Series Editor: Herbert L. Fred, MD

Prepared by Samir H. Navik, Medical Student, and Waleed Ibrahim-Ali, MD, Attending Physician, Department of Medicine, OSF St. Francis Medical Center, Peoria, Ill

A 70-year-old woman complained of right-arm pain that started acutely after she had reached for a sofa cushion. Physical examination revealed tenderness and swelling of the right upper arm. Breast examination revealed a large, fungating mass on the underside of her right breast (Figure 1). The lesion was draining yellow-green and bloody material. Radiograph of the right arm showed a minimally displaced pathological fracture of the midhumerus (Figure 2). Bone scan revealed abnormal radiotracer activity in the cranial vault, spine, ribs, humeri, and femurs. These findings were diagnostic of a pathological fracture caused by metastatic breast cancer.

Points to remember: Always suspect a pathological fracture when a patient presents with a fracture associated with minimal or no trauma. The most common causes of pathological fracture in the elderly include osteoporosis, Paget’s disease of the bone, multiple myeloma, and metastatic carcinoma. Breast carcinoma is responsible for the majority of bone metastases that require orthopedic management.

Diagnosis: Pathological fracture caused by metastatic breast carcinoma.