femoris muscle, there is a disturbance in the blood supply in the area of ​​the tibia, or more precisely, in the area of ​​its tuberosity. It is accompanied by minor hemorrhages, rupture of the fibers of the patellar ligaments, an aseptic inflammatory process in the bags, as well as changes in the necrotic nature of the tibial tuberosity.

Symptoms and course of the disease

Schlatter's disease is characterized by a gradual, asymptomatic onset. Patients, as a rule, do not associate the occurrence of the disease with a knee injury.

The main symptoms of Osgood-Schlatter disease include:

• swelling and tenderness in the area of ​​the tibial tuberosity, just below the kneecap;
• pain in the knees, which intensifies after physical activity, especially when running, jumping and climbing stairs - and decreases with rest;
• Tightness of the surrounding muscles, especially the thigh muscles (quadriceps).

Pain varies depending on each individual. Some may only have mild pain when doing certain activities, especially running or jumping. For others, the pain can be constant and debilitating. Typically, Osgood-Schlatter disease occurs in only one knee, but sometimes it can occur in both knees. The discomfort may last from several weeks to several months and may recur until the child stops growing.

When examining the knee, swelling is noted, smoothing the contours of the tibial tuberosity. Palpation in the area of ​​the tuberosity reveals local soreness and swelling, which has a densely elastic consistency. A hard protrusion is palpated through the swelling.

Schlatter's disease has a chronic course, sometimes there is a wavy course with pronounced periods of exacerbation. The disease lasts from 1 to 2 years and often leads to recovery of the patient after the end of bone growth (at approximately the age of 17-19 years).

Complications of Osgood-Schlatter disease are rare. These may include chronic pain or localized swelling that responds well to cold compresses and anti-inflammatory medications. Often, even after the symptoms have disappeared, a bone lump may remain on the lower leg in the area of ​​the swelling. This lump may persist to varying degrees throughout the child's life, but it does not usually impair the function of the knee.

In the advanced state of the disease, muscle wasting may develop in the affected limb, which will lead and will manifest itself through minor restrictions in the movements of the knee joint.

Although many doctors claim that Schlatter’s disease can go away on its own after a certain period of time, practice shows exactly the opposite (with rare exceptions). Therefore, if a child complains of constant pain in the knee joint or has a slight swelling of the knee, it is necessary to immediately consult a doctor.

Fractures of the proximal end of the tibia

Osteosynthesis for fractures of the intercondylar eminence

Indications: the presence of displacement of a large bone fragment. General and intraosseous anesthesia.

Wide access to the knee joint is provided along the anterior internal edge of the patella. The capsule and synovial membrane are widely dissected. The joint is washed with a large amount of 0.25% novocaine solution and carefully examined. The torn intercondylar eminence is reduced along with the ligament. Two parallel canals are drilled near the tibial tuberosity so that their proximal sections extend into the fracture zone of the intercondylar eminence.

A thick lavsan thread or wire is passed at the site of attachment of the cruciate ligament and then both ends of the thread are passed through the canals of the bone, i.e. in a similar manner. The knot is tied at the tibial tuberosity. The limb should be bent at an angle of 165-170°, with maximum tension on the anterior cruciate ligament. The joint is washed with novocaine solution. Catgut is used to restore the synovial membrane, and then the joint capsule. The wound is sutured in layers. A deep plaster cast is applied for 3-4 weeks. According to indications, a puncture of the knee joint is performed. With the help of massage and physical therapy, muscle tone and movement in the joint are gradually restored.

Treatment of tibial condyle fractures should pursue the following goals:

• early and anatomically accurate reduction of fragments;
• reliable fixation of the condyles until they are completely consolidated;
• preservation of the physiological function of the joint;
• late axial load of the operated limb.

For this type of fracture, conservative and surgical treatment methods are used. N. Tscherne et al. note that conservative treatment should be carried out for stable types of fractures. For unstable types, osteosynthesis with screws and plates is indicated, often in combination with bone autoplasty.

R. Salter et al., and J. Wadell et al. evaluated the results of treatment of 95 patients with fractures of the proximal tibial epiphysis. They concluded that adequate reduction and early motion of the knee joint determine the final outcome of treatment.

Fractures are divided into 5 types:

• I - splitting of the epiphysis without displacement of the fragment;
• II - splitting of the epiphysis with distal displacement of the fragment;
• III - central compression of the articular surface of the tibia;
• IV - comminuted fracture of both condyles;
• V - fracture of the medial condyle with its compression.

Long-term results were assessed from 1 year to 15 years after injury. The average age of the victims is 52 years. Satisfactory results included knee flexion of more than 90°, varus or valgus deformity of no more than 5°, absence of symptoms and radiological signs of osteoarthritis, and absence of lameness. Results worse than those indicated were considered unsatisfactory. Closed reduction was performed in 26 patients, open reduction in 69. For type I fractures, a good result was achieved by closed reduction followed by immobilization with a plaster cast or open reduction and internal fixation. In some cases, skeletal traction was used.

Type II fractures required open reduction, bone grafting, and internal fixation. Skeletal traction followed by application of a plaster cast gave satisfactory results in a number of cases.

For type III fractures, closed reduction of the fragments is required, followed by bone grafting to replace the defect under the elevated epiphysis. Skeletal traction for this type of fracture does not affect reduction and is therefore not indicated as an alternative method.

In case of a fracture of one condyle, osteosynthesis with collet clamps is effective.

In type IV fractures, skeletal traction does not achieve its goal, since it cannot control varus or valgus deviation. Therefore, the authors used open reduction and internal fixation, as well as bone grafting.

Patients with type I fractures underwent internal fixation of the displaced condyle and additionally bone grafting. With open reduction and bone grafting, movements in the knee joint can begin 8 weeks after surgery.

M. Shatzker et al. pointed out the relationship between the degree of osteoporosis of the proximal epimetaphysis of the tibia and the type of intra-articular fracture that occurs.

E. Foltin found little information in the literature about the role of osteoporosis in the occurrence of different types of fractures of the tibial condyles. He analyzed X-ray data from 353 patients with fractures of the tibial condyles treated in the clinic from 1970 to 1979. E. Foltin used criteria developed by J. Dupare and P. Fikat when assessing the degree of osteoporosis.

Only one patient had severe osteoporosis, stage II in 64, III in 87, IV in 107, and stage V (normal) in 100 patients. The degree of osteoporosis increased with increasing age of patients.

To analyze the degree of bone mineralization, in particular the proximal epiphysis of the tibia, the most informative is double photon absorptiometry. The method makes it possible to identify patients with a critical level of weakening of the strength of the tibial condyles.

N. Bohr and O. Schaadt used this method to assess the mineral component in the tibia in 41 practically healthy women 24-85 years old and in 22 men 17-69 years old. Scanning was performed at the level of the tibial tuberosity. It has been found that bone mineral content and bone density decrease by 8-10% every 10 years.

E. Foltin reported that due to the nature of osteoporosis, compression fractures in the external condyle of the tibia are twice as common as in the internal one. If there was no osteoporosis, then there were no fractures. At the same time, in grade II osteoporosis, fractures with compression of the entire condyle accounted for 17%. The proportion of fractures with local compression of the tibial condyles also increased. As the degree of osteoporosis increases, predominantly the lateral condyle begins to be damaged, subject to compression. In the group of patients without osteoporosis, compression types of fractures accounted for 27%, and in the presence of osteoporosis - 78%. A relationship has also been found between the degree of osteoporosis and age.

G. Santos et al. presented an analysis of the results of treatment of fractures of the tibial condyles in 100 patients, 69 of them were treated conservatively, 31 - surgically. The need for surgical intervention increased as the severity of the fracture increased. With conservative treatment, good results were obtained in 66% of patients, poor results in 34%, after surgery in 74% and 26% of patients, respectively. The authors believe that adequately performed surgical intervention, even with a more complex type of fracture, allows one to achieve better results than with conservative treatment. This is explained by the fact that surgical methods provide a more accurate reposition of fragments and their fixation using screws, bolts and other structures.

V.P. Okhotsky and V.I. Potapov summarized the experience of surgical treatment of 64 patients with intra-articular fractures in the knee joint (the age of the patients ranged from 19 to 72 years, averaging 55 years). Fractures of the tibial condyles occurred in 46 patients. Open reduction and osteosynthesis were performed in 45 of them. Good results were obtained in 4 2 patients, and unsatisfactory results were obtained in 4 patients. The function of the knee joint was restored in a shorter period of time in patients who received an external fixation device with a hinge device.

R. Locht et al. developed a method of late osteochondral alloplasty with the aim of restoring the articular surface of the tibial condyles after their traumatic destruction. The results of the operation were assessed in 17 patients. The osteochondral allograft was fixed after careful adaptation with cancellous bone screws. In 6 patients, long-term results were very mediocre.

F. Alpecht et al. studied experimentally methods for filling osteochondral defects with autocartilage cells mixed with collagen sponge and fibrin. Regeneration of the cartilaginous surface was noted by the 16th week after application of the defect.

J. Dupare and R. Cavagne operated on 205 patients with plateau fractures of the tibia. The results were studied in PO patients with an average long-term follow-up of 3 years (the average age of those operated on was 49 years). A fracture of the external condyle occurred in 64 patients, a fracture of the internal condyle in 5 patients, a fracture of both condyles and the intercondylar eminence in 17 patients, and a fracture of both condyles in 20 patients. In 80% of cases, the fracture was avulsion with displacement. Concomitant damage to the ligamentous apparatus was noted in 12.7% of cases, damage to the meniscus - in 15.5%. The authors are supporters of active surgical treatment of patients with such fractures, with the exception of cases of non-displaced fractures and contraindications due to general somatic status. During the operation, they performed an anatomically accurate reduction of the fragments with reconstruction of the articular surface and filling the tibial bone defect with a corticospongiosal autograft. The operations were performed in an urgent manner. The success of the operation depended on a gentle intervention technique, as well as on stable fixation of fragments, allowing early initiation of active and passive movements in the knee joint. An excellent result was achieved in 54.5% of cases, good in 24.5%, satisfactory in 12%, and poor in 9% of cases.

S. Gansewitz and M. Hohl treated 160 patients with fractures of the proximal end of the tibia. Long-term follow-up periods averaged 1.8 years.

Three groups of patients were identified:

• I - with closed fractures without displacement, treated conservatively;
• II—displaced fractures treated conservatively;
• III - treated surgically.

For non-displaced fractures, a plaster cast with a hinge was used, as well as skeletal traction (43 patients). The authors emphasize the need to reduce postoperative immobilization periods to 6 weeks by ensuring more reliable fixation.

F. Behreus and R. Searls used transosseous osteosynthesis in patients with tibial fractures, with 15 closed fractures and 54 open fractures. Six patients were admitted to the clinic with a process of delayed consolidation. In 44 cases, the authors had to perform additional bone grafting. In 9 patients, a complication arose - an infectious process along the wound channels and around the rods.

G. Evans et al., R. Clifford et al. note that for fractures of the tibia, transosseous osteosynthesis designs known abroad are not widely used due to the large number of complications (non-union, deformation, infection around the rod canals). The high incidence of nonunion is explained by instability of the constructs and bone resorption around the rods. In order to increase the reliability of fixation of bone fragments, the authors propose a new arrangement of rods that allows them to withstand torsional and angular loads. The angle between the rods inserted into the tibia is about 60°. This is quite enough to stabilize bone fragments. The diameter of the rods is 5 mm. Typically, 3 rods are inserted into each fragment. The proportion of infection was 2.8%. The authors believe that any types of unstable fractures of the tibia are subject to transosseous osteosynthesis, and surgical interventions should be performed as early as possible.

When assessing long-term results, the scheme developed by P. Rasmussen may be useful. 5 tests are assessed ranging from 0 to 6 points: pain syndrome, ability to walk, joint stability, range of motion in the knee joint and ability to straighten the lower leg at the knee joint. The maximum score is 30. Each test is scored as follows. Pain: no pain - 6 points; periodic pain when the weather changes - 5 points; increased pain at a certain position of the joint - 4 points; increase in constant pain in the afternoon, i.e. after exercise - 2 points; presence of pain at rest (at night) – 0 points. Walking ability: normal walking appropriate for age - 6 points; can walk the streets for at least 1 hour - 4 points; short walks for 15 minutes - 2 points; can move only in the apartment - 1 point; moves only in a wheelchair - 0 points. Joint stability: normal joint stability in extension and flexion 20° - 6 points; violation of stability when bending the knee joint by 20° - 5 points; instability during extension by 10° - 2 points; instability at a smaller angle - 0 points. Range of motion in the knee joint: at least 140° – 6 points; at least 120° - 5 points; at least 90° - 4 points; at least 60° - 2 points; not less than 30° - 1 point; 0° - 0 points. Extension of the lower leg at the knee joint: fully - 6 points; limitation of extension by 10° - 4 points; more than 10° - 2 points.

The degree of developing post-traumatic arthrosis can be assessed according to the scheme of D. Resnick and G. Niwoyama. Zero degree - no degenerative changes; I degree - minimal narrowing of the joint space, moderate sclerosis, no noticeable changes; II degree - moderate narrowing of the articular space, there is the formation of osteophytes, there is no bone collapse, moderate subchondral sclerosis, the presence of intra-articular osteochondral bodies, moderate disruption of the contours of the articular ends; III degree - pronounced narrowing of the joint space up to obliteration, collapse of bone tissue, pronounced subchondral sclerosis, the presence of osteochondral bodies in the joint, severe deformation or curvature, as well as pronounced changes in the contours of the articular end.

Using these criteria when assessing the long-term results of treatment of plateau fractures of the tibia, P. Duwelius and J. Counolly found that conservative treatment in 89% of cases provides excellent or good results.

The experience of domestic authors confirms that in unstable four-fragment types of fractures of the proximal end of the tibia, favorable results are achieved by stabilizing the fragments using the method of transosseous osteosynthesis while maintaining movements in the knee joint.

Treatment of the disease

Osgood-Schlatter disease usually resolves on its own, and symptoms disappear after bone growth has completed. If the symptoms are severe, then treatment is prescribed.

Conservative treatment

Patients with Schlatter's disease usually undergo outpatient conservative treatment with a surgeon, traumatologist or orthopedist. First of all, it is necessary to eliminate physical activity and ensure the maximum possible rest of the affected knee joint. In severe cases, it is possible to apply a fixing bandage to the joint.

The basis of drug treatment for Schlatter's disease is anti-inflammatory and painkillers.

Physiotherapeutic methods are also widely used: mud therapy, magnetic therapy, UHF, shock wave therapy, paraffin therapy, massage of the lower limb. To restore damaged areas of the tibia, calcium electrophoresis is performed.

Physical therapy classes include a set of exercises aimed at stretching the hamstrings and quadriceps femoris muscles. Their result is a decrease in the tension of the patellar ligament, which attaches to the tibia. To stabilize the knee joint, the treatment complex also includes exercises that strengthen the thigh muscles.

After a course of treatment for Schlatter's disease, it is necessary to limit the load on the knee joint. The patient should avoid jumping, running, kneeling, and squatting. It is better to change traumatic sports to more gentle ones, for example, swimming in a pool.

Surgery

With severe destruction of bone tissue in the area of ​​the head of the tibia, surgical treatment of Schlatter's disease is possible. The operation consists of removing bone growths, necrotic foci and suturing a bone graft that fixes the tibial tuberosity, which allows healing of the avulsion fracture and complete restoration of the function of the knee joint.

After surgery, a course of physical therapy and medication is required. You can play sports only six months after the operation.

Osteochondropathies

Perthes disease

The full name is Legg-Calvé-Perthes disease.
Osteochondropathy of the hip joint. Affects the head of the hip bone. It most often develops in boys aged 4-9 years. The occurrence of osteochondropathy may be preceded (not necessarily) by trauma to the hip joint. Perthes disease begins with a slight lameness, which is later joined by pain in the area of ​​the injury, often radiating to the knee joint. Gradually, the symptoms of osteochondropathy intensify, movements in the joint become limited. Upon examination, mild atrophy of the muscles of the thigh and lower leg, limitation of internal rotation and abduction of the hip are revealed. Possible pain when loading the greater trochanter. Often the affected limb is shortened by 1-2 cm, caused by upward subluxation of the hip.

Osteochondropathy lasts 4-4.5 years and ends with restoration of the structure of the femoral head. Without treatment, the head becomes mushroom-shaped. Since the shape of the head does not correspond to the shape of the acetabulum, deforming arthrosis develops over time. For diagnostic purposes, ultrasound and MRI of the hip joint are performed.

In order to ensure restoration of the shape of the head, it is necessary to completely unload the affected joint. Treatment of osteochondropathy is carried out in a hospital with bed rest for 2-3 years. Skeletal traction may be applied. The patient is prescribed physio-vitamin and climate therapy. Constant exercise therapy is of great importance to maintain the range of motion in the joint. If the shape of the femoral head is abnormal, osteoplastic surgery is performed.

Ostgood-Schlatter disease

Osteochondropathy of the tibial tuberosity. The disease develops at the age of 12-15 years, boys are more often affected. Swelling gradually appears in the affected area. Patients complain of pain that worsens when kneeling and walking up stairs. The function of the joint is not impaired or only slightly impaired.

Treatment of osteochondropathy is conservative, carried out on an outpatient basis. The patient is prescribed a limitation of the load on the limb (in case of severe pain, a plaster splint is applied for 6-8 weeks), physiotherapy (electrophoresis with phosphorus and calcium, paraffin baths), and vitamin therapy. Osteochondropathy proceeds favorably and ends with recovery within 1-1.5 years.

Köhler's disease-II

Osteochondropathy of the heads of the II or III metatarsal bones. It most often affects girls and develops at the age of 10-15 years. Köhler's disease begins gradually. Periodic pain occurs in the affected area, lameness develops, which goes away when the pain disappears. Upon examination, slight swelling is revealed, sometimes - hyperemia of the skin on the back of the foot. Subsequently, shortening of the second or third finger develops, accompanied by a sharp limitation of movements. Palpation and axial load are sharply painful.

In comparison with the previous form, this osteochondropathy does not pose a significant threat to subsequent impairment of limb function and the development of disability. Outpatient treatment with maximum unloading of the affected part of the foot is indicated. Patients are given a special plaster boot, vitamins and physical therapy are prescribed.

Keller's disease-I

Osteochondropathy of the navicular bone of the foot. Develops less frequently than previous forms. It most often affects boys aged 3-7 years. Initially, pain in the foot appears for no apparent reason, and lameness develops. Then the skin on the back of the foot turns red and swells.

Treatment of osteochondropathy is outpatient. The patient is limited in the load on the limb, in case of severe pain, a special plaster boot is applied, and physical therapy is prescribed. After recovery, it is recommended to wear shoes with arch support.

Schinz's disease

Osteochondropathy of the calcaneal tuberosity. Schinz disease develops rarely, usually affecting children aged 7-14 years. Accompanied by the appearance of pain and swelling. Treatment of osteochondropathy is outpatient and includes exercise limitation, calcium electrophoresis and thermal procedures.

Sherman-Mau disease

Osteochondropathy of the vertebral apophyses. Common pathology. Scheuermann-Mau disease occurs in adolescence, most often in boys. Accompanied by kyphosis of the middle and lower thoracic spine (round back). The pain may be mild or completely absent. Sometimes the only reason to visit an orthopedist is a cosmetic defect. Diagnosis of this type of osteochondropathy is carried out using radiography and CT scan of the spine. Additionally, to study the condition of the spinal cord and ligamentous apparatus of the spinal column, an MRI of the spine is performed.

Osteochondropathy affects several vertebrae and is accompanied by severe deformation that remains for life. To maintain the normal shape of the vertebrae, the patient must be provided with rest. The patient should remain in bed in a supine position for most of the day (if pain is severe, immobilization is performed using a posterior plaster bed). Patients are prescribed massage of the abdominal and back muscles, therapeutic exercises. With timely, correct treatment, the prognosis is favorable.

Calvet disease

Osteochondropathy of the vertebral body. Calve's disease develops at the age of 4-7 years. The child, for no apparent reason, begins to complain of pain and a feeling of fatigue in the back. Upon examination, local pain and protrusion of the spinous process of the affected vertebra are revealed. Radiographs reveal a significant (up to ¼ of normal) decrease in vertebral height. Usually one vertebra in the thoracic region is affected. Treatment of this osteochondropathy is carried out only in a hospital. Rest, therapeutic exercises, and physiotherapy are indicated. The structure and shape of the vertebra is restored within 2-3 years.

Partial osteochondropathy

They usually develop between the ages of 10 and 25 and are more common in men. About 85% of partial osteochondropathy develops in the knee joint. As a rule, an area of ​​necrosis appears on the convex articular surface. Subsequently, the damaged area can separate from the articular surface and turn into an “articular mouse” (a loose intra-articular body). Diagnosis is carried out by ultrasound or MRI of the knee joint. In the first stages of the development of osteochondropathy, conservative treatment is carried out: rest, physiotherapy, immobilization, etc. With the formation of an “articular mouse” and frequent joint blockades, surgical removal of the free intra-articular body is indicated.

Diagnosis of the disease

Diagnosis of Osgood-Schlatter disease is carried out by a specialist doctor (orthopedist). For diagnosis, the history of the disease is of great importance and the doctor needs the following information:

1. Detailed description of the child's symptoms.
2. Relationship between symptoms and physical activity.
3. Information about past medical problems (especially previous injuries).
4. Information about medical problems in the family.
5. All medications and nutritional supplements that the child takes.

To diagnose Osgood-Schlatter disease, the doctor will examine the child's knee joint, which will determine the presence of swelling, tenderness, and redness. In addition, range of motion in the knee and hip will be assessed.

To make an accurate diagnosis, it is necessary to conduct an X-ray examination of the joints of the affected limb, which most often reveals a slight increase in the area of ​​the tibia tuberosity and separation of the apophysis (bone process) from it.

X-ray examination also allows you to determine the stage of development of this disease.

To obtain more complete information, the doctor may prescribe diagnostic methods such as computer thermography, magnetic resonance imaging and ultrasonography. Densitometry is also used to obtain data on the structure of bone tissue. Laboratory diagnostics are prescribed to exclude the infectious nature of damage to the knee joint (specific and nonspecific arthritis). It includes a clinical blood test, a blood test for C-reactive protein and rheumatoid factor, and PCR studies.

In the initial period, Schlatter's disease is characterized by a radiographic picture of flattening of the soft cover of the tibial tuberosity and raising of the lower border of the clearing, corresponding to the adipose tissue located in the anterior part of the knee joint. The latter is due to an increase in the volume of the subpatellar bursa as a result of its aseptic inflammation. There are no changes in the nuclei (or nucleus) of ossification of the tibial tuberosity at the onset of Schlatter's disease.

Over time, radiologically, a displacement of the ossification nuclei forward and upward by 2 to 5 mm is noted. The trabecular structure of the nuclei may be blurred and their contours uneven. Gradual resorption of displaced nuclei is possible. But more often they merge with the main part of the ossification nucleus to form a bone conglomerate, the base of which is the tibial tuberosity, and the apex is a spine-like protrusion, clearly visualized on a lateral radiograph and palpated in the area of ​​the tuberosity.

Differential diagnosis of Schlatter's disease must be carried out with a fracture of the tibia, syphilis, tuberculosis, osteomyelitis, and tumor processes.

New bone formation - symptoms and treatment

The diagnostic algorithm includes interviewing the patient, detailing complaints and clarifying the medical history. Particular attention should be paid to fever, weight loss, loss of appetite and other general symptoms. The time that has passed since the discovery of a bone tumor, the presence and intensity of its growth are also specified.[8]

During examination, the size of the formation, its structure, localization and skin changes are assessed. The areas of regional lymph nodes are palpated to assess possible changes - enlargement of the lymph nodes, their adhesion to the surrounding tissue and to each other.

A laboratory search begins with a general and biochemical blood test: determination of alkaline phosphatase, phosphate and calcium.[1] These analyzes provide evaluative information.

There are laboratory markers of bone resorption (dissolution) that confirm the predominance of bone breakdown (possibly at the tumor site).[9]

But their diagnostic value, unfortunately, is limited, since bone resorption can also occur in other conditions not associated with a bone tumor.

Instrumental diagnostics

The most accessible, fastest and most revealing instrumental diagnostic method is radiography. An x-ray taken in two projections gives an idea not only of the size and location of the bone tumor, but also of its type.[3]

A more detailed and sensitive visualization of new bone formations is computed tomography.[16] It is especially relevant for joint tumors and small bone tumors that are poorly visible on ordinary X-rays.[8]

Scintigraphy is used as a screening (search evaluation method) - bone scanning after intravenous administration of a radioactive isotope. The isotope accumulates in the bone tumor, causing it to “glow” on the scanner screen. This method provides information about the presence of skeletal tumors and their number. It is also effective for the early detection of bone metastases in cancer patients.[6] However, it is impossible to distinguish a benign tumor from a malignant one, much less determine the type of tumor on a scintiogram.[16]

It is noteworthy that radiation methods for diagnosing neoplasms do not provide the right to reliably diagnose a specific type of bone tumor. Even with all the X-ray signs that speak in favor of a certain tumor, only examination of the tumor under a microscope is decisive.

For microscopy, cells are obtained using a biopsy - taking part of the tumor. For this, a puncture biopsy is used, when the bone is obtained with a wide needle, or an incisional biopsy - surgical removal of the tumor, i.e. cutting off part of it.[16]

Often a biopsy is performed immediately during surgery to obtain a preliminary result. This makes it possible to determine the volume of the operation.[2]

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