Pathological fractures; a consideration with metachondromatosis and differential diagnoses. Osteochondromatosis and Gauchers disease.

BACKGROUND: Metachondromatosis is a condition that causes gross conical metaphyseal expansion (sometimes irregular), cortical thinning, exostoses. Metachondromatous lesions occur mainly in the extremities and are roughly symmetrical. The lesions can involve the bones of the hand and all long bones in the arms and legs. The distribution in this case additionally involved the acromion process and ischia. The bone changes, although dramatic, can be confused with other types of metaphyseal dysplasia such as Gaucher disease and multiple exostoses. OBJECTIVE: This paper will review the literature with regard to Metachondromatosis, Gaucher disease and Osteochondromatosis due to their similarities. The case study serves as an example of these findings and documents a history of fractures secondary to the obvious bone changes. DISCUSSION: Clinical manifestations of these conditions and how they may present to the manual therapist are discussed. With respect to Metachondromatosis, the manual therapist needs to be mindful of pathological fractures that can occur with little trauma. Manual therapists are cautioned against using long bones as levers for spinal manipulation in these patients.