A cause of pathological fracture
A 62 year old woman presented to the emergency department after having a fall at home. She had left hip pain but was not clinically dehydrated or disorientated. On further examination, her left leg was shortened and externally rotated, indicative of a fracture. Her history included type 2 diabetes, depression, hypercholesterolaemia, hypertension, and recurrent chest infections over the previous six months. Routine blood tests on admission were normal apart from an alkaline phosphatase of 245 IU/l and a corrected calcium of 2.60 mmol/l. Radiographs were taken on admission (figs 1 and 2), and further investigations were performed (figs 3 and 4).
(1) What does the radiograph taken on admission show (fig 1), and what are the differential diagnoses?
(2) What investigations would you do next to investigate a lesion suggesting a pathological fracture?
(3) What would you look for on a full length femur radiograph in a case of pathological