Text in Italics is general (instructional) information
Lateral X Ray
The X ray views show a lytic process about 3 cm in diameter in the distal fibular shaft. There is a shell of bone around the expansile lesion, a pathological fracture has taken place and this probably represents a healing response. Radiological findings demonstrate an eccentrically placed lytic lesion with well defined margins in the metaphysis of the lower extremity. The lesion usually has a sclerotic margin of bone and a lobulated contour. Ridges and grooves that appear in the margins secondary to scalloping falsely appear to be trabeculae.
Being a slender bone the eccentricity in this case cannot be marked. The x rays as well as the MRI images also give an impression of scalloping. There is less reactive bone on the outer than inner aspect, so the typical 'punched out' nature of a CMF cannot be appreciated.
Management An en bloc excision was done and the ankle stabilised with a bone graft and syndesmosis screw. The histology was in keeping with a CMF, with a layer of reactive bone on the outside.