Paget disease with insufficiency fractures

Case contributed by Michael Stewart
Diagnosis almost certain

Presentation

Pre-op left THR

Patient Data

Age: 80 years
Gender: Male

Left hip

x-ray

Diffuse cortical thickening and coarse trabecular pattern in the left proximal femur, consistent with Paget disease. 

Several linear lucencies oriented perpendicular to the long axis of the bone, compatible with insufficiency fractures. 

Case Discussion

Complications of Paget disease include:

  • pain
  • deformity
  • compression of adjacent structures (e.g. SNHL from compression of CNVIII in Paget disease of the skull)
  • pathological fracture
  • high output congestive cardiac failure
  • malignant transformation (most commonly to Osteosarcoma) 

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