Management of a Displaced Pathological Fracture in the Proximal Humerus of a Patient with Autism Spectrum Disorder: A Rare Case Report

Introduction: Pathological fractures in pediatric age group are most commonly secondary to bone tumors. Management of such cases in patients with autism spectrum disorder (ASD) is complicated by the prevalence of low bone mineral density (BMD) in these patients.

Case report: Through this case, we report a 13-year-old male diagnosed with autism spectrum disease, who was brought by his parents with a history of trivial trauma and gross deformity of the left humerus. On plain radiography, a displaced fracture in the foreground of a lytic, cystic lesion was noted which on magnetic resonance imaging was confirmed to be metadiaphyseal unicameral bone cyst. The patient underwent extensive curettage, allograft impaction, and definitive fixation by a locking compression plate. Following a relatively extended period of immobilization, he was started on range of motion exercises followed by strengthening. He was able to return to his pre-operative activity levels at 14 weeks postoperatively. At 1-year postoperatively, the patient achieved excellent clinical and radiological outcomes, without any signs of failure, complications, or signs of recurrence.

Conclusion: Management of pathological fractures in pediatric patients with ASD can be challenging due to the associated low BMD and potential non-compliance from the patient's end. Such cases are best treated with open curettage, allograft impaction, and definitive fixation by locking compression plate, even if present in a non-weight bearing bone.