An 80-year-old man was seen at the emergency department following a minor fall and inability to weight bear.
His right leg was shortened and externally rotated. x Ray of the pelvis confirmed fracture neck of femur.
However, the orthopaedic surgeon was concerned about the x ray appearance of the pelvis.
Further enquiry revealed that he was becoming increasingly frail and prone to develop respiratory tract
infections. He also complains of pain in the lower back worse at night.
Apart from cachexia and pallor his physical examination was normal.
What is the likely diagnosis?
Chronic osteomyelitis
Metastatic carcinoma
Multiple myeloma (Correct)
Osteoporosis
Paget’s disease
Metastatic carcinoma is a possibility, but the patient would be expected to have symptoms of the primary
malignancy, for example, prostate, lungs.
Osteoporosis and Paget’s disease both can present with pathological fractures, but generalised cachexia and
recurrent chest infections are against them.
Chronic osteomyelitis is more likely to present with pain in the joint, pyrexia or loss of the joint.