Pathological femoral neck fracture caused by an echinococcus cyst of the vastus lateralis - case report

Abstract

BackgroundMusculoskeletal hydatid cysts are rare, but being locally invasive, can potentially cause significant deformity or pathological fracture.Case presentationA 39 y.o. male presented to our orthopaedic outpatient clinic complaining of severe right hip pain, and inability to ambulate. Symptoms were not preceded by trauma. Subsequent imaging confirmed a large, 17 × 3 × 5 cm echinococcus cyst in the vastus lateralis, causing erosion of the proximal metaphysis of the femur. As a consequence the patient suffered a non-traumatic pathological intertrochanteric femur fracture. The patient was treated with an en-bloc excision of the lesion - the affected soft tissue envelope containing the large cyst - and as a second surgical step a cemented total hip replacement (THR) was implanted under the same anaesthetic.The manuscript reviews the literature regarding musculoskeletal hydatid disease.

Global Distribution of Alveolar and Cystic Echinococcosis

“…As the patient had travelled several times to Romania in the past, the case is not necessarily autochthonous (Antolova, personal communication). In Hungary, few case reports of echinococcosis or CE have been published (Casulli et al, 2010a;Csotye et al, 2011) and the origin of these patients is not documented. p1050 Echinococcus granulosus has been known in southern Europe since ancient times but it was only in 1801 that Rudolphi established the genus Echinococcus, the name referring to the small, round, 'spiny' protoscoleces found in the cysts .…”

Hydatid Disease Involving the Entire Femur Treated with Wide Resection and Reconstruction with Total Femur Replacement—a Case Report

“…There are no speci c guidelines on how to treat hydatid cyst disease of the bone, but most authors recommend wide surgical resection to achieve local control and reduce the recurrence rate [5][6][7][8][9][10] ; this should be accompanied by anthelmintic therapy such as albendazole for 3-6 months after surgery 11,12 .…”

Bone Hydatid Disease with Long Term Follow-Up: A Case Report

“…The principal factor associated with positive serology is the presence or absence of complications (rupture and infection/abscess) caused by the release of parasite antigens (9). Bony hydatid lesions are associated with a 50% rate of local recurrence (10). The recurrence rate is also significant in extraosseous hydatid disease.…”