Massive osteolysis of the humerus treated by resection and prosthetic replacement.

Massive osteolysis or vanishing bone disease was described by Jackson in 1 838. Since then over fifty cases have been reported. The etiology, however, is still in dispute and the treatment presents many problems. In the instance recorded here prosthetic replacement of diseased bone was carried out with preservation of a useful limb. The patient was a thirty-seven year old man born in British Guinea. He first noticed pain in the region of his right shoulder in January 1962. There was no history of injury, though he was at that time doing heavy work involving much lifting. The pain gradually increased so that in January 1963 he reported to a hospital. Radiography at that time showed no abnormality and he was treated by radiant heat and exercises. Seen in October 1963 he was still complaining of pain. The radiographs showed an irregular circumferential osteolytic lesion (Fig. 1). A few weeks later he fell and sustained a pathological fracture of the right humerus (Fig. 2). A biopsy specimen of bone from above and below the site of the pathological fracture, including adjacent soft tissue and curettings of the medullary cavity, did not show any evidence of tumour; there