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

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.


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Bilateral femoral neck fracture in pregnancy- outcome of conservative and operative treatment: a case report

Vol 5 | Issue 2 | May-Dec 2019 | page: 11-13 | Hemjit Das, Shyam Sunder. S

DOI 10.13107/ti.2019.v05i01.092


Author: Hemjit Das [1], Shyam Sunder. S [1]

[1] Department Of Orthopaedics, Assam Medical college and hospital, Dibrugarh, Assam, India-786002. India.

Address of Correspondence
Dr. Shyam Sunder. S,
Department Of Orthopaedics, Assam Medical college and hospital,
Dibrugarh, Assam, India-786002.
E-mail: shyam.arun90@gmail.com


Abstract

Introduction: Transient osteoporosis of pregnancy is usually benign in nature. Rarely serious complication like fragility fracture of neck of femur can occur. Usually idiopathic in nature and self-limiting. So far only 12 such cases and bilateral in only 2 patients have been reported in literature. Since, X-rays are usually avoided in pregnancy this condition is usually missed leading to late diagnosis.
Case report: A 26-year-old primigravida was referred to our institute on her 7th month of gestation with bilateral hip pain and limp. She developed bilateral hip pain on her 5th month of gestation which was progressive in nature. Her radiograph showed bilateral femoral neck fracture. To avoid radiation hazard to the fetus fracture fixation was delayed till caesarean section on her 38th week of gestation. Closed reduction and internal fixation with three CC screws was done for left femur neck fracture. Fixation was planned for right side fracture simultaneously but since the patient did not consent for bilateral surgery she was asked to review after one month for right femur neck fracture fixation. The patient who lost to follow-up showed up after 6 months walking comfortably. Radiological examination showed that in the nonoperated side the fracture united in Varus with shortening of 0.5 cm.
Conclusion: Musculoskeletal problems during pregnancy should not be overlooked. MRI should be used for early diagnosis whenever feasible. Fracture Neck of femur in pregnancy in-spite of delayed diagnosis and treatment has a better prognosis even with conservative treatment.
Keywords: transient osteoporosis, pregnancy, femoral neck fracture, spontaneous healing.


References

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9. Alioune GB, Lamine S, Badara D, Alioune DB, Andre DS, Charles DB. Bilateral fracture of femoral neck during pregnancy:A case of spontaneous Healing. SM journal of orthopaedics. 2017.
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How to Cite this article:  Das H, Sunder Shyam. S.  Bilateral femoral neck fracture in pregnancyoutcome of conservative and operative treatment: a case report. Trauma International May – Dec 2019: 5(2):11-13.

 




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