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A pathological fracture in a 10 year old boy

Case Identification
Case ID Number: 
20120907RR
Periosteal Reaction: 
absent
Benign/Malignant: 
Benign
Clinical case information
Case presentation: 

This 10 year old boy sustained a pathological fracture in his right arm whilst catching a football in his arms. On further questioning, this occurred on a background of vague intermittent pain in that arm.

Radiological findings:: 
There is a pathological spiral displaced fracture through the mid-shaft of the right humerus. The fracture is through a large, ovoid, well-circumscribed osteolytic lesion in the middle third of the right humerus with scalloping of the inner cortex. On MRI, it is mostly hyperintense on T2 weighted imaging, but complex superiorly where there is mixed isointense and hypointense signal. There is mild surrounding edema, however there is no soft tissue component.
Laboratory results:: 
None needed.
Differential Diagnosis: 
Unicameral bone cyst, fibrous dyplasia, Langerhans cell histocytosis and nonossifying fibroma
Treatment Options:: 
The patient was treated conservatively with a long arm splint and followed up with repeat x-rays.