Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive, deep-seated pain in the [proximal/mid/distal] femur, exacerbated by weight-bearing and movement. History of known primary malignancy [specify: breast/prostate/lung/other]. Reports recent onset of localized swelling, functional limitation, and nocturnal pain. No history of acute trauma; however, patient notes increasing instability and difficulty with ambulation.
Clinical Examination Findings
Inspection reveals localized soft tissue swelling and erythema over the affected femoral region. Palpation elicits significant tenderness over the [specify site]. Range of motion of the hip and knee is restricted due to pain. Neurovascular assessment: distal pulses (dorsalis pedis/posterior tibial) are palpable and symmetric; capillary refill < 2 seconds; no focal motor or sensory deficits noted in the lower extremity.
Treatment Protocol
Plan: 1. Orthopedic oncology consultation for stabilization assessment (Mirels' score). 2. Pain management: initiate bisphosphonates or RANK ligand inhibitors (denosumab) as indicated. 3. Consider palliative radiotherapy for pain control. 4. Surgical stabilization (intramedullary nailing or prophylactic fixation) if fracture risk is high. 5. Physical therapy for mobility support and fall prevention.