Tuyển tập các báo cáo nghiên cứu về hóa học được đăng trên tạp chí sinh học quốc tế đề tài : Hypertrophic non-union of a pathological forearm fracture secondary to multiple myeloma: a case report | Okoro and Ashford Journal of Orthopaedic Surgery and Research 2010 5 26 http content 5 1 26 éHMÌ JOURNAL OF ORTHOPAEDIC MBs SURGERY AND RESEARCH CASE REPORT Open Access Hypertrophic non-union of a pathological forearm fracture secondary to multiple myeloma a case report Tosan Okoro 1 2 and Robert U Ashford3 Abstract Skeletal lesions in multiple myeloma are predominantly lytic and when non-union of pathological fractures occur it is typically atrophic. We report a lady of 61 years of age with myeloma who presented with a pathological fracture through an ulnar myeloma deposit. The fracture was immobilised initially then irradiated. Nine months later she represented with marked forearm pain particularly on rotation. Radiographs demonstrated a hypertrophic non-union of a pathological fracture with a typical elephant s hoof appearance. The fracture was immobilised using an ulnar nail. Whilst non-unions in metastatic malignancy are typically atrophic just occasionally hypertrophic non-unions can occur. Management principles remain the same with stabilisation of the entire bone and early mobilisation being appropriate. Background Multiple myeloma MM is an incurable disease that is characterised by the accumulation of clonal plasmocytes in the bone marrow 1 . It accounts for 10-15 of all haematological malignancies and 1-2 of all cancers 1 . MM occurs in Europe in approximately 4 out of every 100 000 individuals 2 Approximately 10-40 of patients are asymptomatic at diagnosis 1 whilst 50-70 of MM patients have bone pain due to lytic lesions and pathological vertebral fractures 1 . The characteristic bone lesion seen in myeloma is a sharply defined small lytic area with no reactive bone formation arising in the medulla the absence of bone sclerosis is due to an inhibition of osteoblastic activity 3 . Involvement of the cortex causes characteristic endosteal scalloping with invasion of the periosteum and occasionally extraosseous extension 4 Radiotherapy .
