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Had treatment for cancer in tibia with liquid nitrogen, reconstructed bone marrow and chips. Now having a tumor on it. Option?

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My mom had cancer in her tibia in 1993. It was removed, sprayed with liquid nitrogen, and reconstructed with donated bone marrow and chips. A plate was screwed in the entire length of the bone. That plate was removed in 2003 due to Staff F infection with the plate itself. After that procedured healed the bone looked fine. Somewhere between there and last year the bone chips came loose and formed a mass/tumor at the top tibia below the knee. July 1, 2011 the tibia, and fibia broke. The fibia healed fine. It is July 5, 2012 and the the tibia is only 60% healed and not improving. It caused my mom contant pain of various sorts. The doctor, who ironically, performed the surgury in '93 is her doctor the past year. He seems to have a, "Well, I don't know what to do" attitude. He last told my mom to come back in 6 months, or if it breaks before that time. He wiped surgury off the agenda because of the Staff F and hhe said he wasn't even sure how to drill through it and place a rod or what. I can't find any information about a tumor of bone chips. Its been over a year, my mom isn't getting better, she's upset with her progress and the doctor. Like I said, my reserch has turned up nothing. Any help would be so appreciated. I'm not out of options...I can't find options. Mom is 62. Thank you.
Posted Mon, 30 Jul 2012 in Bones, Muscles and Joints
Answered by Dr. Atul Wankhede 4 hours later
Dear user,
Thanks for choosing XXXXXXX for your health related queries.

Sorry to hear your mothers ordeal. It looks pretty clear to me. She had a tumour(which must've been benign, hence excised at margins and cauterised with liquid nitrogen), reconstructed with bone grafts, stabilised with plate, landed with a delayed staphylococcal infection, plate removed, latent infection or persistent low grade tumour resurfaced and caused weakness and eventually fractured the bones, fibula healed and tibia's healing is unsatisfactory. Hope I got the order of events correct.

Now here's what we need to do. First to diagnose that if there is any persistent infection, if yes to treat it with anti biotics or if its resistant to antibiotics then to surgically debride the wound. If there's no infection then to diagnose with bone scan (possibly with gadolinium) for presence of tumour and its extent. If tumour is present, then to take a biopsy for identifying the type of tumour and its possible outcome. If its removable then to plan its excision and reconstructing the deficit with bone graft/bone cemment(PMMA) or custom made prosthesis and restoring patients mobility at the earliest.

Pain needs to be managed with medications temporarily, but we both know that till she gets a definitive treatment the pain wont subside. Nor will she have pain free movements on her own. Meanwhile I hope she has a splint applied to leg for added stability. If you are not satisfied with your physician, think of consulting someone else.

Follow this as a protocol and I'm sure this will be over soon. For any further assistance please write back, I'm available for follow up. I'll appreciate if you can post soft copies of her latest x rays as well for better understanding.
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Follow-up: Had treatment for cancer in tibia with liquid nitrogen, reconstructed bone marrow and chips. Now having a tumor on it. Option? 4 days later
Dr. Wankhede,

Thank you for your response. I appreciate your time. We went to to mom's doctor today. He said the leg was really the same. He seldom gives a definate answer on anything. He said no progress really. He really thinks she should avoid sugury because the outcome might be worse than her current condition. My mom told him that the past 3 weeks there has been pain and tightness in that leg (entire leg length) by the late afternoon. After a night in bed (rest) it felt fine. She inquired if she should try to stay off of it more. He told her no to walk on it more. (???) This is one of the top specialist at Emory University in Atlanta, GA USA. He seems, to me, to be he wants her to break it something. I don't know. He basically told her to file for permanent disability benefits.

I shared your comments with him. He smirked and said, "That's interesting XXXXXXX He remarked he didn't know you; like he would know all doctors out there. He said there is no way you could offer any valid advise having never seen her. I find him arogant, but he's not my doctor. He offered a CT scan to look inside the bone better, and a prosthetic-type splint could be made to cover her leg if she felt she needed more security. I'm going to look for an upload to send you the 2 x-rays that were taken today.
Answered by Dr. Atul Wankhede 3 hours later
Thank you so much for replying back.
Also thank you for posting those x XXXXXXX copies, they were of immense help.

The fibula has healed so well that I could not identify where the fracture was. But tibia sure is in a bad state. My experience tells me that the abnormal opacity we see adjoining the site of previous fracture is probably the extra amount of callus(soft bone that later solidifies that forms during healing of bone). The opacity inside the bone could be a tumour although benign, or remnants of an infection of bone(osteomylitis), which leaves behind dead bony tissue called sequestrum and involucrum. The bone is definitely unstable and has chances of refracture soon if not stabilised internally or externally.

In any case, the management protocol is fixed and known worldwide. I'm not sure why your physician is unable to see it. In my opinion one needs to take a biopsy with needle(FNAC) and send it for histopathology and culture sensitivity to rule out tumour cells and infection respectively. If its positive for tumour cells, wide excision and filling it with bone graft(patients own bone or from bone bank) or bone cement(PMMA). If its positive for infection, then opening the fracture site-clearing the dead and active infected material/pus/debris-putting antibiotic impregnated bone cement beads-externally stabilising in long leg brace or plaster slab-checking after 6 weeks for trace of infection with help of x rays and blood profile-after confirmation of no residual infection reoperation for beads removal and XXXXXXX stabilisation with plating and bone grafts and sufficient antibiotic cover.

This along with physiotherapy can get her back to normal in no time. And it has to be done soon. He's right about not commenting on a patient unless one examines in person. But I'm sure with all that you have shared on this forum, the information I've told you shall stand true in all circumstances. Hope you take a second opinion of an orthopaedician near you.

You are welcome to ask more queries, I'm available for follow up.

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