Management of a Fracture in a Known Case of Gorham's Vanishing Bone Disease

Description: We present the case of a right handed construction worker who has sustained two fractures in his left forearm. In 1990 he sustained a wrist fracture which failed to heal. The bone of the distal radius, ulna and carpus was re-absorbed. In 1995 he had radiotherapy and a free vascularized fibular graft from proximal ulna to 2nd metacarpal resulting in fusion of his left wrist and forearm but resolution of the injury. The history and a bone biopsy showing intense neovascularity together made the diagnosis of Gorham's Disease. He injured himself again in 1998 sustaining a fracture of the left olecranon process. A bone biopsy at the time of internal fixation confirmed that the bone was affected by his condition. Aggressive adjunctive therapy was initiated immediately following the surgery and included electrical stimulation, osteoclast inhibitory therapy and radiotherapy. At three months post injury the patient had painless function of his elbow and returned to work against advice. ! The Xray showed evidence of healing. This case will be discussed and the literature reviewed with emphasis on the pathological process. Since this involves haemangiomatous replacement of normal bone we suggest that the new anti- neovascularization drugs be tried in this condition.