PMC5106554_01
85-year-old woman on bisphosphonate therapy. Radiographic evaluation of the femur demonstrated mild, diffuse cortical thickening and a focal, domed, conical, projection along the lateral cortex (arrow).
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Radiographic evaluation of the femur demonstrated a focal pyramidal-shaped projection of bone on the lateral cortex (Fig. 1).
85-year-old woman on bisphosphonate therapy. Tc99m MDP bone scan shows a focus of moderately intense uptake at the subtrochanteric region of the right femur (arrows) and a degenerative pattern of activity in the spine, shoulders, knees, and wrists, without evidence of metastatic disease.
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The bone scan performed following injection Tc99m methylene disphosphonate (MDP) (Fig. 2) revealed a moderately-intense focus of increased uptake at the subtrochanteric region of the right femur and a degenerative pattern of activity in the spine, shoulders, knees, and wrists without evidence of other lesions concerning for metastatic disease.
85-year-old woman on bisphosphonate therapy. 3D surface rendered CT reformation demonstrates the cortical ridge at the antero-lateral aspect of the femur at the junction of the proximal and middle thirds (arrow).
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CT demonstrated a focal beak of cortical thickening on the lateral cortex (Fig. 3), and 3-dimensional reformations showed the lesion to be a domed roughly-pyramidal ridge, similar to a volcano such as Mt.
The volcanic mountain peak, Mt. Rainier, as viewed from Puget Sound offshore Seattle, Washington. (Courtesy Mahesh Thapa, M.D., starvingphotographer.com.)
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Rainier (Fig 4).
85-year-old woman on bisphosphonate therapy. Post-fracture radiograph depicts a severely-angulated, simple, transverse, subtrochanteric femoral shaft fracture at the junction of the proximal and middle thirds that extends through the middle of the triangular cortical ridge seen on the earlier studies. Old, healed fractures of the superior and inferior rami of the left obturator ring are also evident (arrows).
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Radiographs of the fracture showed a severely-angulated, simple, transverse, subtrochanteric femoral shaft fracture at the junction of the proximal and middle thirds (Fig 5).
85-year-old woman on bisphosphonate therapy. Proximal femoral shaft fracture following closed reduction of the marked angular deformity, the simple transverse fracture extends through the beak-shaped region of the insufficiency fracture (arrow). Mild diffuse cortical thickening is also present.
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Following closed reduction, the fracture is seen to extend through the middle of the cortical ridge seen on the earlier radiograph (Fig. 6).
85-year-old woman on bisphosphonate therapy. Subtrochanteric femur fracture 10 weeks post operative fixation with an 11mm x 40cm reconstruction rod with 75 and 85mm screws proximally and a 65 mm locking screw distally (not included in this image). Exuberant callus is present at the fracture site (arrows).
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Follow up radiographs of the fracture site obtained ten (Fig. 7) and nineteen weeks (Fig. 8) after surgery demonstrated abundant fracture callus and were deemed consistent with appropriate interval fracture healing.