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Year |
2001 |
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Question Number |
44. |
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Category |
Select |
Question
A patient reports groin pain and has painful ROM of the hip 3 weeks after undergoing locked IM nailing of a comminuted femoral shaft fracture. The first step in assessment should consist of obtaining which of the following imaging studies?
1. Radiographs of the femur
2. Radiographs of the femoral neck
3. Radiographs of the acetabulum
4. MRI
5. Bone scan
Figures
Answer (click for answer)
Answer: 2
Explanation: Don’t ask me about this question, it should have been beaten into your head by now. The number one missed fracture associated with a femoral shaft fracture is a FEMORAL NECK FRACTURE. The reference article reported on a study of femoral shaft fractures with ipsilateral femoral neck fractures. In the study of 32 fractures, there were 10 fractures that were diagnosed after undergoing diaphyseal fixation. Each case had a negative pre-operative xray for femoral neck fracture. In the majority of cases, the femoral neck fracture was not found until post-operative follow-up x-rays were obtained or the patient presented with groin or hip pain.
The article recommends obtaining radiographs of the femur immediately after surgery, 2-weeks, and 4-weeks after surgery. It is still possible to miss a femoral neck fracture in this population. A high level of suspicion for femoral neck fracture is necessary when evaluating trauma patients with fixed femoral shaft fractures that complain of hip or groin pain.
Also of note, the fracture angle is between 70-90 degrees secondary to the longitudinal shear forces across the femoral neck.
Reference: Riemer BL, Butterfield SL, Ray RL, Daffner RH: Clandestine femoral neck fractures with ipsilateral diaphyseal fractures. J Orthop Trauma 1993; 7:443-49.