This patient was shoveling, had sudden onset of forarm pain…
This is a pathologic fracture from a forearm malignancy. The patient’s primary malignancy was rectal adenocarcinoma. This is a rare place for a metastasis.
The mechanism for this patient did not support a broken bone. However one should keep in mind pathologic fractures when deciding whether to obtain plain films. Plain films in the ED are quick, inexpensive, and don’t come with significant radiation risks. I usually argue these points with my residents when discussion about plain film utilization in musculoskeletal pain.
Author: Russell Jones, MD