A healed echinococcus pathological femoral shaft non-union—A case report and a literature review

Hydatid disease is prevalent throughout much of the world, mainly in the developing world and unprivileged areas. There are twelve subtypes of Echinococcus known today. However, in humans there are two main types of infection—Echinococcus multilocularis causing alveolar and Echinococcus granulosus which causes the cystic echinococcosis. The incidence of bone disease, caused by echinococcus is rare as only 0.5–4.5% of cases of echinococcosis have bony involvement. Primary hydatid disease of bone, is caused by E. granulosus, occurs when a bloodborne scolex settles in bone. In bone involvement, pericyst formation of the echinococcus does not occur, thereby allowing aggressive proliferation in an irregular branching fashion along the line of least resistance, especially the bone canals. When this proliferation causes damage severe enough to create a compromise in the solidity of the bone, a pathological fracture may occur. However, very few reports deal with the treatment of pathological long bone fractures, especially as the sole presentation of the echinococcus usually with a grim outcome. We present a case of a pathological femur fracture non-union caused as an isolated bony infection of echinococcus, treated successfully with serial debridements, antibiotics and fixation with a locked plate construct.