Yang Siu Ming, Lo Chor Man
Kwong Wah Hospital, Accident and Emergency Department, Kowloon, Hong Kong, China.
World J Emerg Med. 2014;5(4):306-9. doi: 10.5847/wjem.j.issn.1920-8642.2014.04.011.
We commonly encounter fractures secondary to trauma on and off in our daily practice. While it is not uncommon to see fractures due to underlying pathology, we need to be on the alert when patients present atypically because the treatment for pathological fractures is far different from that for simple fractures.
We presented a case of left clavicle fracture secondary to minor trauma, in which the initial X-ray shows suspicious lesion around the fracture site and further investigation reveals multiple myeloma. The patient received treatment at the clinical oncology department upon diagnosis. Since he was relatively young and fit, he was started on the induction therapy of VTD, which was followed by high dose melphalan and autologous stem cell transplant.
He is currently free from symptoms and on maintenance thalidomide.
Though multiple myeloma is not commonly encountered in emergency practice, earlier identification of relatively subtle symptoms can allow early treatment. Missing this diagnosis will delay treatment and produce severe outcome to the patient. We should be on the alert for such important condition.
在日常医疗实践中，我们经常会遇到因创伤导致的骨折。虽然因潜在病理状况导致骨折并不罕见，但当患者表现不典型时我们需要保持警惕，因为病理性骨折的治疗与单纯骨折的治疗截然不同。
我们报告了一例因轻微创伤导致的左锁骨骨折病例，最初的X线显示骨折部位周围有可疑病变，进一步检查发现为多发性骨髓瘤。患者确诊后在临床肿瘤科接受治疗。由于他相对年轻且身体状况良好，开始接受VTD诱导治疗，随后进行大剂量美法仑和自体干细胞移植。
他目前无症状，正在接受沙利度胺维持治疗。
虽然多发性骨髓瘤在急诊实践中并不常见，但早期识别相对细微的症状可实现早期治疗。漏诊会延误治疗并给患者带来严重后果。我们应对这种重要情况保持警惕。
