BACKGROUND
During an intramedullary nailing procedure for impending or actual pathological fractures, the reamings are commonly saved and sent for confirmation of the diagnosis. However, positive results are not always achieved due to insufficient sampling or thermal damage to the specimen. Hassan et al showed that only 60% of cases in which reamings were sent for histology showed positive results.1 We report on our experience with an alter-native technique for obtaining an intramedullary biopsy using Paterson or Lloyd Davis biopsy forceps.
TECHNIQUE
A standard approach for an intramedullary nail is used. The femoral cortex is breached using a guidewire and awl/drill. Prior to reaming of the canal, biopsy forceps are inserted under image intensifier control and tissue samples taken. By using this method, adequate tissue sampling can be achieved.
Figure 1.
Biopsy forceps within medullary canal; particular areas of interest can be targeted using an image intensifier to guide into position
DISCUSSION
To date, we have used this technique in four cases, all of which have yielded good amounts of tissue. A positive diagnosis was obtained in three. The fourth case confirmed a carcinoma of unknown origin; however, earlier biopsies taken in the same patient showed the tumour to be too poorly differentiated for a positive result.
This is a very simple procedure that allows the surgeon to evaluate the amount of tissue taken to give pathologists the best chance of obtaining a diagno-sis, without thermal necrosis of the sample.
Reference
- 1.Hassan K, Kalra S, Moran C. Intramedullary reamings for the histological diagnosis of suspected pathological fractures. Surgeon. 2007;5:202–204. doi: 10.1016/s1479-666x(07)80003-5. [DOI] [PubMed] [Google Scholar]