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Open Access Case report

Hypertrophic non-union of a pathological forearm fracture secondary to multiple myeloma: a case report

Tosan Okoro12* and Robert U Ashford3

Author Affiliations

1 School of Medical Sciences, Bangor University, Bangor LL57 2AS, UK

2 Department of Orthopaedics, Ysbyty Gwynedd, Bangor LL57 2PW, UK

3 University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK

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Journal of Orthopaedic Surgery and Research 2010, 5:26  doi:10.1186/1749-799X-5-26

Published: 21 April 2010

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 re-presented 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.