In Paget's disease of bone, the most feared orthopaedic complication and the most common orthopaedic presentation respectively are:
- A Most feared: osteosarcoma; Most common: bowing deformity causing abnormal gait (particularly tibial bowing with 'sabre tibia') ✓
- B Most feared: osteosarcomatous transformation; Most common: pathological fracture through pagetic bone
- C Most feared: high-output cardiac failure; Most common: spinal stenosis with neurological deficit
- D Most feared: hypercalcaemia crisis; Most common: acetabular protrusio
Explanation
In Paget's disease: (1) Sarcomatous transformation (typically osteosarcoma, rarely fibrosarcoma or chondrosarcoma) occurs in <1% of patients but is the most feared complication due to uniformly poor prognosis — it should be suspected with sudden increase in pain and rising ALP in a known pagetic patient. (2) The most common orthopaedic manifestation is bowing deformity, most strikingly in the tibia ('sabre tibia'), which causes abnormal gait, increased fracture risk (chalk-stick fracture through the anterior tibial cortex), and osteoarthritis. Protrusio acetabuli and spinal stenosis occur but are less frequent.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.