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Osteosarcoma in the distal femur two years after an ipsilateral femoral shaft fracture: a case report.

Dorrestijn O, Jutte PC - J Med Case Rep (2011)

Bottom Line: Was it coincidence?We think that the history of the trauma is crucial to answering this question.When radiographs do not raise any suspicion but the history of trauma or the physical examination does, we recommend further radiological and/or histological diagnostic examinations.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, PO Box 30,001, NL-9700 RB Groningen, The Netherlands. o.dorrestijn@orth.umcg.nl.

ABSTRACT

Introduction: The duration of symptoms preceding a definitive diagnosis of osteosarcoma is quite long. Pathological radiological signs are often evident by the time of diagnosis. Although several case reports have been published on osteosarcoma of the femur, to the best of our knowledge this report is the first one with such an unusual clinical course.

Case presentation: We describe the case of a 58-year-old Caucasian man who presented with a femoral shaft fracture. Two years post-trauma osteosarcoma in the ipsilateral distal femur was diagnosed. Was it coincidence? We think that the history of the trauma is crucial to answering this question.

Conclusion: This case report underlines the need to keep up awareness of pathological fractures in emergency medicine and trauma surgery. When radiographs do not raise any suspicion but the history of trauma or the physical examination does, we recommend further radiological and/or histological diagnostic examinations.

No MeSH data available.


Related in: MedlinePlus

Some bony callus at the fracture site.
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Figure 4: Some bony callus at the fracture site.

Mentions: A 58-year-old, previously healthy Caucasian man visited our emergency department after stumbling in a local pub. He complained of pain in his left upper leg and was not able to bear weight on it. An examination showed a large swelling on his upper leg that was very tender upon palpation, and his leg was shortened. Radiographs showed a comminuted spiral fracture of the femoral shaft, AO type 32 C1.1 (Figures 1A and 1B). A closed reduction of the fracture and an internal fixation with an Unreamed Femoral Nail (UFN; Synthes BV, Zeist, the Netherlands) (Figures 2A and 2B) were performed. Postoperative radiographs showed a persistent marked diastasis between the fracture fragments. One large fragment was shifted dorsomedially. After a six-month period, no signs of consolidation were seen. The patient complained of pain at the level of the fracture as well as at the distal femur, just above the knee. A second operation was performed for autologous bone grafting with bone harvested from the iliac crest. The patient's weight-bearing was increased, but consolidation of the fracture did not progress. Ten months post-trauma there was still no callus at the fracture site, and the patient's pain at the level of the distal femur persisted (Figure 3A). The pain was thought to be caused by the migrating distal screws (Figure 3B); therefore, the screws were removed. The osteolytic area in the distal femoral metaphysis was explained as bone loss resulting from immobilization. Thirteen months postoperatively some bony callus appeared (Figure 4), and the patient increased weight-bearing without crutches.


Osteosarcoma in the distal femur two years after an ipsilateral femoral shaft fracture: a case report.

Dorrestijn O, Jutte PC - J Med Case Rep (2011)

Some bony callus at the fracture site.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3117825&req=5

Figure 4: Some bony callus at the fracture site.
Mentions: A 58-year-old, previously healthy Caucasian man visited our emergency department after stumbling in a local pub. He complained of pain in his left upper leg and was not able to bear weight on it. An examination showed a large swelling on his upper leg that was very tender upon palpation, and his leg was shortened. Radiographs showed a comminuted spiral fracture of the femoral shaft, AO type 32 C1.1 (Figures 1A and 1B). A closed reduction of the fracture and an internal fixation with an Unreamed Femoral Nail (UFN; Synthes BV, Zeist, the Netherlands) (Figures 2A and 2B) were performed. Postoperative radiographs showed a persistent marked diastasis between the fracture fragments. One large fragment was shifted dorsomedially. After a six-month period, no signs of consolidation were seen. The patient complained of pain at the level of the fracture as well as at the distal femur, just above the knee. A second operation was performed for autologous bone grafting with bone harvested from the iliac crest. The patient's weight-bearing was increased, but consolidation of the fracture did not progress. Ten months post-trauma there was still no callus at the fracture site, and the patient's pain at the level of the distal femur persisted (Figure 3A). The pain was thought to be caused by the migrating distal screws (Figure 3B); therefore, the screws were removed. The osteolytic area in the distal femoral metaphysis was explained as bone loss resulting from immobilization. Thirteen months postoperatively some bony callus appeared (Figure 4), and the patient increased weight-bearing without crutches.

Bottom Line: Was it coincidence?We think that the history of the trauma is crucial to answering this question.When radiographs do not raise any suspicion but the history of trauma or the physical examination does, we recommend further radiological and/or histological diagnostic examinations.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, PO Box 30,001, NL-9700 RB Groningen, The Netherlands. o.dorrestijn@orth.umcg.nl.

ABSTRACT

Introduction: The duration of symptoms preceding a definitive diagnosis of osteosarcoma is quite long. Pathological radiological signs are often evident by the time of diagnosis. Although several case reports have been published on osteosarcoma of the femur, to the best of our knowledge this report is the first one with such an unusual clinical course.

Case presentation: We describe the case of a 58-year-old Caucasian man who presented with a femoral shaft fracture. Two years post-trauma osteosarcoma in the ipsilateral distal femur was diagnosed. Was it coincidence? We think that the history of the trauma is crucial to answering this question.

Conclusion: This case report underlines the need to keep up awareness of pathological fractures in emergency medicine and trauma surgery. When radiographs do not raise any suspicion but the history of trauma or the physical examination does, we recommend further radiological and/or histological diagnostic examinations.

No MeSH data available.


Related in: MedlinePlus