Atypical Presentation of Multiple Myeloma Affecting Appendicular Skeleton Associated with Pathological Neck of Femur and Proximal Humerus Fractures - A Case Report.

Introduction: The increasing incidence of atraumatic neck of femur (NOF) fractures, often linked to age-related bone weakening, is a notable clinical trend. This case report highlights a 72-year-old male presenting with NOF and proximal humerus fractures post-trivial fall, revealing lytic lesions suggestive of multiple myeloma (MM). Despite inconclusive skeletal and metabolic evaluations, a comprehensive surgical approach confirmed MM, emphasizing the importance of thorough diagnostic and therapeutic management in complex cases. Case Report: A 72-year-old male presented with a trivial fall resulting in hip and shoulder trauma, revealing right transcervical NOF and proximal humerus fractures on X-rays, alongside multiple lytic lesions suggesting MM. Despite inconclusive metabolic evaluations, conservative management was pursued for the humerus fracture, while a complex surgical approach involving curettage and cemented bipolar hemiarthroplasty was undertaken for the femur fracture, confirming MM on histopathology. Conclusion: Evaluating atypical MM manifestations in the appendicular skeleton requires comprehensive assessment and diagnostic procedures to influence outcomes and improve quality of life. Managing suspected pathological fractures involves detailed evaluation and surgical planning, highlighting the importance of collaboration among different specialties.

A Novel Approach to Grade 2 Closed Olecranon Fractures (Oestern and Tscherne Classification) Through Percutaneous Tension Band Wiring: A Case Report.

Introduction: Olecranon fractures with compromised overlying skin such as superficial and deep abrasions and puncture wounds pose a challenge to manage as they are at a higher risk of wound and hardware-associated complications such as wound dehiscence, infection, gaping, and prominent hardware. Management of such fractures requires a holistic approach with special attention to the skin and soft tissues. Case Report: This case highlights a 28-year-old male with a history of falls from a bike resulting in the right comminuted displaced olecranon fracture with multiple superficial abrasions which was managed with a thorough wound wash, antibiotics for 3 days after which percutaneous tension band wiring was performed through a 3 cm incision to prevent any wound complications. Rehabilitation and physical therapy were started immediately and the patient restored the complete range of motion at the elbow thus resuming his activities of daily living. Conclusion: Utilizing a percutaneous technique for fixation in closed olecranon fractures with compromised overlying skin is considered an innovative, secure, dependable, and effective approach.