Pillai Suresh
Department of Spine, Aster MIMS Hospital, Govindapurasam, Calicut, Kerala, India.
J Orthop Case Rep. 2018 Sep-Oct;8(5):54-56. doi: 10.13107/jocr.2250-0685.1210.
Pathological fractures resulting from trivial trauma may be overlooked, especially, when it is after a road traffic accident.
A 56-year-old male was operated elsewhere for burst fracture L3 vertebra following a trivial road traffic accident. Due to the persistence of symptoms, he was reevaluated. Magnetic resonance imaging revealed infection at the operated site. The implants were removed, pus drained, and a transpedicular biopsy was taken from L3 vertebral body along with bone marrow aspirate from the iliac crest, suspecting a pathological fracture. He was diagnosed to have multiple myeloma and was treated in consultation with medical oncology department. His spine was stabilized 6 weeks later when the infection healed. He was further treated at the medical oncology department for multiple myeloma. Then, he developed infection again and underwent implant removal and wound debridement. 3 weeks later, he developed electrolyte imbalance and infection and succumbed to the disease.
Pathological fracture should be suspected in fractures resulting from trivial trauma. Multiple myeloma patients have a higher chance of infection with MRSA. With chemotherapy, the immunity goes further down resulting in florid infection.
轻微创伤导致的病理性骨折可能会被忽视,尤其是在道路交通事故之后。
一名56岁男性在一场轻微道路交通事故后,于其他地方接受了L3椎体爆裂骨折手术。由于症状持续存在,他接受了重新评估。磁共振成像显示手术部位感染。取出植入物,引流脓液,并从L3椎体进行经椎弓根活检,同时从髂嵴抽取骨髓,怀疑是病理性骨折。他被诊断为多发性骨髓瘤,并在与医学肿瘤学部门会诊后接受治疗。6周后感染治愈,他的脊柱得到了固定。他在医学肿瘤学部门进一步接受多发性骨髓瘤治疗。随后,他再次发生感染,接受了植入物取出和伤口清创术。3周后,他出现电解质失衡和感染,最终因病死亡。
对于轻微创伤导致的骨折,应怀疑病理性骨折。多发性骨髓瘤患者感染耐甲氧西林金黄色葡萄球菌的几率更高。化疗会使免疫力进一步下降,导致严重感染。