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Abstract: A 54-year-old male patient presented with pain in the right hip after a fall from a height, accompanied by limitation of movement for 3 hours. After admission to the hospital, a series of examinations determined a pathological fracture under the right femoral trochanter, and the patient was also found to have abnormal proliferation of bone fibers in the right proximal femur, that is, poor bone fiber structure. The patient was treated surgically with medication, and the fracture healed after 1 year of follow-up, the fracture line disappeared, and no recurrence was seen at the lesion.
[Basic information] Male, 54 years old
Disease Type】Bone fibrous dysplasia and pathological fracture of the right femur under the trochanter
Hospital】Shaanxi Nuclear Industry Hospital No. 215
Time of consultation】January 2019
Treatment plan】Medication (mannitol injection, diclofenac sodium extended-release capsule) + surgery (right femur subtrochanteric fracture lesion scraping, iliac bone graft extraction, incisional repositioning plate internal fixation)
Treatment period】2 weeks of inpatient treatment, 1 month of postoperative outpatient review
Treatment effect】The fracture healed, the fracture line disappeared, and no recurrence was seen at the lesion.
I. Initial consultation
The patient was admitted to the hospital with the chief complaint of pain in the right hip caused by a fall injury with limited movement for 3 hours. The patient had limited movement of the right hip, but the ankle and knee joints were still movable, the dorsalis pedis artery was still pulsating, the peripheral blood flow was normal, and there were no obvious abnormalities in sensory function. After other auxiliary examinations, including X-ray and CT, the patient was diagnosed with pathological fracture under the right femoral trochanter and abnormal proliferation of bone fibers (poor bone fiber structure).
X-ray examination
CT examination
II. Treatment history
After admission, the patient was given mannitol injection to reduce swelling and diclofenac sodium extended-release capsule to relieve pain. After excluding contraindications to surgery, the patient underwent elective scraping of the right subtrochanteric fracture lesion, iliac bone grafting and internal fixation with incisional repositioning plate. The lesion was scraped thoroughly and a large amount of abnormal lesion fibrous proliferation was seen, the bone at the lesion was thinned and the local protrusion was changed. Postoperative imaging showed good fracture repositioning, good position of the internal fixation, and complete scraping of the implant changes at the lesion.
(X-ray examination on the 2nd postoperative day: good fracture repositioning and plate position, complete scraping of bone grafting changes at the lesion)
III. Treatment effect
The patient’s surgery was successful, and postoperative nutrition was given to prevent postoperative wound infection and other complications. Before the operation, the patient had obvious pain in the right hip due to the fracture, and the limb could not be moved and turned over, which seriously affected the daily life. Through the surgical treatment, the fracture end was stabilized, and the pain was significantly reduced when the limb was moved after the operation, and there was only postoperative wound pain. On the first day after surgery, the patient could sit up and eat, and could passively perform functional exercises of flexion and extension of the affected limb and turn over. At 1 week after surgery, the patient could actively perform functional exercises of the affected limb and could go out in a wheelchair. After 2 weeks of hospitalization, the wound healed well and the sutures were removed. The patient was discharged and advised to come to the hospital for regular review. 1 year after surgery, the imaging showed that the fracture had healed and the fracture line had disappeared, and there was no recurrence at the lesion.
(1-year postoperative X-ray review: the fracture had healed, the fracture line disappeared, and no recurrence was seen at the lesion)
IV. Notes
We are glad that the patient’s pain is relieved after treatment, but the patient should come to the hospital for X-ray review 1 month after discharge. Although the patient can walk on the ground with the help of crutches, the affected limb should not be on the ground to avoid re-displacement of the fracture or breakage of the plate screw. The X-ray will be reviewed at 3 months after surgery, and the patient can gradually walk down to the ground with weight-bearing exercises with the help of crutches, but weight-bearing work is not recommended. At 6 months after the operation, the patient can resume normal life and walk, and can resume some physical work. One year after the operation, the patient returned to normal life and returned to normal work. Regular postoperative follow-up X-ray examination can dynamically observe whether the lesion recurs and the fracture healing situation, and decide whether the patient can go to the ground for functional exercise according to the fracture healing situation.
V. Personal insight
Abnormal bone fiber proliferation disorder, also known as bone fiber dysplasia, is a benign disease characterized by the proliferation and degeneration of bone fiber tissue into naïve interwoven bone, commonly seen in the age group of 10-30 years old, but also in patients over 50 years old, with no clear etiology yet. The common clinical manifestations are local deformity and pain. In the early stage, there is usually no obvious discomfort, and as the disease progresses, local soreness and swelling or mild pain may appear. In this case, the patient was only discovered by taking X-rays due to fracture and other reasons. For patients with large lesions and great risk of fracture, early surgical treatment is recommended. For patients with smaller lesions or asymptomatic patients, observation can be continued without surgical treatment for the time being. However, there is a possibility of recurrence after treatment of this disease, so it should be reviewed regularly after surgery.