PMC9587748_01
preoperative X-ray of pelvis showing displaced intertrochanteric fracture right femur
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F1
During her stay in that hospital, she had a fall and sustained displaced intertrochanteric fracture of right proximal femur (Figure 1).
preoperative X-ray of left shoulder showing pathological comminuted fracture of proximal humerus (involving neck, greater and lesser tuberosities) with extensive lytic areas and cortical destruction of the metadiaphyseal region of the humerus (white arrow), and another intramedullary lytic area at the proximal diaphysis (blue arrow)
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F2
Diagnostic approach: a radiograph of the left shoulder and humerus (Figure 2) showed pathological comminuted fracture of proximal humerus (involving neck, greater and lesser tuberosities) with extensive lytic areas and cortical destruction of the metadiaphyseal region of the humerus.
CT 3-D imaging of left shoulder showing pathological fracture of proximal left humerus with areas of lysis and cortical destruction
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F3
Computed tomography (CT) scan of the left shoulder (Figure 3) confirmed the above findings of pathological fracture of proximal left humerus with areas of lysis and cortical destruction.
intraoperative specimen showing multiple bony fragments obtained from left proximal humerus pathological fracture site
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F4
The bone and tissue (Figure 4) were sent for culture and sensitivity as well as histopathological examination.
H & E stained section 40 x magnification showing extensive coagulative necrosis of marrow within intertrabecular spaces
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F5
Histopathological examination revealed extensive marrow necrosis without any signs of malignancy or infection (Figure 5).
postoperative X-ray of pelvis at 6 months follow-up showing proximal femoral nail (PFN A2) on right side
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F6
She had regular follow-up with X-rays (Figure 6, Figure 7) and blood investigations.
postoperative X-ray of left shoulder at 6 months follow-up showing hemi replacement implant in situ; there are no new lesions or any signs of implant loosening
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F7
She had regular follow-up with X-rays (Figure 6, Figure 7) and blood investigations.