A 55-year-old female presented to the emergency department with severe left thigh pain after tripping and hitting her thigh on an open kitchen cabinet. On examination, her left thigh showed proximal-lateral deformity, swelling, and was externally rotated and shortened with intact neurovascular status distally. Notes indicate the patient has metastatic breast cancer with lytic lesions visible at the fracture site, suggesting a pathologic fracture.

2.  55 YOF presenting to the ED
with severe left thigh pain 30
min PTA. Pt tripped and hit the
left lateral thigh on the open
kitchen cabinet. She experienced
immediate severe pain to the left
thigh and felt her left lower
extremity give in under her
weight. Pt laid on the ground
until EMS arrived. She denies
head trauma or LOC/syncope. Pt
states that she is currently being
evaluated for a lump in her right
breast.
 T 97.9 P 109 BP 147/75 RR 16 O2





95% on RA
Gen: Uncomfortable and in
distress 2/2 pain.
Pulm: BS equal and CTA
bilaterally.
CV: S1S2 tachycardia, pulses
equal.
Pelvic: Stable
Ext’s: Left thigh proximal-lateral
deformity and swelling,
externally rotated and
shortened, no ecchymosis or
signs of contusions,
neurovascular distally intact.

4.  Pt has metastatic
breast cancer.
 Note the lytic lesion
on the fracture site.

5.  Pt has metastatic
breast cancer.
 Note the multiple
lytic lesions.

6.  ABC’s of trauma resuscitation
 Type and Screen
 IV fluids/PRB’s transfused as needed.
 Antibiotics and copious irrigation if open fracture.
 Update Tetanus.
 Traction splint/Immobilization
 Emergent Orthopedic consult for admission if
necessary.
 Address the underlying cause of bone disease.

7.  Pathologic Femur Fractures can be subtle and not
necessarily involve trauma.
 Pathologic fractures are often associated with
underlying serious disease such as metastatic cancer,
hereditary or renal disease..
 Investigate for the etiology of the bone weakening and
provide appropriate referral/admission as needed.

8.  Bone Cyst fracture in
a pediatric patient.
 Femur Neck Fracture in Multiple
Myeloma

9.  Femoral Shaft fracture in a 70 yof with
Hyperparathyroidism.
 Lesser Trochanteric Fracture in a patient
with Lymphoma and chronic pain

10.  http://www.imageinterpretation.co.uk/pelvis.html
 http://www.wheelessonline.com/ortho/pathologic_fra
cture
 http://www.tumorlibrary.com/case/detail.jsp?image_i
d=1714
 http://www.journalmc.org/index.php/JMC/article/vie
wArticle/21/23
 Tintinalli's Emergency Medicine:
A Comprehensive Study Guide, 7e . Chapter 270: Hip
and Femur Injuries