Case presentation

1. A CASE OF UNICAMERAL BONE
CYST WITH PATHOLOGICAL
INTERTROCHANTERIC
FRACTURE
DR. M.BAXAMUSA
DR.S.BARDHAN

2. PATIENT PARTICULARS
 Name: DH
 Age: 22 years
 Sex: Male
 C/c: Right sided hip pain after fall on
January’08

3. CLINICAL EXAMINATION
 Right leg was externally rotated, minimal shortening.
 All movements of the hip joint was painfully restricted.
 SLR: 0 deg
 No distal neurovascular deficit.
 Right trochanteric region tender.

4. PRE-OPERATIVE X-RAYS
(16.01.08)

5. PRE-OPERATIVE X-RAYS
(16.01.08)

6. PRE-OPERATIVE PLANNING
 Date of admission: 22-01-08
 Open biopsy and curettage of the cystic lesion was done
under SA on 24-01-08.
 H/P report: Unicameral bone cyst.

7. DEFINITIVE SURGERY
 Date: 14-02-08
 Spinal anaesthesia
 Cyst was filled up with cancellous bone graft from Iliac
bone and bone supplement (Porous β-Tricalcium
Phosphate granules).
 Fracture was fixed by Proximal Femoral Nail .

8. POST-OPERATIVE X-RAYS
(14-02-08)

9. POST-OPERATIVE X-RAYS
(25-02-08)

10. POST-OP REHABILITATION
 Static and dynamic quadriceps drill.
 Bed side knee bending exercises.
 Right sided NWB crutch walking.
 Discharged on 29-02-08, followed up in OPD after 6
weeks.
 May’08: PWB crutch walking
 July’08: Single crutch walking
 August’08: Walking without support
 Dec’08: Squatting was allowed.

11. POST-OPERATIVE X-RAYS
(03-01-09)

12. RECENT X-RAYS (27-02-10)

13. CLINICAL EVALUATION
 No limb length discrepancy .
 Normal gait .
 No c/o hip pain.
 No difficulty in squatting or sitting on floor
 ROM: Full and painless

14. CLINICAL PHOTOS

15. DISCUSSION
 A large osteolytic lesion can lead to pathological #
especially in a weight bearing bone.
 Fixation through a cyst with # poses problem of stability.
Therefore modality of fixation has to be chosen carefully.
In this case a PFN has adequately achieved the above
objective.
 The bone cyst was treated conventionally with curettage
and bone grafting with supplementation.

16. DISCUSSION
 This case in particular is being presented as a
comparative case study with the one shown at the last
month’s WBOA Clinical meeting in CNMC.
 In that case, a DHS was used for fracture fixation and a
further subtrochanteric osteotomy was done to achieve
stability.
 We feel that creating an iatrogenic fracture close to the
pathological # leads to further instability, thus increasing
the difficulty in achieving stable fixation.

17. THANK YOU