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Complex Femoral Reconstruction Following Pathologic Subtrochanteric Femur Fracture Secondary to Paget’s Disease of the Bone: A Case Report with Long-Term Follow-up

INTRODUCTION: Paget’s disease (PD) is the most common metabolic bone disorder after osteoporosis. Clinically, it can result in pain, bony deformity, pathologic fractures, and, in the late stage, progression to malignancy. At a pathophysiological level, PD manifests as an imbalance between the homeos...

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Autores principales: Berger, Garrett K., Graf, Alexander R., Wooldridge, Adam N., Hackbarth, Donald A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Indian Orthopaedic Research Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051579/
https://www.ncbi.nlm.nih.gov/pubmed/33954128
http://dx.doi.org/10.13107/jocr.2020.v10.i03.1730
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author Berger, Garrett K.
Graf, Alexander R.
Wooldridge, Adam N.
Hackbarth, Donald A.
author_facet Berger, Garrett K.
Graf, Alexander R.
Wooldridge, Adam N.
Hackbarth, Donald A.
author_sort Berger, Garrett K.
collection PubMed
description INTRODUCTION: Paget’s disease (PD) is the most common metabolic bone disorder after osteoporosis. Clinically, it can result in pain, bony deformity, pathologic fractures, and, in the late stage, progression to malignancy. At a pathophysiological level, PD manifests as an imbalance between the homeostasis of bone destruction and formation. Bones most often involved with this disease process include the pelvis, femur, tibia, vertebra, and skull. The goals of orthopedic intervention in PD are two-fold: Prevention of pathologic fracture with internal stabilization and reconstruction following fracture, which is often complicated by poor bone quality and advanced deformity. In this case report, authors detail a patient with PD who presented with a pathologic left subtrochanteric femur fracture requiring a novel complex femoral reconstruction with a 29-year follow-up period. To the best of our knowledge, no such report exists, particularly with this degree of long-term follow-up. CASE REPORT: A 70-year-old Caucasian man with PD presented with an atypical subtrochanteric femur fracture after a ground level fall. Due to his significant femoral deformity and osteopenia, proximal femoral resection followed by composite femoral allograft reconstruction with total hip arthroplasty was performed. Long-term durability of this novel reconstruction method as well as longitudinal clinical and radiographic outcomes is described. CONCLUSION: Complex pathologic fractures in patients with PD can be effectively treated with composite femoral allograft reconstruction and total hip arthroplasty with good long-term radiographic and clinical outcomes. Broadly, it is important to note the unique healing pattern seen in PD bone and to consider the implications it may have when planning surgical intervention.
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spelling pubmed-80515792021-05-04 Complex Femoral Reconstruction Following Pathologic Subtrochanteric Femur Fracture Secondary to Paget’s Disease of the Bone: A Case Report with Long-Term Follow-up Berger, Garrett K. Graf, Alexander R. Wooldridge, Adam N. Hackbarth, Donald A. J Orthop Case Rep Case Report INTRODUCTION: Paget’s disease (PD) is the most common metabolic bone disorder after osteoporosis. Clinically, it can result in pain, bony deformity, pathologic fractures, and, in the late stage, progression to malignancy. At a pathophysiological level, PD manifests as an imbalance between the homeostasis of bone destruction and formation. Bones most often involved with this disease process include the pelvis, femur, tibia, vertebra, and skull. The goals of orthopedic intervention in PD are two-fold: Prevention of pathologic fracture with internal stabilization and reconstruction following fracture, which is often complicated by poor bone quality and advanced deformity. In this case report, authors detail a patient with PD who presented with a pathologic left subtrochanteric femur fracture requiring a novel complex femoral reconstruction with a 29-year follow-up period. To the best of our knowledge, no such report exists, particularly with this degree of long-term follow-up. CASE REPORT: A 70-year-old Caucasian man with PD presented with an atypical subtrochanteric femur fracture after a ground level fall. Due to his significant femoral deformity and osteopenia, proximal femoral resection followed by composite femoral allograft reconstruction with total hip arthroplasty was performed. Long-term durability of this novel reconstruction method as well as longitudinal clinical and radiographic outcomes is described. CONCLUSION: Complex pathologic fractures in patients with PD can be effectively treated with composite femoral allograft reconstruction and total hip arthroplasty with good long-term radiographic and clinical outcomes. Broadly, it is important to note the unique healing pattern seen in PD bone and to consider the implications it may have when planning surgical intervention. Indian Orthopaedic Research Group 2020 /pmc/articles/PMC8051579/ /pubmed/33954128 http://dx.doi.org/10.13107/jocr.2020.v10.i03.1730 Text en Copyright: © Indian Orthopaedic Research Group https://creativecommons.org/licenses/by-nc-sa/3.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Berger, Garrett K.
Graf, Alexander R.
Wooldridge, Adam N.
Hackbarth, Donald A.
Complex Femoral Reconstruction Following Pathologic Subtrochanteric Femur Fracture Secondary to Paget’s Disease of the Bone: A Case Report with Long-Term Follow-up
title Complex Femoral Reconstruction Following Pathologic Subtrochanteric Femur Fracture Secondary to Paget’s Disease of the Bone: A Case Report with Long-Term Follow-up
title_full Complex Femoral Reconstruction Following Pathologic Subtrochanteric Femur Fracture Secondary to Paget’s Disease of the Bone: A Case Report with Long-Term Follow-up
title_fullStr Complex Femoral Reconstruction Following Pathologic Subtrochanteric Femur Fracture Secondary to Paget’s Disease of the Bone: A Case Report with Long-Term Follow-up
title_full_unstemmed Complex Femoral Reconstruction Following Pathologic Subtrochanteric Femur Fracture Secondary to Paget’s Disease of the Bone: A Case Report with Long-Term Follow-up
title_short Complex Femoral Reconstruction Following Pathologic Subtrochanteric Femur Fracture Secondary to Paget’s Disease of the Bone: A Case Report with Long-Term Follow-up
title_sort complex femoral reconstruction following pathologic subtrochanteric femur fracture secondary to paget’s disease of the bone: a case report with long-term follow-up
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051579/
https://www.ncbi.nlm.nih.gov/pubmed/33954128
http://dx.doi.org/10.13107/jocr.2020.v10.i03.1730
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