Spontaneous fractures in tuberculous meningitis.
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During childhood, pathologic fractures are found in systemic diseases of the skeleton (e.g. osteogenesis imperfecta or rachitis), but especially when bone tumors or tumorlike changes are present. Conservative measures such as continuous traction and application of a plaster cast lead to healing of the fracture only in a limited number of cases. Treatment of benign and potentially malignant and tumors and of tumorlike growths by excochleation and by resection and subsequent filling of the defect with autologous spongiosa and in some cases metallic fixation respectively has proved useful. The surgical treatment of malignant tumors depends on the king of tumor and its localization.
We report a case of a fracture of the inferior angle of the scapula related to prolonged cough, without triggering trauma, sport, or occupational activity. Bone insufficiency was present in this patient. Stress fractures of the scapula are rare; the fatigue type is the most frequent, associated with sports or occupational activity. We do not find any published case report about scapula stress fracture related to cough, until rib fractures are frequent in this situation. Repetitive muscular activity of the serratus anterior and major rhomboid on the inferior angle of the scapula during cough may explain this avulsion fracture.
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Chronic recurrent multifocal osteomyelitis is rarely associated with pustular psoriasis in children. We describe a child with severe pustular psoriasis in whom multiple fractures, bone deformities, and severe growth failure from chronic recurrent multifocal osteomyelitis developed. The recurrent fractures led to an incorrect assumption of child abuse. Both the bone disease and pustular psoriasis responded to treatment with etretinate.
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A 70-year-old woman was admitted from a local nursing home with extensive bruising and bilateral hip discomfort. The referring doctor had reported the possibility of elder abuse to the police. Full examination showed that osteomalacia, precipitated by a poor diet and lack of exposure to sunlight, was sufficient to explain the patient's condition. Caution is recommended in diagnosing elder abuse until other possibilities have been excluded.
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