QT 2096-6198 TIBIAL EWING PRESENTED AS TRAUMATIC DETERMISNISM

SWELLING RT LOWER LEG, 3 WKS , DOES TRAMPOLINING , TRAUMATIC DETERMINISM

Traumatic determinism

The presence of an unsuspected tumor tends to bring about the occurrence of injuries at the tumor bearing area and to intensify the subjective symptoms and local effects of injury. This principle may be designated as traumatic determinism.

A man is found at the bottom of a stairs unconscious and with a hematoma of the scalp. He recovers but complains of headache and attacks of vertigo. After three months, the symptoms persisting, an operation discloses a slowly growing glioma of the brain, exactly beneath the hematoma. It then transpires that he had suffered from attacks of vertigo for some months before the accident. In one of these he became unconscious and fell down stairs.

A carpenter slipped down a ladder and bruised his shin. Pain continuing, two weeks later a radiograph showed a sclerosing osteogenic sarcoma occupying the upper end of the tibia. The leg was immediately amputated, but pulmonary metastases had occurred and proved fatal. It was then attested that he had been noticed to limp and spare the limb for some weeks before the accident. It is evident that the tumor antedated the accident and interfered with the normal mobility of the knee joint.

A young woman fell down the subway steps and injured her knee cap. She continued working as usual for two months when pain set in and she was treated for traumatic arthritis for two months. Radiographs then disclosed a large tumor of the lower end of femur, many small cysts in the patella, several cysts in the upper ends of both femora, pubes, and lumbar vertebrae and pronounced scoliosis of the dorsal spine. The leg was amputated and a benign giant cell tumor occupying much of both condyles was found. The structure was fibrous, and therefore, of slow growth. Here the tumor of the femur antedated the accident, and the general signs of osteitis fibrosa cystica showed that she was suffering from Recklinghausen’s disease with complicating giant cell tumor. The marked disease in both patella and femur satisfactorily accounts for the accident which occurred, without other adequate explanation.

With cancer of breast, tumors of testis, cancer of sigmoid, neurofibromas of superficial nerve trunks, and many others, the local conditions produced by the tumor include increase in bulk, fixation in the organ, adherence to skin and deep structures and often some inflammatory reaction. All these conditions tend to convert many simple blows, pressures, stretchings, etc., into forces capable of injuring the tissues with pain and hemorrhage, whereas in normal tissues the effects would have been nil. It is in this manner that injury usually brings to light unsuspected tumors. Whenever an apparently trivial injury is said to have produced some peculiar and exaggerated effect, and a tumor is later discovered, it should raise the suspicion that the tumor antedated the injury.