Absence of callus two months after surgical fixation of a hip fracture in a patient with Paget’s disease

Abstract

Introduction: Paget’s disease is a disorder of bone remodeling that typically begins with excessive bone resorption followed by an increased bone formation. This misbalance into new bone formation process and osteoclastic activity leads to a structurally disorganized mosaic of bone, which is mechanically weaker, larger, less compact, more vascular, and more susceptible to fracture than normal adult bone. Case description: We report the case of a 66-year-old woman who came to us due to a nonunion two months after surgical fixation of the right femoral neck fracture. Upon admission, a pelvic radiograph revealed right femoral neck fracture with osteolysis. A biopsy of the greater trochanter demonstrated histopathological patterns of Paget’s disease. After the surgical intramedullary metallic osteosynthesis of the femoral neck, the patient left the hospital suggested for physiotherapeutic treatment with quadriceps isometric exercises. After 2 months, the pelvic X-ray revealed absence of callus, and the patient was referred to a rheumatologist. Intravenous administration of bisphosphonates (zoledronic acid), as well as oral intake of calcium and vitamin D has been prescribed. Conclusions: Besides rheumatologists and endocrinologists, clinical recognition of Paget’s disease is also very important for orthopedic surgeons in order to achieve better results for patients suffering from any kind of major osteoporotic fracture.