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Threatening Fracture of Intraosseous Lipoma Treated by Internal Fixation

Case Report and Review of the Literature

Igor Frangež Department of Traumatology, Surgical Clinic, Clinical Center Ljubljana, Ljubljana, Slovenia.

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Tea Nizi?-Kos Department of Traumatology, Surgical Clinic, Clinical Center Ljubljana, Ljubljana, Slovenia.

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Matej Cimerman Department of Traumatology, Surgical Clinic, Clinical Center Ljubljana, Ljubljana, Slovenia.

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Intraosseous lipomas are rare benign bone neoplasms with an incidence of less than 0.1%; origin in the calcaneus has been reported in only a few patients. First-line treatment remains conservative, but several surgical techniques have also been described. We describe a 44-year-old woman with increasing pain in her left heel for a year and a half, who noticed swelling on the lateral side of the calcaneus. The patient underwent radiography, magnetic resonance imaging, and computed tomography of her left foot, which was suspicious for an intraosseous lipoma with a threatening calcaneal fracture. We performed a surgical procedure, curettage of the tumor, spongioplastics (by autologous bone transplant and ?-tricalcium phosphate), and internal stabilization with a calcaneal plate considering the goal of immediate postoperative weightbearing. Histologic examination confirmed an intraosseous lipoma of the calcaneus. The patient's pain was relieved immediately after surgery. Internal stabilization of the calcaneus allowed the patient to immediately fully weightbear and to return to usual daily activities. Although a benign bone tumor, intraosseous lipoma can cause many complications, such as persistent pain, decreased function, or even pathologic fracture as a result of calcaneal bone weakening. Choosing an appropriate treatment is still controversial. Conservative treatment is the first option, but for patients with severe problems and threatening fracture, surgery is necessary. Internal fixation for stabilization enables immediate postoperative weightbearing and shortens recovery time.

Corresponding author: Igor Frangež, MD, DMD, PhD, Department of Traumatology, Surgical Clinic, Clinical Center Ljubljana, Zaloška 2, Ljubljana, 1000 Slovenia 003861. (E-mail: ifrangez@gmail.com)