Please find below our case of the month that identifies a very important radiographic finding, of particular importance in people over 65 years.
The image below is of a 79y/o F c/o LBP and pain in the anterior and posterior right thigh.
Whilst you will note the obvious right-sided sacral inferiority with compensatory lumbar dextro-scoliosis and advanced DDD, spondylosis and facet arthrosis, I would like to draw your attention to the right hip. When observing the alignment, there appears to be a more varus angulation of the femoral head and neck when compared to the left side. There is some cortical offset that is sharply marginated at the medial basi-capitus, unlikely to represent a sub-capital collar osteophyte, although this could be considered. You can also appreciate an irregular line of condensation at the base of the femoral head that likely represents some impaction. The thin curvilinear density almost superimposing this is the posterior acetabular rim that may distract the viewer somewhat.
In this case, the diagnosis is a right basi-capital femoral insufficiency fracture.
Femoral neck fractures are associated with significant mortality and morbidity with a one year mortality rate varying between 14-58% for people 65 years and over1. There is an increasing relative risk of mortality of 4% per year2. Earlier surgical intervention post fracture results in a reduced mortality, indicating a need for early and accurate diagnosis.
This case highlights the importance of careful review of images to identify hip fractures in the absence of significant trauma.
- Schnell, S. Friedman, S. Mendelson, D. Bingham. K & Kates, S. The 1-Year Mortality of Patients Treated in a Hip Fracture Program for Elders. J. Geriat Orthop Surg Rehab 2010;1(1):6-14.
- Paksima N, Koval K, Aharanoff G, et al. Predictors of mortality after hip fracture: a 10-year prospective study. Bull NYU Hosp Jt Dis. 2008;66(2):111–117