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A Case Series of Occult Femoral Neck Fracture, Why Plain Radiograph is not Enough?

May 10, 2019/in May- Aug 2019 | Volume 5 | Issue 2

Vol 5 | Issue 2 | May-Dec 2019 | page: 02-04 | John Butarbutar, Rio Aditya, Prettysia Suvarly, Nyoman Aditya Sindunata DOI 10.13107/ti.2019.v05i02.086 Author: John Butarbutar [1], Rio Aditya [2], Prettysia Suvarly [2], Nyoman Aditya Sindunata [2] [1] Department of Orthopedic & Traumatology, Siloam Hospitals Lippo Village – Pelita Harapan University, Jl. Siloam No. 6, […]

Spontaneous Iliopsoas Hematoma After Total Hip Arthroplasty In A Patient On Rivaroxaban: A rare case report

May 10, 2019/in May- Dec 2019 | Volume 5 | Issue 2

Vol 5 | Issue 2 | May-Dec 2019 | page: 08-10 | Danai Grammatikopoulou, Themistoklis Vampertzis, Eirini Iosifidou, Christina Barmpagianni, Eleni Melikidou, Fotios Girtovitis, Stergios Papastergiou DOI 10.13107/ti.2019.v05i02.090 Author: Danai Grammatikopoulou [1], Themistoklis Vampertzis [1], Eirini Iosifidou [1], Christina Barmpagianni [2], Eleni Melikidou [3], Fotios Girtovitis [4], Stergios Papastergiou [1] [1] Orthopaedics Department, Agios Pavlos […]

A Case Series of Occult Femoral Neck Fracture, Why Plain Radiograph is not Enough?

May 10, 2019/in May- Aug 2019 | Volume 5 | Issue 2

Spontaneous Iliopsoas Hematoma After Total Hip Arthroplasty In A Patient On Rivaroxaban: A rare case report

May 10, 2019/in May- Dec 2019 | Volume 5 | Issue 2

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A Case Series of Occult Femoral Neck Fracture, Why Plain Radiograph is not Enough?

May 10, 2019/in May- Aug 2019 | Volume 5 | Issue 2

Vol 5 | Issue 2 | May-Dec 2019 | page: 02-04 | John Butarbutar, Rio Aditya, Prettysia Suvarly, Nyoman Aditya Sindunata

DOI 10.13107/ti.2019.v05i02.086

Author: John Butarbutar [1], Rio Aditya [2], Prettysia Suvarly [2], Nyoman Aditya Sindunata [2]

[1] Department of Orthopedic & Traumatology, Siloam Hospitals Lippo Village – Pelita Harapan University, Jl. Siloam No. 6, Lippo Karawaci 1600 Tangerang 15811, Indonesia.
[2] Clinical Researcher at Orthopedic & Traumatology Department, Siloam Hospitals Lippo Village – Pelita Harapan University, Jl. Siloam No. 6, Lippo Karawaci 1600 Tangerang 15811, Indonesia.

Address of Correspondence
Dr. John Butarbutar,
Department of Orthopedic & Traumatology, Siloam Hospitals Lippo Village – Pelita Harapan University, Jl. Siloam No. 6, Lippo Karawaci 1600 Tangerang 15811, Indonesia.
E-mail: johnbutar2@gmail.com

Abstract

Background: About 10% of hip fractures are missed on initial presentation and potentially expose patients to increased morbidity and unnecessary complex surgeries. 2,3 CT-scan and MRI in the emergency settings have been proposed to avoid a misdiagnosis.3,6,7
Case Series: three cases (two female and one male patient) patients with hip pain were presented with normal x-ray on initial presentation. Further investigation using CT-scan and MRI revealed femoral neck fractures.
Case 1 : A 77 years-old female presented with right hip pain after a ground-level fall. Plain radiograph was normal and the patient was discharged from emergency. One week later, her hip pain worsened and a follow up x-ray showed a displaced femoral neck fracture. The fracture then treated with bipolar hemiarthroplasty.
Case 2 : An 87 years-old female presented with left hip pain after a fall in the bathroom. She was able to bear weight. Initial hip x-ray appeared normal. Further investigation with a pelvic CT scan revealed a displaced femoral neck fracture.
Case 3 : A 49 years-old male presented with worsening right hip pain since more than a week. The patient was physically active and has no history of trauma or associated hip injury. Initial x-ray showed a normal hip but further imaging study using MRI revealed an undisplaced femoral neck fracture. The patient was treated conservatively as he refused to do surgery.
Conclusion: Traumatic hip pain with negative plain radiograph should be followed by MRI or CT -scan to avoid misdiagnosis.
Keywords : Occult hip fracture, Missed hip fracture, Femoral Neck Fracture, Elderly patient

References

1. B. Gullberg, O. Johnell and J. Kanis, “World-wide projections for hip fracture,” Osteoporosis International, vol. 7, no. 5, pp. 407-13, 1997.
2. O. Lubovsky, M. Libergall, Y. Mattan, Y. Weil and R. Mosheiff, “Early diagnosis of occult hip fractures,” Injury, vol. 36, no. 6, pp. 788-92, 2005.
3. J. Cannon, S. Silvestri and M. Muntro, “Imaging choices in occult hip fracture,” The hournal of emergency medicine, vol. 37, no. 2, pp. 144-52, 2009.
4. W. Brox, K. Roberts and S. Taksali, “The American academy of orthopaedic surgeons evidence-based guideline on management of hip fracture in the elderly,” Journal of Bone and Joint Surgery, vol. 97, pp. 1196-9, 2015.
5. N. Yoshida, Y. Komaru and Y. Tsuchida, “Occult femoral neck fracture,” Case reports, vol. 2017, 2017.
6. S. Gill, J. Smith, R. Fox and C. T, “Investigation of occult hip fractures : the use of CT and MRI,” The scientific world journal, vol. 2013, pp. 1-4, 2013.
7. D. Collin, D. Dunker, J. Gothlin and M. Geijer, “Observer variation for radiography, computed tomograpy, and magnetic resonance imaging of occult hip fractures.,” Acta Radiologica, vol. 52, no. 8, pp. 871-4, 2011.
8. C. Wei, W. Tsai, C. Tiu, H. Wu and H. Chiou, “Systematic analysis of missed extremity fractures in emergency radiolgy,” Acta Radiol, vol. 47, pp. 710-7, 2006.
9. B. Yun, M. Myriam Hunink, A. Prabhakar, M. Heng, R. Qudsi and A. Raja, “Diagnostic imaging strategies for occult hip fractures : a decision and cost-effectiveness analysis,” Academic Emergency Medicine, vol. 23, no. 10, pp. 1161-9, 2016.
10. F. Frihagen, L. Norsletten, R. Tariq and J. Madsen, “MRI diagnosis of occult hip fractures,” Acta Orthop, vol. 76, no. 4, pp. 524-30, 2005.
11. R. Pandey, E. McNally, A. Ali and C. Bulstrode, “The role of MRI in the diagnosis of occult hip fractures,” Injury, vol. 29, pp. 61-3, 1998.
12. M. Haubro, C. Stougaard, T. Torfing and e. al, “Sensitivity and specificity of CT and MRI scanning in evaluation of occult fracture of the proximal femur,” Injury, vol. 46, pp. 1557-61, 2015.

How to Cite this article: Butarbutar J, Aditya R, Suvarly P, Sindunata N A. | A Case Series of Occult Femoral Neck Fracture, Why Plain Radiograph is not Enough? | Trauma International | May-Dec 2019; 5(2): 02-04.

(Abstract)(Full Text HTML) (Download PDF)

Spontaneous Iliopsoas Hematoma After Total Hip Arthroplasty In A Patient On Rivaroxaban: A rare case report

May 10, 2019/in May- Dec 2019 | Volume 5 | Issue 2

Vol 5 | Issue 2 | May-Dec 2019 | page: 08-10 | Danai Grammatikopoulou, Themistoklis Vampertzis, Eirini Iosifidou, Christina Barmpagianni, Eleni Melikidou, Fotios Girtovitis, Stergios Papastergiou

DOI 10.13107/ti.2019.v05i02.090

Author: Danai Grammatikopoulou [1], Themistoklis Vampertzis [1], Eirini Iosifidou [1], Christina Barmpagianni [2], Eleni Melikidou [3], Fotios Girtovitis [4], Stergios Papastergiou [1]

[1] Orthopaedics Department, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece;
[2] Aristotle University of Thessaloniki, Faculty of Medicine, Thessaloniki, Greece;
[3] Radiology Department, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece;
[4] Blood Centre, AHEPA University Hospital, Thessaloniki, Greece.

Address of Correspondence
Dr. Themistoklis Vampertzis,
Orthopaedic Department, Agios Pavlos General Hospital Thessaloniki, Thessaloniki, Greece.
E-mail: themisvamper@yahoo.com

Abstract

Introduction: Pain in the inguinal region, frequently spreading to the femur, is a common symptom with a variable differential diagnosis. Spontaneous iliopsoas hematoma is a rarely reported adverse effect of anticoagulation therapy that can present with pain in the hip, with or without previous injury or surgery at the region. This case report aims to remind clinicians of this rare condition that can result in major complications.
Case Presentation: An 83 year old male patient presented to our Emergency Department with pain at the right hip which within a week expanded to the lower back and anterior femur. During clinical examination restriction of movement due to soreness was noted, the hip joint was kept in slight flexion, while there were no abnormal vascular findings. Medical history included a right-sided total hip replacement 8 years ago, chronic atrial fibrilation, chronic cardiac failure and hypertension. He was on anticoagulant (rivaroxaban) and anti-hypertensive regimen. Laboratory results showed low hematocrit (HTC) and hemoglobin (HB), elevated prothrombin time (PT) and increased international normalized ratio (INR). Imaging showed a large iliopsoas hematoma. Conservative treatment was decided. Subsequently, the hematocrit normalized, the hematoma regressed and the pain receded.
Conclusion: Despite being a frequent cause of complain, pain of the hip, lumbar or femur region could be the result of a more complex pathology. Such cases should therefore not be overlooked but examined thoroughly, especially if presenting with suspicious signs or symptoms or in a setting of co morbidities. When complains are with regard to an area that has been operated on, as in our case, clinicians should not attribute all symptoms on the presence of prior surgery.
Keywords: Anticoagulation, spontaneous hematoma, iliopsoas, total hip arthroplasty.

References

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2.Yegen SF, Ekiz T, Gilikli BE, Dogan A. Spontaneous Iliopsoas Haematoma Presenting with Groin Pain under Warfarin Therapy. Pain Physician. 2015 Nov;18(6):E1145-6.
3.Boţianu AM, Demian S, Macarie I, Georgescu D, Oltean G, Băţagă S. Acquired haemophilia complicated with gastrointestinal bleeding and spontaneous iliopsoasmuscle haematoma in woman with chronic C hepatitis under treatment with pegylated IFNalpha 2a and ribavirin. J Gastrointestin Liver Dis. 2012 Mar;21(1):93-5
4.Kumar A, Mondal S, Sethi P, Manchanda S, Biswas A, Wig N. Spontaneous iliopsoas haematoma in a patient with dengue haemorrhagic fever (DHF): A casereport. J Vector Borne Dis. 2017 Jan-Mar;54(1):103-105.
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7.Sarcon A, Botta GP, Patel N, Saven A. Spontaneous Iliopsoas Muscle Hemorrhage Secondary to Ibrutinib (Imbruvica; Pharmacyclics). Journal of Investigative Medicine High Impact Case Reports. 2016;4(2):232470961664845. doi:10.1177/2324709616648457.
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11.Podger H, Kent M. Femoral nerve palsy associated with bilateral spontaneous iliopsoas haematomas: a complication of venous thromboembolism therapy. Age and Ageing. 2016;45(1):175-176. doi:10.1093/ageing/afv176.
12.Andreani L, Nucci AM, Giuntoli M, Lisanti M .Compressive Femoral Neuropathy Associated with Iliopsoas Hematoma Complicating Hip Hemiarthroplasty: A Case Report. J Orthop Case Rep. 2017 Sep- Oct;7(5):3-6. doi: 10.13107/jocr.2250-0685.872.
13.Torres GM, Cernigliaro JG, Abbitt PL, Mergo PJ, Hellein VF, Fernandez S, Ros PR. Iliopsoas compartment: normal anatomy and pathologic processes. Radiographics. 1995 Nov; 15(6): 1285–1297. doi: 10.1148/radiographics.15.6.8577956
14.Retselas I, Vaiopoulos C, Chronopoulos P, Kaisidis G, Fotopoulou C, Skandalos I. Spontaneous iliopsoas muscle haematoma during anticoagulant treatment. Hell J Surg 2015;87:434-6
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How to Cite this article: Grammatikopoulou D, Vampertzis T, Iosifidou E, Barmpagianni C, Melikidou E, Girtovitis F, Papastergiou S. Spontaneous Iliopsoas hematoma after total hip arthroplasty in a patient on Rivaroxaban: A rare case report. Trauma International May -Dec 2019;5(2): 8-10.

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

A Case Series of Occult Femoral Neck Fracture, Why Plain Radiograph is not Enough?

Spontaneous Iliopsoas Hematoma After Total Hip Arthroplasty In A Patient On Rivaroxaban: A rare case report

A Case Series of Occult Femoral Neck Fracture, Why Plain Radiograph is not Enough?

Spontaneous Iliopsoas Hematoma After Total Hip Arthroplasty In A Patient On Rivaroxaban: A rare case report

Full Sized Blog Element (Big Preview Pic)

A Case Series of Occult Femoral Neck Fracture, Why Plain Radiograph is not Enough?

Author: John Butarbutar [1], Rio Aditya [2], Prettysia Suvarly [2], Nyoman Aditya Sindunata [2]

Abstract

References

(Abstract)(Full Text HTML) (Download PDF)

Spontaneous Iliopsoas Hematoma After Total Hip Arthroplasty In A Patient On Rivaroxaban: A rare case report

Author: Danai Grammatikopoulou [1], Themistoklis Vampertzis [1], Eirini Iosifidou [1], Christina Barmpagianni [2], Eleni Melikidou [3], Fotios Girtovitis [4], Stergios Papastergiou [1]

Abstract

References

(Abstract)(Full Text HTML) (Download PDF)

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