Chronic expanding hematoma of the thigh as a cause for pathological fracture of femur – A rare case report
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 diagnos...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-03-01
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| Series: | Journal of Orthopaedic Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2773157X22000078 |
| _version_ | 1811212186363625472 |
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| author | Gaurav Nimkar H. Tandon Anoop K. Ganjoo Nitin Ghonge |
| author_facet | Gaurav Nimkar H. Tandon Anoop K. Ganjoo Nitin Ghonge |
| author_sort | Gaurav Nimkar |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-12T05:23:44Z |
| format | Article |
| id | doaj.art-ad3da431770c4210a88c93d5aabeb509 |
| institution | Directory Open Access Journal |
| issn | 2773-157X |
| language | English |
| last_indexed | 2024-04-12T05:23:44Z |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Orthopaedic Reports |
| spelling | doaj.art-ad3da431770c4210a88c93d5aabeb5092022-12-22T03:46:21ZengElsevierJournal of Orthopaedic Reports2773-157X2022-03-01112832Chronic expanding hematoma of the thigh as a cause for pathological fracture of femur – A rare case reportGaurav Nimkar0H. Tandon1Anoop K. Ganjoo2Nitin Ghonge3Department of Orthopaedics and Joint Replacement Surgery, Indrparastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076, India; Corresponding author.Department of Orthopaedics and Joint Replacement Surgery, Indrparastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076, IndiaDepartment of Cardio-thoracic and Vascular Surgery, Apollo Hospital, New Delhi, 110076, IndiaDepartment of Radiology, Apollo Hospital, New Delhi, 110076, IndiaIntroduction: 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.http://www.sciencedirect.com/science/article/pii/S2773157X22000078Pathological fractureFemurHaematomaSurgeryPlating |
| spellingShingle | Gaurav Nimkar H. Tandon Anoop K. Ganjoo Nitin Ghonge Chronic expanding hematoma of the thigh as a cause for pathological fracture of femur – A rare case report Journal of Orthopaedic Reports Pathological fracture Femur Haematoma Surgery Plating |
| title | Chronic expanding hematoma of the thigh as a cause for pathological fracture of femur – A rare case report |
| title_full | Chronic expanding hematoma of the thigh as a cause for pathological fracture of femur – A rare case report |
| title_fullStr | Chronic expanding hematoma of the thigh as a cause for pathological fracture of femur – A rare case report |
| title_full_unstemmed | Chronic expanding hematoma of the thigh as a cause for pathological fracture of femur – A rare case report |
| title_short | Chronic expanding hematoma of the thigh as a cause for pathological fracture of femur – A rare case report |
| title_sort | chronic expanding hematoma of the thigh as a cause for pathological fracture of femur a rare case report |
| topic | Pathological fracture Femur Haematoma Surgery Plating |
| url | http://www.sciencedirect.com/science/article/pii/S2773157X22000078 |
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