Velayuthampalayam Government Hospital, Velayuthampalayam, Tamil Nadu, India
Orthopaedic Research Group, Coimbatore, Tamil Nadu, India.
BMJ Case Rep. 2020 Dec 21;13(12):e238567. doi: 10.1136/bcr-2020-238567.
A 60-year-old man presented to our hospital with complaints of pain and deformity on his right thigh for the past 2 days following a history of accidental slip and fall. Radiological investigations suggested a pathological type 2 Seinsheimer subtrochanteric fracture of the right femur with a 'bone within bone' appearance, which posed a diagnostic dilemma as this radiological appearance is seen in a spectrum of conditions. Radiographic skeletal survey failed to identify a similar appearance elsewhere in the body. Laboratory investigations pointed in favour of bone mineral disease, and histopathological examination of the bone narrowed it down to Paget's disease. The fracture was fixed with a contralateral distal femur locking compression plate. The fracture site failed to show signs of union until 6 months postsurgery and hence the patient was advised for grafting procedure. The patient deferred surgery and remains without major complications until 18 months of follow-up.
一位 60 岁男性因滑倒摔伤右大腿，出现疼痛和畸形 2 天，前来我院就诊。影像学检查提示右侧股骨发生病理性 2 型 Seinsheimer 转子下骨折，呈现“骨内骨”表现，这给诊断带来了困难，因为这种影像学表现可见于一系列病症。全身骨骼放射性检查未在其他部位发现类似的表现。实验室检查提示存在骨矿物质疾病，骨骼组织病理学检查则提示为佩吉特病。骨折用对侧股骨远端锁定加压钢板固定。术后 6 个月，骨折部位仍未见愈合迹象，因此建议患者进行植骨手术。患者推迟了手术，随访 18 个月期间无重大并发症。
