Paget Disease of Bone Presenting as Fracture of the Neck of Femur: Case Report and a Brief Review of the Literature

Abstract

We present a case of a 77-year-old man who was admitted for the treatment of a right femoral neck fracture resulting from a minor fall at home. The patient reported pain intensity fluctuating from mild to extremely severe. Laboratory tests showed elevated alkaline phosphatase levels (ALP) with normal calcium and phosphate homeostasis. The patient reported no significant past medical history, but notably, his family history included his grandmother and cousin affected by skull involvement of Paget's disease of bone (PDB). Physical examination revealed a right genu varum deformity and a fixed adduction contracture of the right knee, with chronic knee pain. Besides the femoral head fracture, radiological findings on posteroanterior bilateral knee X-rays demonstrated marked genu varum and diffuse enlargement of the femur and tibia, with proximal and distal ends sparing. PDB disease was first diagnosed from the pathological findings of the fractured femur. After surgical fixation of the fracture with total hip arthroplasty (THA), the patient was managed conservatively and showed stability with no complications over a 28-month follow-up period. This case highlights the clinical and radiological features of Paget's disease-related bone deformities and reviews the relevant literature on clinical presentation, diagnosis, management, and outcomes.