Undetected Incomplete Stress Fracture in the Proximal Femur of a Patient with Paget's Disease - A Case Report -

Hong Kyun Kim; Jung Han Yoo; Yong Wook Park; Jin Soo Park; Kyu Cheol Noh; Kook Jin Chung; Min Young Jo; Ji Hyo Hwang

doi:10.5371/jkhs.2011.23.1.60

Journal List > J Korean Hip Soc > v.23(1) > 1048749

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Kim, Yoo, Park, Park, Noh, Chung, Jo, and Hwang: Undetected Incomplete Stress Fracture in the Proximal Femur of a Patient with Paget's Disease - A Case Report -

Case Report

The Journal of the Korean Hip Society

The Journal of the Korean Hip Society 2011; 23(1): 60-65.

Published online: 31 March 2011

DOI: https://doi.org/10.5371/jkhs.2011.23.1.60

Undetected Incomplete Stress Fracture in the Proximal Femur of a Patient with Paget's Disease - A Case Report -

Hong Kyun Kim, MD, Jung Han Yoo, MD, Yong Wook Park, MD, Jin Soo Park, MD, Kyu Cheol Noh, MD, Kook Jin Chung, MD, Min Young Jo, MD, Ji Hyo Hwang, MD

Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea.

Address reprint request to Ji Hyo Hwang, MD. Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, 948-1 Daerim 1-dong Yeongdeungpo-gu, Seoul 150-950, Korea. TEL: +82-2-829-5165, FAX: +82-2-834-1728, hwangjihyo7309@gmail.com

Received 18 March 2010 Revised 2 December 2010 Accepted 6 December 2010

Abstract

Paget disease is a well-documented skeletal disease and it has an increased rate of tissue breakdown due to the excessive turnover of osteoblasts and osteclasts. Stress fracture is one of the most common complications in the late phase of Paget disease, but the clinical presentation of incomplete pathologic fracture is rare and this is an important clue to plan the treatment. We experienced a case of Paget's disease in a 74 year old woman with a periprosthetic fracture from the undetected, imcomplete stress fracture in the proximal femur.

Keywords: Paget disease, Incomplete stress fracture, Proximal femur

Figures and Tables

Fig. 1

Preoperative plain x-ray shows both femoral coxa vara and radioopaque lesions in the femoral head and the proximal femur.

Fig. 2

Bone scan shows hot uptake in the femoral head and proximal femur, some parts of the ilium and T11 which suggests inflammatory bone lesion.

Fig. 3

(A) Preoperative local MRI shows low signal intensity and (B) high signal intensity in the lateral aspect of the femoral head and relatively well preserved articular cartilage.

Fig. 4

On the gross examination, there is loss of articular cartilage with exposure of eburnated bone. The subchondral bone is sclerotic with irregular thickening of the trabecular and changes of the cortex.

Fig. 5

(A) On the microscopic examination, there are irregularly thickened and disorganized trabeculae lined by increased numbers of osteoblasts (short arrow) and multinucleated osteoclasts (long arrow), (H&E, ×100). (B) Woven bone with irregular, wavy, and curliform cement lines (arrow) is noted (H&E, ×400).

Fig. 6

Transverse fracture line is seen on the convex area of the proximal femur on 6 months after operation.

Fig. 7

(A) It shows incomplete pathologic fracture in the lateral cortex on the both plain x-ray and (B) MRI.

Fig. 8

Revisional arthroplasty was done with allogenic strut bones and cables.

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