Pathologic fracture of lower extremity
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6/4/2018 at 10:32:45 PM GMT
Posts: 17
Pathologic fracture of lower extremity

Forum submitted by SE regional director Steven A. Kelham, DHSc, PA-C

 

 The patient is a 41-year-old right-hand-dominant Caucasian male with a history of multiple myeloma and subsequent pathologic and insufficiency fractures.  He is 5 foot 10 inches tall and approximately 190 pounds.  He presented to our office for initial evaluation of non traumatic left thigh pain.  He reported an insidious onset of pain that he rated a7 out of 10 over a 6 week period of time.  The pain was localized to the mid thigh radiating through his left knee.  His pain was aggravated with all weight-bearing activities.  Given his past history of multiple myeloma and previous pathologic fractures of his clavicles requiring surgical stabilization, there was a high probability of additional metastatic lesions.  Radiographs were obtained of the left femur revealing a large lytic lesion in the distal third of his left femur. 

#1- How would you treat this patient?

#2- What surgical criteria can be a guideline for surgical stabilization of pathologic fractures?

#3- What lab finding is highly specific and sensitive to the diagnosis of multiple myeloma?



Sam Dyer, PA-C, MHS
President PAOS

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6/20/2018 at 3:48:54 PM GMT
Posts: 4
Answer:
#1- To stabilize or not to stabilize. That is the orthopedic question. Remember Mirels Criteria.

#2- Ultimately, it is the decision of the attending surgeon how to proceed with the management of the patient. However, using an evidenced based approach, Mirel is a good guideline.

#3- A peripheral blood smear with will show "Rouleaux formation" or a stacked coin appearance of aggregated red blood cells. This is a pathognomonic finding for Multiple Myeloma


Last edited Thursday, June 21, 2018