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DOUBLE JEOPARDY : PATHOLOGICAL FRACTURE AND NONUNION OF PROXIMAL HUMERUS DUE TO CHONDROCALCINOSIS
Fractures of the humerus constitute 5% to 8% of fractures and most have an uneventful healing, but occasionally non-unions of the fracture with joint stiffness of shoulder and/or elbow and prolonged debilitating pain may be encountered. Predisposing conditions usually are osteoporosis, obesity, alcoholism and smoking. Comminuted or segmental fractures, soft tissue interposition at the fracture site, improper fixation and infection may also result in non-union.
A fracture of neck of the right humerus (dominant limb) in a young lady failed to unite following internal fixation and lead to atrophic non-union with implant loosening, which initially was suspected to be due to poor fixation and or infection, but histopathological evaluation on two separate occasions of the fracture site revealed a picture of Chondrocalcinosis (CC). CC is a condition wherein deposition of calcium pyrophosphate dihydrate (CPPD) crystals occurs within articular cartilage and synovial tissue and is associated with joint pain leading to arthritis. The presence of these CPPD crystal has not been mentioned in the bone or at fracture sites in the literature, The histopathological evidence of CPPD at the fracture site in this case of humerus non-union did not establish whether the fracture was due to the pathology or the CPPD got deposited at the fracture site and was a cause of non-union.
Article published online:
22 April 2020
Thieme Medical and Scientific Publishers Private Ltd.
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