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Paget's Disease with Tibial Fracture

Piran Aliabadi, MD
B Leonard Holman, MD

November 8, 1995

Presentation

An 81-year-old man presented with persistent left lower leg and ankle pain following minor trauma. On physical examination, there was tenderness in the lower aspect of the left leg.

Imaging Findings

Plain radiographs of ankle and distal tibia
Second radiograph after treatment

Plain radiographs of the left ankle show coarse trabeculation of the distal tibia with areas of lucency in the subcortical region (white arrows) and areas of cortical thickening, indicating Paget's disease. An incomplete lucent line consistent with fracture is noted in the tibial shaft (black arrows).

The extent of Paget's disease is shown on this second radiograph taken after treatment. The fracture line is no longer visible.

Diagnosis

Paget's disease with incomplete fracture of the tibial shaft.

Discussion

The radiologic appearance of Paget's disease of the long bone reflects the pathologic stages of the disease: (1) destructive or active, (2) combined destructive and proliferative, and (3) sclerotic. Paget's disease of the long bones begins at one end of the bone (the shaft of the tibia may occasionally be involved by itself). Complications of Paget's disease are insufficiency and true fractures; sarcoma is a rare complication. Paget's disease does not require follow-up imaging unless complications occur.

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