Pathological Fracture proximal Tibia by metastatic Renal Cell Carcinoma in 83F

HPI

An 83-year-old female with a known history of metastatic renal cell carcinoma presented with acute onset right knee pain following a low-energy incident (while walking indoors). She experienced a sudden inability to bear weight.

PMH

Metastatic renal cell carcinoma (diagnosed 3 years ago) Hypertension Osteopenia

PE

Moderate swelling and ecchymosis over the proximal tibia and knee area. No open wounds. Tenderness to palpation over the tibial plateau and anterior proximal tibia. Distal tibia mildly tender to deep palpation. Severely limited knee movement due to pain (0–15° passively). Cannot perform active straight leg raise; limited secondary to pain. Sensation intact to light touch in peroneal, tibial, and saphenous distributions. Dorsalis pedis and posterior tibial pulses palpable and symmetric. Non-ambulatory; requires assistance for transfers