Paget's disease of bone is a chronic disorder of disorganised bone remodelling that poses unique challenges in orthopaedic surgery. In this masterclass, we cover everything from its classic biochemical hallmarks and radiological phases to managing pathological fractures and preventing massive operative bleeding. ⏱ Chapters 0:00 Intro 0:23 Essentials 0:57 Paget Mnemonic 1:24 Disease Phases 1:57 Biochemistry 2:26 Radiographic Signs 2:54 Fast Mnemonic 3:20 Surgical Algorithm 3:51 Pharmacology 4:23 Complications Numbers 4:54 Clinical reasoning — Incidental 5:28 Clinical reasoning — Sarcoma This comprehensive orthopaedic masterclass delves into the pathophysiology, diagnosisand surgical management of Paget's disease. Viewers will explore the three distinct radiological phases, from lytic flame-shaped lesions to burnt-out sclerotic boneand learn how to differentiate this condition from metastatic disease. We also detail critical operative strategies for handling highly vascular, mechanically compromised pagetic bone and the medical management of bone turnover using bisphosphonates. 🦴 IN THIS VIDEO YOU'LL LEARN • How to identify the hallmark biochemistry of markedly elevated alkaline phosphatase with normal calcium metabolism • Recognising the three radiological phases: lytic, mixedand sclerotic • Identifying pathognomonic X-ray signs like the flame-shaped lytic front, brim signand picture-frame vertebra • Using the FAST mnemonic to anticipate orthopaedic complications like fractures, arthritisand sarcomatous transformation • Surgical strategies to mitigate severe intraoperative haemorrhage in highly vascular pagetic bone • The importance of using long implants to bypass abnormal bone tissue during fracture fixation • Understanding the role of potent bisphosphonates like zoledronic acid as first-line medical therapy • Differentiating bone expansion in Paget's disease from metastatic bone lesions • Recognising the clinical presentation and devastating prognosis of sarcomatous transformation ⏱️ CHAPTERS 📌 KEY TAKEAWAYS ✔️ Markedly raised alkaline phosphatase with normal calcium and phosphate is the biochemical signature of Paget's disease. ✔️ Physical bone expansion is the single best radiographic discriminator from metastatic disease. ✔️ Despite appearing dense and sclerotic on imaging, woven pagetic bone is mechanically weak and prone to transverse stress fractures. ✔️ Administer bisphosphonates months before elective surgery to significantly reduce intraoperative haemorrhage. ✔️ Sarcomatous transformation to osteosarcoma is rare but devastating, classically presenting with a sudden increase in pain and a soft tissue mass. ✔️ A single 5mg intravenous infusion of zoledronic acid normalises alkaline phosphatase in around 90% of patients. 👩⚕️ WHO THIS IS FOR This video is designed for orthopaedic trainees, medical studentsand clinicians seeking a deep understanding of metabolic bone disease. Curious patients looking to understand the orthopaedic implications of Paget's disease will also find this masterclass highly informative. 📚 RELATED TOPICS: Metabolic bone diseases and osteoporosis · Osteosarcoma and sarcomatous transformation · Bisphosphonates mechanism of action in orthopaedics · Pathological fractures and bone lesions · Bone tumour radiology and lytic lesions · Hyperparathyroidism vs malignancy biochemical profiles 🔗 More free orthopaedic teaching at Orthovellum.com — subscribe for weekly videos. 🎨 CREDITS • Original Orthovellum production. ⚠️ DISCLAIMER: Educational only — not individual medical advice. Always consult a qualified clinician for diagnosis and treatment. #PagetsDisease #Orthopaedics #MetabolicBoneDisease #BonePathology #OrthopaedicSurgery #BoneRemodelling #Osteosarcoma #Bisphosphonates #Orthovellum #MedicalEducation #Radiology #PathologicalFracture