Pathologic fracture of the distal radius in a 25-year-old patient with a large unicameral bone cyst

Background: Distal radius fractures (DRF) are often referred to as
osteoporosis indicator fractures as their incidence increases from
age 45. In the group of young adults, distal radius fractures
normally result from high-energy trauma. Wrist fractures in young
patients without adequate trauma thus raise suspicion of a
pathologic fracture. In this report we present the case of a
fractured unicameral bone cyst (UBC) at the distal radius in a
young adult. To the author's best knowledge, this is the first
detailed report in an UBC at the distal radius causing a pathologic
DRF in an adult patient. Case presentation: A 25-year-old otherwise
healthy male presented to our Emergency Department after a simple
fall on his right outstretched hand. Extended diagnostics revealed
a pathologic, dorsally displaced, intra-articular distal radius
fracture secondary to a unicameral bone cyst occupying almost the
whole metaphysis of the distal radius. To stabilize the fracture, a
combined dorsal and volar approach was used for open reduction and
internal fixation. A tissue specimen for histopathological
examination was gathered and the lesion was filled with an
autologous bone graft harvested from the ipsilateral femur using a
reamer-irrigator-aspirator (RIA) system. Following one revision
surgery due to an intra-articular step-off, the patient recovered
without further complications. Conclusions: Pathologic fractures in
young patients caused by unicameral bone cysts require extended
diagnostics and adequate treatment. A single step surgical
treatment is reasonable if fracture and bone cyst are treated
appropriately. Arthroscopically assisted fracture repair may be
considered in intra-articular fractures or whenever co-pathologies
of the carpus are suspected.