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1965 Publications

FRACTURE OF THE FEMUR IN PATIENTS WITH PAGET'S DISEASE; RESULTS OF TREATMENT IN TWENTY-THREE CASESby NICHOLAS JA, KILLORAN P. - last modified 2013-05-21 10:54
J Bone Joint Surg Am. 1965 Apr;47:450-61.

 

Pathological fracture of a femur in a femur involved with Paget’s disease presents a formidable problem in treatment. Although compromise in the objectives of treatment for pathological fractures associated with malignant disease if frequently justified, this is usually not the case for fractures in patients with Paget’s disease because the life expectancy of these patients is not likely to be shortened.

Despite reports in the literature that this is a rare problem, Paget’s disease is common. Its incidence in any study apparently depends on the extent of the roentgenographic survey of each patient. The disease is often relatively quiescent without clinical manifestations.

Lake studied the incidence of the two complications of Paget’s disease, sarcoma and fracture. In thirty –four patients with forty-five fractures in various bones, he found that fractures are common in the earlier, vascular phase of Paget’s disease. It was his impression that in the vascular stage fractures unite rapidly, whereas in the sclerotic phase union is often difficult to achieve, even though callus in abundant and immobilization is adequate. In his series there were twenty-two fractures of the femur (six in the shaft and sixteen in the intertrochanteric and subtrochanteric regions of the femoral neck). Delayed union or non-union occurred in six fractures, and four patients died. He did not state how many of the deaths or complications occurred in patients with femoral fractures. He concluded that: “A minority of fractures complicating Paget’s disease do badly. After prolonged and careful supervision, either the patient dies or discouragement gains the upper hand.”

There is disagreement among the authors of textbooks on fractures about this problem. Key, Conwell, and Reynolds and Watson-Jones stated that healing after such fractures is slow and often fails; DePalma and Adams remarked that there are no unusual problems associated with the treatment of fractures of the femur with Paget’s disease or the rate of healing.

This report concerns fractures of the femur in patients with Paget’s disease. The records, roentgenograms, and follow-up studies on twenty-three patients admitted for treatment of these fractures were reviewed, Nine of the patients were examined shortly before this paper was written.