This is a retrospective review of two adult siblings with osteogenesis imperfecta (OI) type III (according to Sillence classification), who sustained a spontaneous femoral neck fracture and subsequent nonunion. The diagnosis of OI in these two patients was made based on clinical, radiological and genetic findings. The fracture was most likely caused by femoroacetabular impingement secondary to OI induced acetabular protrusio. A valgus osteotomy according to Pauwels'principles and fixation of the osteotomy and nonunion with a locking plate resulted in healing despite compromised bone quality and limited bone stock. Long-term follow up (4.5 years and 6.5 years, respectively) is provided. When treating this difficult problem, improving the mechanobiological environment and decreasing the femoroacetabular impingement by a Pauwels type osteotomy should be considered.
Acetabulum ; Adult ; Diagnosis ; Femoracetabular Impingement ; Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Humans ; Osteogenesis Imperfecta ; Osteogenesis ; Osteotomy ; Retrospective Studies ; Siblings

The aim of this study was to evaluate the bone mineral density and the prevalence of osteoporosis in postmenopausal Korean women with low-energy distal radius fractures and compared with those of aged-matched normal Korean women. Two hundred and six patients with distal radius fractures between March 2006 and March 2010 were included in this study. Patients were divided into three groups by age; group 1 (50-59 years), group 2 (60-69 years), and group 3 (70-79 years). Controls were age-matched normal Korean women. The bone mineral density values at all measured sites, except for the spine, were significantly lower in group 1 than those of control. While the bone mineral density values in group 2 and 3 were lower than those of controls, these differences were not statistically significant. All groups had significantly higher prevalence of osteoporosis at the Ward's triangle; however, at the spine, femoral neck and trochanteric area it was not significantly different from those of age-matched controls. Although the prevalence of osteoporosis of the postmenopausal women with low-energy distal radius fractures may not be higher than that of the control, osteoporosis should be evaluated especially in younger postmenopausal patients to prevent other osteoporotic hip and/or spine fractures.
Aged ; Body Mass Index ; Bone Density ; Female ; Femoral Neck Fractures/diagnosis ; Humans ; Middle Aged ; Osteoporosis/*epidemiology ; Postmenopause ; Prevalence ; Radius Fractures/*diagnosis ; Republic of Korea/epidemiology ; Retrospective Studies ; Spinal Fractures/diagnosis

Diagnostic Errors ; Female ; Femoral Neck Fractures ; diagnosis ; diagnostic imaging ; Femur Neck ; diagnostic imaging ; injuries ; Humans ; Radiography ; Young Adult

A 60-year-old woman suffered from recurrent femur neck fracture. Laboratory data showed serum hypophosphatemia, elevated alkaline phosphatase, normal serum calcium levels, and normal parathyroid hormone levels. Radiological examinations revealed a tumor in the right maxillary alveolar bone. The nasal cavity mass was removed, and the histological features were those of glomangiopericytoma. After removal of the tumor, some of the laboratory data normalized. Based on the clinical features, histopathological diagnosis and postoperative course of events, a diagnosis of glomangiopericytoma causing oncogenic osteomalacia was confirmed. We report a case of oncogenic osteomalacia caused by sinonasal glomangiopericytoma.
Alkaline Phosphatase ; Calcium ; Diagnosis ; Female ; Femoral Neck Fractures ; Hemangiopericytoma ; Humans ; Hypophosphatemia ; Middle Aged ; Nasal Cavity ; Osteomalacia* ; Parathyroid Hormone

Femoral neck fractures are associated with femoral shaft fractures in 1% to 9% of cases. Undisplaced neck fractures are susceptible to displacement during shaft nailing. We report the case of a 57-year-old male patient in whom we performed standard intramedullary nailing for a femoral shaft fracture. In doing so, we identified a vertical radiolucent line at the femoral neck, which was thought to be further displacement of a hidden silent fracture or an iatrogenic fracture that developed during nail insertion. Consequently, we decided to switch to reconstructive femoral nailing. Postoperative hip imaging failed to show the femoral neck fracture that we saw in the operating room. Here, we discuss the aforementioned case and review the literature concerning this artifact.
*Artifacts ; Femoral Fractures/diagnosis/*radiography/surgery ; Femoral Neck Fractures/diagnosis/*radiography/surgery ; Fracture Fixation, Intramedullary ; Humans ; Male ; Middle Aged

A number of reports regarding atypical fractures of the femur have raised questions concerning the possible correlation between long-term bisphosphonate treatment and the occurrence of insufficiency fractures in the proximal femur. However, clinically, it is often confused whether is it a fatigue fracture because of implant induced stress concentration or a bisphosphonate-related atypical fracture, especially in a patient with a subtrochanteric fracture who receive bisphosphonate therapy after open reduction and internal fixation, such as dynamic hip screw (DHS) fixation for previous ipsilateral femoral neck or intertrochanteric fracture. The authors experienced a case of a progressive femoral insufficiency fracture in a woman who had been on Fosamax (Alendronic acid with Vitamin D; Merck & Co. Inc, NJ, USA) therapy for four years after ipsilateral femoral neck fracture treated with a two hole DHS system. Despite a high suspicion of an insufficiency femoral subtrochanteric fracture by bone scan, the occult fracture progressed to a displaced femoral subtrochanteric fracture one year after. The fracture site was fixed with a 6 hole DHS plate, and six months after reoperation the patient had no symptoms and the fracture site had united without any complication.
Alendronate ; Early Diagnosis ; Female ; Femoral Fractures ; Femoral Neck Fractures ; Femur ; Femur Neck ; Fractures, Closed ; Fractures, Stress ; Hip ; Humans ; Osteoporosis ; Reoperation ; Vitamins

OBJECTIVESTo investigate the clinical features of femoral neck fractures and analyze related causes.

METHODSThe clinical data of patients with femoral neck fractures from June 2002 to August 2009 were retrospectively analyzed. The gender, age, fracture side, fracture type, basic social data, activities before injury, injury causes and treatment were analyzed.

RESULTSA total of 219 patients (106 male and 113 female) was analyzed. All patients were divided into children group (age < 16 years), adult group (age ranged from 16 to 60 years) and older group (> 60 years). There were 5 patients (2.3%) in the children group, 81 patients (37.0%) in the adult group and 133 patients (60.7%) in the older group. There were 11 patients (5.0%) with Garden I fractures, 32 patients (14.6%) with Garden II fractures, 90 patients (41.1%) with Garden III fractures and 86 patients (39.3%) with Garden IV fractures. Fall damage and traffic injury were the main injury types. Home and public place were the main injury sites.

CONCLUSIONSThe incidence of femoral neck fracture shows the highest in the old persons. The male patients with femoral neck fractures are more than female patients in children and adult group, while the male patients with femoral neck fractures are less than female patients in older group. The dominant fractures type according to Garden classification is Garden III fractures in children and adult groups, but Garden IV fractures in older group. Fall damage and traffic injury are the main injury types. Home and public place are the main injury sites.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Femoral Neck Fractures ; diagnosis ; diagnostic imaging ; epidemiology ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Young Adult

PURPOSE: To analyze diagnostic process and clinical data in cases of fracture of the femoral shaft with fracture of the proximal femur. MATERIALS AND METHODS: We reviewed 24 cases of patient who undergone surgery for fracture of the femoral shaft with ipsilateral fracture of the proximal femur and more than 1 year of examination of follow up was available. Age, sex.location and classification of the fracture, the time of diagnosis and operation, the method of operation, the associated injuries, the time of bony union and complication were investigated, postoperative function was evaluated on Friedman and Wyman criteria. RESULTS: Bony union showed significant difference in the displacement and comminution of fracture, postoperative function revealed significant difference according to the associated injuries. The 6 cases (25%) out of 24 cases are failed early diagnosis, 4 cases out of 6 cases was detected during operation and 2cases was found after surgery. 21 cases out of 24 cases of femoral shaft fractures showed union, 23 cases out of 24 cases of femoral neck fractures showed union. There were eleven good, eleven fair, and two poor functional result according to Friedman and Wyman criteria. CONCLUSION: Precious clinical and radiologic examination is needed not to miss the diagnosis of proximal femur fractures in ipsilateral femoral shaft fractures with proximal femur fractures. Anatomical reduction and rigid fixation of proximal femur are important to reduce avascular necrosis of femoral head and nonunion of proximal femoral fractures.
Displacement (Psychology) ; Early Diagnosis ; Femoral Fractures ; Femoral Neck Fractures ; Femur ; Follow-Up Studies ; Head ; Humans ; Necrosis

Femoral Fractures ; diagnosis ; surgery ; Femoral Neck Fractures ; diagnosis ; surgery ; Humans

OBJECTIVETo evaluate the contribution of the deep circumflex iliac arterial vascularized iliac bone grafting to the reconstruction of the blood supply of the femoral head through the digital subtraction angiography (DSA) or computied tomographic scanning angiography (CTA) of the both deep circumflex iliac artery and ECT, MRI judgement.

METHODSForty-five patients with the intracapsular fracture of femoral neck included 30 males and 15 females with an average age of 36.5 years ranging from 16 to 50. The course was from 6 to 25 days(means 10.2 days). There were 20 cases of sub-headfractures, 10 cases of head-neck, 15 cases of trans-neck. All patients were treated by 3 titanium alloy cannulated screws and deep circumflex iliac arterial vascularized iliac bone grafting. A follow-up for an average of 3 years and 6 months was performed. The engorging of the artery and reconstruction of the blood supply of the femoral head was viewed dynamicly,using digital subtraction angiography (DSA) or computied tomographic scanning angiography (CTA) of the both deep circumflex iliac artery and ECT, MRI judgement of the femoral head.

RESULTSThree weeks after operation, 38 transferred arteries were engorging via DSA, 2 of 7 not via CTA, but engorging via DSA. One year later after operation, all arteries were engorging via DSA or CTA. ECT examination in 3, 6, 12 months after operation displayed nuclide enriching in the femoral head and distributing uniformity. The region of interest (ROI) ratios of the fractured head of femur to contralateral counterpart (D/N) in all cases > 1.0. The average D/N after 3 months was (2.12 +/- 0.21), (2.04 +/- 0.14) after 6 months, (l1.71 +/- 0.11) after 12 months. There was statistical differation between D/N after 12 months and 3 or 6 months (P < 0.05), but not between 3 and 6 months (P > 0.05), and MRI examination in all cases no founded decreasing of the density and changing of the form of the femoral head.

CONCLUSIONDSA, CTA, ECT, MRI confirmed that the deep circumflex iliac arterial vascularized iliac bone can provide effective blood supply and is profit to the reconstruction of the blood supply of the femoral head after the fracture of the femoral neck.

Adolescent ; Adult ; Angiography, Digital Subtraction ; Female ; Femoral Neck Fractures ; diagnosis ; surgery ; Femur Head ; blood supply ; surgery ; Humans ; Iliac Artery ; transplantation ; Ilium ; transplantation ; Magnetic Resonance Imaging ; Male ; Middle Aged