Absence of callus two months after surgical fixation of a hip fracture in a patient with Paget’s disease

V. Mukuchyan, G․ Bdoyan, E. Mkhitaryan, A. Mardyan
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Abstract

Introduction: Paget’s disease is a disorder of bone remodeling that typically begins with excessive bone resorption followed by an increased bone formation. This misbalance into new bone formation process and osteoclastic activity leads to a structurally disorganized mosaic of bone, which is mechanically weaker, larger, less compact, more vascular, and more susceptible to fracture than normal adult bone. Case description: We report the case of a 66-year-old woman who came to us due to a nonunion two months after surgical fixation of the right femoral neck fracture. Upon admission, a pelvic radiograph revealed right femoral neck fracture with osteolysis. A biopsy of the greater trochanter demonstrated histopathological patterns of Paget’s disease. After the surgical intramedullary metallic osteosynthesis of the femoral neck, the patient left the hospital suggested for physiotherapeutic treatment with quadriceps isometric exercises. After 2 months, the pelvic X-ray revealed absence of callus, and the patient was referred to a rheumatologist. Intravenous administration of bisphosphonates (zoledronic acid), as well as oral intake of calcium and vitamin D has been prescribed. Conclusions: Besides rheumatologists and endocrinologists, clinical recognition of Paget’s disease is also very important for orthopedic surgeons in order to achieve better results for patients suffering from any kind of major osteoporotic fracture.
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Paget病患者髋部骨折手术固定两个月后骨痂消失
简介:佩吉特病是一种骨重塑疾病,通常以骨吸收过度开始,随后骨形成增加。这种在新骨形成过程和破骨细胞活动中的不平衡导致骨的结构紊乱,其机械强度较弱,较大,致密性较差,血管较多,并且比正常成人骨更容易骨折。病例描述:我们报告了一位66岁的女性,她在右股骨颈骨折手术固定两个月后出现骨不连而来找我们。入院时,骨盆x光片显示右股骨颈骨折伴骨溶解。大转子活检显示Paget病的组织病理学模式。在股骨颈髓内金属骨融合术后,患者出院,建议进行四头肌等长训练的物理治疗。2个月后,骨盆x线显示没有骨痂,患者被转介到风湿病专家。静脉注射双膦酸盐(唑来膦酸),以及口服钙和维生素D。结论:除了风湿病学家和内分泌学家,临床对Paget病的认识对骨科医生也很重要,以便对任何一种重大骨质疏松性骨折患者取得更好的治疗效果。
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