Bilateral proximal ulnar looser zones

Case contributed by Dr Aneta Kecler-Pietrzyk

Presentation

Bilateral elbows pain. No history of trauma. Background of celiac disease.

Patient Data

Age: 30 years
Gender: Male

Plain radiographs of both elbow joints demonstrate a slightly superiorly displaced fracture of the right proximal ulnar shaft and a nondisplaced fracture of the left proximal ulnar shaft with cortical sclerosis of the osseous ends.

The fractures are symmetrical and perpendicular to the long axis of both ulnar bones and represent advanced pseudofractures - Looser zones.

Bilateral joint effusions are also see, more marked on the right. 

Case Discussion

The case presents advanced pseudofractures (Looser zones) involving the proximal ulnar bones resulting from osteomalacia secondary to celiac disease 1,2.

The proximal ulnae are a rare site of Looser zones, which are most commonly seen in the scapulae, femora or pubic rami.

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