Functional bracing for delayed union of a femur fracture associated with Paget's disease of the bone in an Asian patient: a case report

Abstract

Paget's disease of the bone is a common metabolic bone disease in most European countries, Australia, New Zealand, and North America. Conversely, this disease is rare in Scandinavia, Asia, and Africa. In Japan, it is extremely rare, with a prevalence of 0.15/100000. Paget's disease is a localized disorder of bone remodeling. Excessive bone resorption and abnormal bone formation result in biomechanically weakened bone and predispose patients to fracture. Delayed union and non-union of fractures have been reported in patients with Paget's disease. Therefore, open reduction and internal fixation of fractures has been recommended to prevent such complications. Here we report an unusual case of a 63-year-old Asian woman with delayed union of a femur fracture secondary to Paget's disease, which was treated successfully by functional bracing.

Figure 1

Transverse fracture at the junction of proximal and middle thirds, and Paget's disease involving the entire femur.

Figure 2

Radionuclide bone scan showing markedly increased uptake affecting the left femur.

Figure 3

Anteroposterior radiographic view 6 month after injury shows no sign of bone healing.

Figure 4

Anteroposterior radiographic view showing fracture healing 6 months after application of the functional brace.

Figure 5

Anteroposterior radiographic view 5 year after injury.