Subtrochanteric Fracture as First Sign of Metastatic Breast Cancer: Case Presentation

Abstract

Atraumatic subtrochanteric fractures represent a serious injury of the lower limb as they represent the clinical expression of a preexisting pathology. Atypical subtrochanteric femur fractures can result from long-term bisphosphonate therapy but a primary or metastatic tumor of the proximal femur should always be included in the differential diagnosis. We present the case of a young female patient without any previous pathological conditions that presented to the emergency room with a subtrochanteric fracture. She was admitted to our clinic and treated with a long cephalomedullary device (CMD). Tissue from the fracture zone was harvested and sent for a pathology analysis. While pathologic bone fractures are not a new entity by any mean in orthopedic practice, they seldom are the first sign of a metastatic disease. This presents a therapeutic challenge especially in young patients because of the reserved overall prognosis in the medium and long term. Better screening methods should be employed in a bid to eliminate this category of patients. We consider this case of a young woman with undetected breast cancer and one skeletal-related event (SRE) in the form of a pathological bone subtrochanteric fracture as an interesting development of the underlying pathology since as the literature shows these cases are quite rare and she did not present any of the usual symptoms associated with a bone metastasis.




J Med Cases. 2015;6(8):367-372
doi: http://dx.doi.org/10.14740/jmc2216w