股骨髁内生软骨瘤及股骨颈转移瘤误诊原因剖析及早期鉴别诊断要点OA

Objective To analyze the causes of misdiagnosis of femoral condyle enchondroma and femoral neck metastatic tumor as non-pathological fracture,and to investigate the early differential diagnostic approach.Methods The clinical data of 2 patients diagnosed with comminuted fracture of the right femoral condyle and left femoral neck fracture respectively from June to September 2025 were retrospectively analyzed.The clinical characteristics,imaging manifestations,and treatment processes were reviewed.Results One patient presented to Department of Emergency with right knee pain caused by a fall.The patient was diagnosed with right femoral condyle fracture based on X-ray and a CT scan from another hospital,and was recommended for fracture surgery.The patient was admitted to the Trauma Department,where tibial tubercle traction was applied to prepare for surgical treatment.After admission,CT scan suggested the possibility of pathological fracture,and the reexamination showed elevated D-dimer and multiple venous thrombosis in the right lower extremity.Puncture biopsy showed no definite malignant components.Combined with imaging findings,the lesion was diagnosed as a pathological fracture of the right femoral condyle(possibly of cartilaginous origin).Postoperative pathology showed cartilaginous tumor(atypical cartilaginous tumor)with secondary changes of fracture,and the diagnosis was revised to enchondroma of right femoral condyle with pathological fracture.The misdiagnosis lasted 4 d.After the diagnosis was confirmed,the patient was treated with curette of bone tumor in the right distal femur,open reduction of comminuted pathological fracture of the femoral condyle,ipsilateral iliac bone,and artificial bone grafting and internal fixation under nerve block and spinal anesthesia.The postoperative healing was primary,non-weight-bearing knee flexion and extension function exercises,and venous thrombosis prevention treatment were provided.One patient presented with left hip pain caused by sprain,was diagnosed with left femoral neck fracture according to X-ray examination,and was treated with skin traction and immobilization.After further inquiry into the medical history,a pathological fracture was suspected.ECT showed abnormal bone metabolism of the left femoral neck before admission,CT showed smooth fracture end with osteolytic destruction and increased tumor markers,and MRI showed fracture with bone marrow edema.After consultation,the patient was diagnosed with metastatic carcinoma of the left femoral neck with pathological fracture.The misdiagnosis lasted 2 d.After confirmation of the diagnosis,left artificial femoral head replacement was performed,and the tumor at the femoral neck was completely removed during the operation.Postoperative pathology and immunohistochemistry confirmed metastatic carcinoma of bone,and the postoperative prognosis was good.Conclusion For middle-aged and elderly fracture patients,irregular fracture lines,blunt osteolytic changes at the fracture ends,and a history of venous thrombosis or tumor should be considered imaging plus clinical red flags suggestive of a pathological fracture.For suspicious patients,tumor marker screening and needle biopsy should be immediately performed to avoid internal fixation surgery for simple fractures,to reduce misdiagnosis and mistreatment.