Pathological fracture of the humerus in an adolescent due to intramedullary cavernous hemangioma

Introduction. Among fractures in pediatric patients, humeral fractures rank fourth in prevalence. They are typically associated with direct external trauma. However, non-accidental trauma and pathological lesions should not be overlooked. Aim. This study aims to highlight the statistically rare non-neoplastic lesion known as primary intraosseous hemangiomas or hemangiomas of bone. Materials and methods. To describe the case, we utilized data from our hospital’s system. We analyzed database entries, imaging studies, and histological examinations. Then we reported the available literature. Results. A 14-year-old male amateur athlete presented to our hospital with a preliminary diagnosis of a pathological right humeral fracture after throwing a water ball during training. Imaging studies revealed a spiral fracture of the distal shaft of the right humerus with bone fragments. Additionally, there was thinning of the cortical bone at the site of the fracture, as well as a change in the proximal two-thirds of the humeral shaft with heterogeneous contrast enhancement, suspected to be fibrous dysplasia or aneurysmal bone cyst. The patient underwent surgery with closed reduction and stabilization using TEN rods. Three months later, the patient required reoperation due to irritation from the hardware. Finally, after an oncological consultation, the patient underwent excision of the lesion, with the defect filled using an allograft bone. Histopathological examination confirmed a cavernous hemangioma of the bone. Conclusion. Primary Intraosseous hemangiomas are rare non-neoplastic lesions, accounting for less than 1% of all bone tumors. However, the orthopedic surgeon should be vigilant to enable early and accurate diagnosis, as well as ensure appropriate treatment.