Fractures in Paget's disease.

After analyzing the various types of anatomical and radiographic fractures in pagetic bone, the authors explain the reason for their preference for surgical treatment if the lesion is localized in the lower limbs. This choice allows for a reduction in the duration of immobilization and a lowered incidence of local (rapid and intense osteolysis of the pagetic bone) and general complications (hypercalciuria, at times, hypercalcemia). It is best to resort to internal osteosynthesis for diaphyseal fractures and prosthetic substitution for fractures of the femoral neck where treatment with screws and plates is less reliable due to the fragility of the pagetic bone. Non-surgical treatment may be used for fractures of the upper limb as the duration of the consolidation process, which is always increased, at any rate remains restricted to acceptable limits. Nonetheless, the radiographic occurrence of repair callus is not a sure sign of healing as it may also be affected by the Paget's disease.