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Trochanteric fracture - Paget disease

Case contributed by Bruno Di Muzio
Diagnosis almost certain

Presentation

Twisting injury left hip. Painful, can't weight bear.

Patient Data

Age: 90 years

CT Left hip

ct

Minimally displaced fracture extending through the base of the left femoral greater trochanter. Increased density within the joint capsule may represent hemarthrosis. Narrowing and mild degenerative changes of the hip joint space. Note is also made of coarse trabeculation of visualized left hemipelvis bones in keeping with Paget disease. Atheromatous calcifications of the femoral artery.

Pelvis XR 6 mth earlier

x-ray

Narrowing and mild degenerative changes of the hip joint spaces, with right femoral head remodeling. Coarse trabeculation and mild extension of the pelvic bones in keeping with Paget disease. 

Case Discussion

Greater trochanteric fracture in a patient showing diffuse asymmetric bony abnormalities in the pelvis characterized by mild expansion, cortical thickening, patchy sclerosis, and coarse trabeculation. Those features are suggestive of Paget disease, for which the patient had already been diagnosed. 

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