Occult left neck of femur fracture

Case contributed by RMH Core Conditions

Presentation

Fall a few days ago. Increasing pain. Now unable to weight bear.

Patient Data

Age: 78
Gender: Female
X-ray

No fracture is identified. No dislocation.

No definite fracture of the pelvis or right hip is identified. A faint linear lucency in the posterior cortex of the femoral neck is equivocal for fracture. Note is made of the ventriculoperitoneal shunt lying within the pelvis. There is a small amount of free fluid within the pelvis presumably, secondary to the shunt device.

Conclusion

No definite displaced fracture is identified. Subtle linear lucency in the posterior cortex of the left femoral neck is equivocal for fracture. 

At the site of the faint cortical defect on CT there is linear oedema on the MRI, confirming an acute transcervical fracture of the right femoral neck, undisplaced. A small amount of hip joint fluid is noted.

There is also high signal in the gluteus maximus tendon suggestive of a partial thickness tear.

Not fully imaged there is oedema, more geographic than linear in the superior left femoral neck, not extending across the full width of the femoral neck, non specific, but in the context of recent trauma a further fracture ?microtrabecular is a possibility at this site.

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Case information

rID: 28953
Case created: 23rd Apr 2014
Last edited: 9th Sep 2015
Inclusion in quiz mode: Included

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