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causes of pathological fracture in femur

E H C C Janssen, L C J de Bree, K M Kant, P van Wijngaarden
A 57-year-old man was admitted because of pain in the right upper leg due to an osteolytic lesion of the femoral bone which was complicated by a spontaneous fracture. At first a malignancy was suspected. However, blood and bone cultures revealed the Streptococcus anginosus group. A diagnosis of acute osteomyelitis was made. In spite of extensive antibiotic and surgical treatment the patient developed severe septic shock with multiple organ failure and died. In the case of a pathological fracture, one should consider the broad differential diagnosis, including osteomyelitis, which should lead to a laboratory work-up and imaging studies...
April 2017: Netherlands Journal of Medicine
Emir Benca, Andreas Reisinger, Janina M Patsch, Lena Hirtler, Alexander Synek, Sandra Stenicka, Reinhard Windhager, Winfried Mayr, Dieter H Pahr
Pathologic fractures of femora in patients with metastatic cancer are associated with high morbidity and mortality. Prediction of impending fractures is based on unspecific clinical criteria or past clinician's experience, which leads to underestimation or overtreatment. The aim of this study was to investigate the effect of the site of metastatic lesions on biomechanical behavior of the proximal femur. Sixteen pairs of human femora were scanned with quantitative computed tomography (QCT) to asses bone mineral density...
February 27, 2017: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Sang-Hyun Park, Gyu-Min Kong, Yong-Uk Kwon, Jun-Ho Park
Brown tumor refers to a change of skeletones that develops as a complication of hyperparathyroidism. As osteoclast is activated to stimulate reabsorption and fibrosis of bone, it causes a cystic change of the bone. Parathyroid carcinoma is being reported as a tumor that induces primary hyperparathyroidism. It causes excessive secretion of the parathyroid hormone and increases the blood parathyroid hormone and calcium. Bone deformation due to brown tumor is known to be naturally recovered through the treatment for hyperparathyroidism...
September 2016: Hip & Pelvis
Tim Rolvien, Till Koehne, Uwe Kornak, Wolfgang Lehmann, Michael Amling, Thorsten Schinke, Ralf Oheim
Gnathodiaphyseal dysplasia (GDD) is a rare skeletal syndrome that involves an osteopetrosis-like sclerosis of the long bones and fibrous dysplasia-like cemento-osseous lesions of the jawbone. Although the genetic analysis of the respective patients has revealed mutations in the ANO5 gene as an underlying cause, there is still no established consensus regarding the bone status of GDD patients. We report a new case of GDD in a 13-year-old boy with recurrent diaphyseal fractures of the femur, in whom we identified a novel de novo missense mutation in the ANO5 gene, causing a p...
August 19, 2016: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
Helin Feng, Jin Wang, Peng Guo, Jianfa Xu, Wei Chen, Yingze Zhang
BACKGROUND: The spine, pelvis, skull, and femur are the most common sites of bone metastases, and pain is the main symptom of metastatic tumors. Percutaneous femoroplasty (PFP) is becoming increasingly popular for treating proximal femoral metastases. OBJECTIVES: To assess the clinical value and feasibility of PFP performed under the guidance of computed tomography (CT). STUDY DESIGN: A retrospective clinical review comparing pain intensity and the ability to perform activities of daily living before and after treatment with PFP...
2016: Pain Physician
Lindsey Caldwell, Charles M Chan, James O Sanders, John T Gorczyca
BACKGROUND: Ipsilateral femoral neck fractures occur in 1% to 9% of adult trauma patients with femoral shaft fractures making dedicated imaging important. This is not as clear in children. Our purpose is to establish the incidence of ipsilateral femoral neck fractures in children with femoral shaft fractures and to provide recommendations regarding diagnostic imaging protocols. METHODS: A retrospective analysis of medical records was performed for pediatric patients (below 18 y) with femoral shaft fractures seen at our trauma center over a 10-year period...
April 2017: Journal of Pediatric Orthopedics
Bastiaan C J Majoor, Marleen J M Peeters-Boef, Michiel A J van de Sande, Natasha M Appelman-Dijkstra, Neveen A T Hamdy, P D S Dijkstra
BACKGROUND: Management of fibrous dysplasia of the proximal femur is a progressive, often recurrent condition of bone that can cause skeletal deformity, fractures, and pain. Allogeneic cortical strut grafting to minimize the risk of fracture or as part of fracture treatment is a promising treatment option, but evidence is scarce on the intermediate- to long-term results of this procedure and there are no data on factors associated with graft failure. QUESTIONS/PURPOSES: The purposes of this study were (1) to evaluate the revision-free survivorship; (2) radiographic findings; (3) factors associated with failure; and (4) complications associated with cortical strut allograft to prevent or treat fractures of the proximal femur in patients with fibrous dysplasia...
March 2017: Clinical Orthopaedics and related Research
Régis Gonthier
Falls are the leading cause of accidental death among the elderly, accounting for about 12 000 deaths per year. The risk of falls increases with age: one-third of subjects over 65 years old living in the community and half of those over 85 fall at least once a year. Despite their frequency, falls should not be trivialized, as they are associated with significant morbidity and care expenditure: 10% of falls have severe traumatic consequences, and30 % of hospital admissions for traumatic injury among elderly individuals are due to falls...
June 2014: Bulletin de L'Académie Nationale de Médecine
Raju Vaishya, Amit Kumar Agarwal, Nishint Gupta, Vipul Vijay
Fibrocartilaginous dysplasia (FCD) is a rare variant of fibrous dysplasia (FD) which frequently involves the long bones, and the proximal femur is the most commonly affected site. This benign, lytic, and expansile bone lesion causes progressive deformity in the bones and may lead to pathological fracture. Radiologically, this lesion may mimic cartilaginous benign and malignant bone tumors. Therefore, histopathological differentiation of FCD from other cartilaginous tumors is of the utmost importance. The treatment is often surgical, in the form of curettage and bone grafting or corrective osteotomy, to treat progressive deformity in the long bones...
2016: Curēus
Isidro Vitoria, Berta López, Jacinto Gómez, Carolina Torres, María Guasp, Inmaculada Calvo, Jaime Dalmau
Scurvy is a rare disease in developed countries. Risk groups include children with restricted diets, mainly patients who are autistic or have cerebral palsy. Furthermore, consumption of plant-based beverages has increased in recent years, especially in developed countries. When plant-based beverages are the exclusive diet in the first year of life and not consumed as a supplement to formula or breastfeeding, it can result in severe nutritional problems. We report a case of scurvy after exclusive intake of almond beverages and almond flour from 2...
February 2016: Pediatrics
Calvin Ngai, David Y Ding, Timothy B Rapp
Maffucci syndrome, a rare sporadic form of enchondromatosis, is characterized by hemangiomas and multiple enchondromas, benign cartilaginous tumors that arise near growth plates. Previous studies demonstrate that individuals diagnosed with Maffucci syndrome have approximately 100% lifetime risk of malignant transformation. Identification of Maffucci syndrome by surgical excision and pathological diagnosis can be life-saving due to its high malignant potential relative to other subtypes of enchondromatosis such as Ollier's disease...
December 2015: Bulletin of the Hospital for Joint Diseases
R Oheim
Pathological and metabolic bone diseases are common and relevant occurrences in orthopedics and trauma surgery; however, fractures are often treated as being the illness itself and not seen as the symptom of an underlying bone disease. This is why further diagnostics and systemic treatment options are often insufficiently considered in the routine treatment of fractures. This review focuses on osteoporosis, osteopetrosis, hypophosphatasia and Paget's disease of bone.In patients with osteoporotic vertebral or proximal femur fractures, pharmaceutical treatment to prevent subsequent fractures is an integral part of fracture therapy together with surgical treatment...
December 2015: Der Unfallchirurg
Domingo L Muscolo, Ezequiel E Zaidenberg, German L Farfalli, Luis A Aponte-Tinao, Miguel A Ayerza
Hydatid disease is caused by the parasitic tapeworm Echinococcus granulosus. Osseous involvement accounts for 0.5% to 4% of cases in humans. Patients usually are from endemic zones and are initially asymptomatic, presenting with pain and edema at a later stage of disease. However, large lesions may present initially as pathologic fractures. Standard radiographs usually show expansive osteolytic lesions associated with initial cortical thinning, with compromise of the metaphysis or epiphysis, and may involve the diaphysis...
October 2015: Orthopedics
Jeff Gadsden, Alicia Warlick
Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform...
2015: Local and Regional Anesthesia
Jakub Jończyk, Wojciech Szubert, Michał Panasiuk
Despite the case of a 19-year-old male with a pathological subtrochanteric left femoral fracture in the course of an extensive arteriovenous malformation of the left thigh. The arteriovenous malformation was diagnosed when the patient was 16 years old. He has undergone several embolization procedures. The fracture was caused by a fall from the patient's own height. Before the patient was qualified for surgery of the fracture, a left lower limb angiography confirmed the presence of extensive pathological vascularity (arteriovenous malformation), and an embolization procedure was performed on the branches and trunk of the left deep femoral artery, several vessels branching off of the proximal and distal segment of the superficial femoral artery and one branch of the internal iliac artery...
May 2015: Ortopedia, Traumatologia, Rehabilitacja
Ashvin K Dewan, Ryan E Tomlinson, Stuart Mitchell, Brian C Goh, Rachel M Yung, Sarvesh Kumar, Eric W Tan, Marie-Claude Faugere, Harry C Dietz, Thomas L Clemens, Paul D Sponseller
Loeys-Dietz syndrome (LDS) is a connective tissue disorder characterized by vascular and skeletal abnormalities resembling Marfan syndrome, including a predisposition for pathologic fracture. LDS is caused by heterozygous mutations in the genes encoding transforming growth factor-β (TGF-β) type 1 and type 2 receptors. In this study, we characterized the skeletal phenotype of mice carrying a mutation in the TGF-β type 2 receptor associated with severe LDS in humans. Cortical bone in LDS mice showed significantly reduced tissue area, bone area, and cortical thickness with increased eccentricity...
October 2015: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Jasper C M Langenberg, Willem-Maarten Bosman, Jephta van den Bremer, Ewan D Ritchie
We describe a case of a 59-year-old woman with a medical history of upper leg pain and chronic lymphatic leucaemia (CLL), with known diffuse bone marrow infiltration and without signs of lymphatic or extra-lymphatic disease activity on positron emission tomography CT (PET-CT). She presented with multiple fractures of the pelvis, sacrum and left proximal femur as a result of a low energy fall. During admission, she sustained a non-traumatic fracture of the right proximal femur. Pathological fractures in patients with CLL are usually based on Richter's transformation or multiple myeloma...
February 25, 2015: BMJ Case Reports
Piotr Magnowski, Hubert Wolski, Magdalena Magnowska, Ewa Nowak-Markwitz
Nowadays, women with genital cancers live longer due to early diagnosis and better treatment schemes. Only few studies assessed bone mass in patients with genital cancer Osteoporosis is a condition characterized by progressive loss of bone mass, weakening of the spatial structure of the bone, and increased susceptibility to fractures. Osteopenia is a condition of reduced, but not yet reaching the pathological values, bone density in relation to norms for age and sex. Metastases are the primary cause of death in cancer patients...
December 2014: Ginekologia Polska
Luis R Ramos-Pascua, Sergio Sánchez-Herraéz, Paula Casas-Ramos, Sebastián Molnar Fuentes, José Ángel Santos Sánchez
INTRODUCTION: There is no consensus on when and how to treat unicameral bone cysts (UBCs), partly because of a lack of knowledge of the aetiology. PURPOSE: To review the different treatment techniques for UBCs and to describe our results with a single injection of autogenous bone marrow (BM) mixed with demineralised bone matrix (DBM) in very young children. PATIENTS AND METHODS: We reviewed five patients under the age of 8 years with UBCs treated by percutaneous aspiration and a single injection of BM associated with DBM...
October 2014: Injury
Dan Radulescu, Bogdan Chis, Valer Donca, Valentin Munteanu
Brown tumors result from excess osteoclast activity and consist of collections of osteoclasts intermixed with fibrous tissue and poorly mineralized woven bone. They are secondary to hyperparathyroidism (HPT). Their incidence is higher in primary than in secondary hyperparathyroidism. We report a 69 years-old male, admitted in a state of confusion, lethargy and bedridden, with a pathological fracture of the femur caused by a brown tumor. The laboratory examination revealed a hypercalcemia (8.85 mEq/L), with high levels of ionized Ca (5...
July 2014: Revista Médica de Chile
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