Insufficiency fracture - Paget disease

Case contributed by Chris Newman
Diagnosis almost certain


Fall from standing height. Deformed leg.

Patient Data

Age: 95 years
Gender: Male
  • transverse fracture through the femoral diaphysis
  • the background bone is trabeculated and overall lucent and demonstrates a lucent endosteal leading edge in keeping with a 'blade of grass sign'
  • partially imaged knee arthroplasty noted
  • CT confirms the insufficiency fracture through abnormal, presumed pagetoid bone

Case Discussion

Low impact mechanism diaphyseal femoral fractures should always raise the possibility of pathological fracture or insufficiency fracture.

This transverse fracture has occurred through abnormal bone, which is presumed pagetoid in this elderly patient given the fairly typical imaging appearances of trabeculated bone and the classic 'blade of grass' sign.

This patient also incidentally had both thoracic and abnormal lymphadenopathy most in keeping with a hematological malignancy. An osseous deposit was considered but is far less likely given the non-aggressive appearance and features classic for Paget disease of bone.

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