Abstract

AN UNUSUAL CASE OF PATHOLOGICAL FRACTURE DUE TO OSTEOID OSTEOMA IN THE DIAHYSEAL REGION OF HUMERUS: A CASE REPORT

Dr. Surendra Kumar Padarya* and Dr. Mudit Jain

Abstract

Introduction: Osteoid osteoma is reported to occur in the cortex of the shafts of long bones in 80-90% of cases. It is also reported in the epiphyseal and metaphyseal regions of both small and large bones of the axial and appendicular skeletons, especially the femur, tibia, and humerus. We report a case of pathological fracture found to have an osteoid osteoma in the diaphyseal region of humerus. Case Presentation: A 20 years male was admitted in our institute with complaints of severe pain in right arm with inability to move the shoulder and elbow since last evening. There was a history of trivial trauma prior to this complaint. Radiographs revealed a fracture at the middle one third of right humerus. There was a suspicious widening of the bone around the fracture area. Patient was taken up for operative fixation of the fracture. Open reduction and internal fixation with locking compression plate was performed. Intra-operatively, it was found that the bone was very brittle and cortex was paper thin. Excision biopsy of the pathological bone was performed. The fixation was augmented with a fibular strut bone graft and cancellous bone grafts from the iliac crest. Post-operatively, the fixation was augmented with a plaster slab. Biopsy reported histological features of osteiod osteoma with areas of bloody infiltrates - presumably from fracture haematoma. Conclusion: Osteoid osteoma is not a very uncommon condition. But there may be unusual presentations. Radiologically, a classical thickening of the bone cortex with nidus may not be appreciable in all the cases, as was seen in our patient. Hence, histopathological examination of bone fragments from all suspicious fractures must always be done.

Keywords: Pathological fracture, osteoid osteoma.