Management of fissure fractures in Paget's disease

Forty-five patients with Paget's disease were studied, of whom 25 had fissure fractures affecting the bones of the lower limb. Ten patients treated with salmon calcitonin showed no improvement in their fissure fractures despite reduction in bone turnover. Treatment was effective where bone deformity was improved by traction or intra-medullary nail fixation combined with osteotomy. Surgical treatment should be undertaken in those patients who complain of acute pain at the site of a fissure fracture and who risk completing the fracture. Fissure fractures involving the femoral neck should be fixed even when asymptomatic because of the risk of non-union if they become complete.