Shafique Ahmad, Faisal Masood, Hamid Qayum.
A Rare Cause of Pathological Fracture.
Proceeding Shaikh Zayed Postgrad Med Inst Jan ;14(1):41-3.

A 65 years old male, an ex-farmer from the rural area of Punjab, was admitted through accident and emergency with presenting complaints of swelling left thigh in proximal portion for the last 3 years. Swelling was progressive with no associated symptoms such as fever, annorexia, weight loss or any discharge. Swelling was painless till a day before presentation and he developed complaints of pain and inability to bear weight on left hip. No evidence of other injury was present. Patient had multiple consultations and medications from local practioners. His systemic review was non-revaling except history of urgency and frequency of urine for the last 1 year. In past history he had a slip and fall on left hip area managed by local bone setter some 6 years back.

Examination : General physical examination revealed healthy, conscious old man of average weight and height. There was no lymphadenopathy. There was no evidence of weight loss. His musculoskeletal examination disclosed a 15xl5cm, soft, firm, and non tender swelling around the proximal left femur. Overlying skin was intact, shiny with prominent veins. There was no gross fluctuation. Local temperature was normal. Range of movement was restricted due to pain. Rest of the systemic examination was inconclusive. His PR revealed mild prostatic enlargement with no nodularity.

Investigations: His roentgenogram of left hip showed a fracture at subtrochanteric level with a radiolucent area extending into the diaphysis. There was medial cortical violation. There was no perilesional sclerosis, no peri-osteal reaction, no cortical widening. Surrounding soft tissue shadow was hazy. There was also a healed pertroch fracture in left femur.

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