Pathologic fractures of the hand in Paget's disease

The radiologic features of Paget's disease of the bones of the hand are similar to involvement in other bones. Widening of the diameter of the bone and loss of cortical medullary distinction with a mottled coarsening of the trabecular pattern are the most characteristic features. In 2 cases reported here, there was a mixture of lysis and sclerosis with a preponderance of lysis. In the lytic phase the bone structure may be weakened and predisposed to pathologic fracture. Prior to the trauma that precipitated the fracture, both cases were asymptomatic. However, the occurrence of fractures in the involve bones led to the consideration of more ominous possibilities in a differential diagnosis. Recognition of the occurrence of Paget's disease in the bones of the hand or without superimposed pathologic fracture may prevent unnecessary surgical intervention.