| Summary: | Introduction: Long-standing hematomas may expand and are called chronic expanding hematomas. These may produce complications from their pressure effect on the surrounding structures. In addition, a variety of their presentations and similarity to benign or locally aggressive tumors present a diagnostic dilemma and surgical challenge to manage. Case presentation: We report a case of a pathological fracture of the proximal left femur in a 62-year-old male. He was on anticoagulation therapy for the past mitral valve surgery. He presented with a long history of pain and swelling in the left thigh. The pain suddenly worsened with an inability to bear weight on the left lower limb. He had sustained a pathological fracture of the left proximal femur. There was an erosion of the femur and obliterated medullary canal from the compression effect of a chronic expanding hematoma in his left thigh. The hematoma was evacuated, and the fracture was internally fixed with a dynamic compression screw and plate. The fracture fixation was augmented with an autologous fibular strut graft and extended immobilization. At one and half year follow-up, the fracture had united, with graft incorporationwith no signs of erosion and recurrence.The patient was pain-free and could mobilize full weight-bearing. Conclusion: Chronic expanding hematomas should form part of the differential diagnosis in the work-up of soft tissue tumors in adults. These can result in erosion of bone with resultant pathological fractures. In addition, they may be challenging to diagnose due to their rarity and present a surgical challenge because of their size, bone defects it produces.
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