Abstract
Paget's disease of the bone is a common metabolic bone disease in most European countries, Australia, New Zealand, and North America. Conversely, this disease is rare in Scandinavia, Asia, and Africa. In Japan, it is extremely rare, with a prevalence of 0.15/100000. Paget's disease is a localized disorder of bone remodeling. Excessive bone resorption and abnormal bone formation result in biomechanically weakened bone and predispose patients to fracture. Delayed union and non-union of fractures have been reported in patients with Paget's disease. Therefore, open reduction and internal fixation of fractures has been recommended to prevent such complications. Here we report an unusual case of a 63-year-old Asian woman with delayed union of a femur fracture secondary to Paget's disease, which was treated successfully by functional bracing.
Highlights
Paget's disease of the bone was first described by Sir James Paget in 1877
We had no alternative but to apply a functional brace for delayed union of the femur fracture with the aim of allowing the patient to walk on crutches, to the best of our knowledge, no familial cases were found in the reported cases
In this case, fracture union was obtained 6 months after application of the functional brace. This treatment period is comparable to that reported by others using functional brace in the treatment of delayed union of the tibia [13,14,15]. We speculate that this treatment was advantageous because the external fixator and functional bracing did not violate the fracture site, allowing vascular regeneration and eliminating further damage to the peripheral and intramedullary blood supply which occurs during plate and screw fixation and intramedullary nailing
Summary
Paget's disease of the bone was first described by Sir James Paget in 1877 It is a well documented metabolic bone disorder in European countries and the United States, with a reported incidence of 3-4% in the adult population [1,2,3]. We present an unusual case of delayed union of a femur fracture secondary to Paget's disease in an Asian patient, which was treated successfully by functional bracing. We diagnosed the patient as having pathological fracture secondary to monostotic Paget's disease. As she suffered from multiple concomitant illnesses, she was judged to be a poor risk for surgery. X-ray revealed fracture healing after 6 months of treatment by functional bracing (Figure 4). Of the fracture (Figure 5), the patient is able to walk unaided with a single T-cane
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