PMC9021574_01
(a) Radiograph showing a subtrochanteric fracture of the left femur with a well-defined geographic lucent lesion that indicated a pathological lesion at the fracture site. (b) Computed tomography scan showing a centrally located well-demarcated metaphyseal lesion with cystic lytic expansion. A bony fragment is observed, suggesting a fallen fragment sign. (c-f) Magnetic resonance images showing low-intensity lesions on T1-weighted (c and e) and T2-weighted (d and f) images (c and e: axial views and d and f: coronal views). Heterogeneity of the lesion is noted with patchy signal changes within the bone marrow lesion.
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The fracture occurred through a well-defined geographic subtrochanteric lucent lesion, which indicated a pathological lesion (Figure 1(a)). Computed tomography (CT) showed a centrally located well-demarcated metaphyseal lesion with cystic lytic expansion (Figure 1(b)). T1- and T2-weighted images. There was heterogeneity of the lesion with patchy signal changes within the bone marrow lesion (Figure 1(c)-(f)).
(a and b) Fluoroscopic images (a: anterior posterior view and b: lateral view) confirming the position where the plate could be installed for as many long screws as possible could be inserted without damaging epiphysis. (c and d) Fluoroscopic images (c: anterior posterior view and d: lateral view) showing the plate and screw installation positions. Three screws are inserted to stabilize the proximal bone fragment, while penetrating the pathological lesion without damaging the epiphysis. (e and f) Radiographs (e: anterior posterior view and f: lateral view) at 12 months after surgery showing that the fracture site is fused, and bone formation is observed within the pathological lesion. No obvious growth failure was noted at this time.
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The plate position was selected to ensure that as many long screws as possible could be inserted without damaging the proximal femoral physis (Figure 2(a) and (b)). The most distal screw was inserted bi-cortically into the distal bone fragment (Figure 2(c) and (d)). Twelve months postoperatively, the fracture was healed and the pathological site was consolidated, and no obvious growth failure was observed (Figure 2(e) and (f)).