Surgical management of intraosseous lipoma of the calcaneus with pathological fracture and subsequent treatment of complications: A case report and literature review

Abstract

Intraosseous lipoma is a very rare finding, which can occur in the calcaneus with unknown etiology. Up to 33% of these lesions are asymptomatic, with between 25–40% of lesions found incidentally. Patients often present with pain, tenderness and swelling, and in severe cases pathological fracture at initial presentation. The aim is to review a multi-faceted case involving evaluation and surgical management of a pathologic fracture of a large intraosseous lipoma of the calcaneus, and subsequent management of complications over a course of 9 months. An overview of the literature detailing intraosseous lipoma is also presented. 49-year-old male presents after a fall from four feet, immediate onset of pain to the right rearfoot, unable to ambulate. Physical exam revealed ecchymosis to medial instep, edema. Radiographs and CT initially obtained, and MRI later revealed intraosseous lipoma involving 80% of the body of the calcaneus with pathological intraarticular fracture. The patient underwent excision via curettage, void fill with bone cement, and plate and screw fixation. Patient later developed osteomyelitis of the calcaneus, requiring removal of hardware and bone cement, and later replacement with an antibiotic spacer. Patient has since required no further surgical intervention. This case presentation seeks to further the literature in understanding of intraosseous lipoma, in addition to the complicating pathologic fracture to the calcaneus.