Fallen fragment sign

Case contributed by Tom Elswood
Diagnosis certain

Presentation

Left shoulder injury and pain.

Patient Data

Age: 10 years
Gender: Male
x-ray

Pathological fracture through a proximal humeral metaphyseal lesion in a skeletally immature patient. The lesion is lucent, expansile, and well demarcated with a narrow zone of transition. Medially at the fracture site, there is a piece of cortex demonstrating the fallen fragment sign (arrow) of fracture through a bone cyst.

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