Pathological Femoral Shaft Fracture from Follicular Thyroid Carcinoma Managed with Cemented Spacer and Nailing: A Rare Case with 2-Year Follow-Up
Case Report | Journal of Clinical Orthopaedics | Vol 10 | Issue 2 | July-December 2025 | page: 125-128 | Suyog Wagh, Pradeep Nair, Shaligram Purohit, Arvind Goregaonkar, Aibin B Michael, Tushar Ramteke
DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.800
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).
Submitted Date: 17 Aug 2025, Review Date: 12 Sep 2025, Accepted Date: 28 Nov 2025 & Published Date: 10 Dec 2025
Author: Suyog Wagh [1], Pradeep Nair [1], Shaligram Purohit [1], Arvind Goregaonkar [1], Aibin B Michael [1], Tushar Ramteke [1]
[1] Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
Address of Correspondence
Dr. Suyog Wagh,
Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India.
E-mail: suyogwagh6159@gmail.com
Abstract
Differentiated thyroid carcinoma (DTC) accounts for a small proportion of all malignancies but is among the cancers most frequently associated with bone metastasis, especially in the axial skeleton. Metastatic involvement of the appendicular skeleton is rare, and pathological fractures of the femoral shaft are even more uncommon. Follicular thyroid carcinoma (FTC), due to its angioinvasive nature, shows a markedly higher propensity for hematogenous spread to bone than papillary thyroid carcinoma. These lesions significantly impair mobility and quality of life, often necessitating surgical intervention when life expectancy is reasonable. We describe a rare case of a 45-year-old male with metastatic FTC who presented with a pathological fracture of the femoral shaft. After multidisciplinary evaluation, the patient underwent wide segmental resection of the diseased femur, followed by intramedullary interlocking nailing with polymethylmethacrylate (PMMA) cement augmentation. This strategy provided immediate structural stability, allowed early weight-bearing, and offered potential cytoreductive benefit from PMMA-induced thermal effects. Postoperative recovery was uneventful, with significant pain relief and restoration of full function within 6 weeks. At 2-year follow-up, the patient remained ambulatory without limitations, with stable local control and ongoing oncological management. This case highlights that aggressive surgical management with stable reconstruction can yield excellent functional outcomes in selected patients with metastatic FTC, particularly when presenting with pathological fractures of weight-bearing bones. Durable fixation, early mobilization, and individualized multidisciplinary planning are crucial in optimizing quality of life in advanced thyroid carcinoma with skeletal metastases.
Keywords: Follicular Thyroid Carcinoma, Bone Metastasis, Pathological Fracture, Intramedullary Nailing, Cement Augmentation
References
1. Nervo A, Ragni A, Retta F, Gallo M, Piovesan A, Liberini V, et al. Bone metastases from differentiated thyroid carcinoma: Current knowledge and open issues. J Endocrinol Invest 2021;44:403-19.
2. Pal P, Singh B, Kane S, Chaturvedi P. Bone metastases in follicular carcinoma of thyroid. Indian J Otolaryngol Head Neck Surg 2018;70:10-4.
3. Satcher RL, Lin P, Harun N, Feng L, Moon BS, Lewis VO. Surgical management of appendicular skeletal metastases in thyroid carcinoma. Int J Surg Oncol 2012;2012:417086.
4. Bernier MO, Leenhardt L, Hoang C, Aurengo A, Mary JY, Menegaux F, et al. Survival and therapeutic modalities in patients with bone metastases of differentiated thyroid carcinomas. J Clin Endocrinol Metab 2001;86:1568-73.
5. Stojadinovic A, Shoup M, Ghossein RA, Nissan A, Brennan MF, Shah JP, et al. The role of operations for distantly metastatic well-differentiated thyroid carcinoma. Surgery 2002;131:636-43.
| How to Cite this Article: Wagh S, Nair P, Purohit S, Goregaonkar A, Michael AB, Ramteke T. Pathological Femoral Shaft Fracture from Follicular Thyroid Carcinoma Managed with Cemented Spacer and Nailing: A Rare Case with 2-Year Follow-UpJournal of Clinical Orthopaedics. July-December 2025;10(2):125-128. |
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