Missed Pathological Femoral Neck Fracture Undergoes Spontaneous Healing
Kong, A. C., Zarate, S. D., & Belzarena, A. C. (2021). Missed pathological femoral neck fracture undergoes spontaneous healing. Radiology case reports, 17(1), 72–76. https://doi.org/10.1016/j.radcr.2021.10.002
View Original Source →Abstract
Pathologic fractures are common complications of metastatic bone disease in patients with breast cancer. Fractures involving the proximal femur generally cause significant pain that is exacerbated by ambulation. Due to excessive stress on the weight-bearing hip joint, these fractures present a significant burden on the quality of life among patients. Here we describe a case of a 38-year-old female patient who was found to have a pathologic fracture of the proximal femur missed on imaging studies that underwent spontaneous union. Pathologic fractures rarely heal on their own, since a tumor at the fracture site interferes with bone healing and most fractures have to be managed with surgical intervention. Fractures can be missed on imaging studies in the setting of extensive metastatic disease. Physicians should be cognizant of this fact and maintain a high level of suspicion to recognize fractures with unusual presentations where patients may not present with the typical findings of acute onset of pain and inability to ambulate or bear weight.
Case Details
Disease Location
Femur
Personal Characteristics
38-year-old female. History of stage IV breast cancer with bone metastases
Clinical Characteristics
Referred for further evaluation and management of lower left leg weakness and management of lower left leg weakness. The patient was initially diagnosed with breast cancer in 2009 and underwent a bilateral mastectomy followed by chemotherapy and radiation therapy to the left breast. She began experiencing intermittent left hip pain 8 years after surgery, with the feeling of leg instability.
Remission Characteristics
2 years later, she stated that her symptoms had been well-controlled with physical therapy and reported an overall improvement in pain. Radiographs of the femur and pelvis were then obtained and revealed a pathologic left femoral neck chronic impacted fracture. The fracture was noted to be healed, although in a varus position with a decreased femoral neck-shaft angle.
Treatment & Mechanisms
Non-Clinical Treatment
Physical therapy