PMC3941085_01
AP (A) & lateral (B) views of the pelvis and right hip 3
weeks prior to current ED presentation.
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F1
At that time, radiographs were performed of the pelvis, hip, and sacroiliac joints (see Fig. 1).
AP (A) & lateral (B) views at the time of current
presentation.
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F2
Radiographs at the time of the current ED presentation are seen in Fig. (2). The orthopedic service was notified and x-rays were ordered to accompany these CT images as seen in Fig. (2).
Past medical (A), surgical (B), and medication (C)
histories.
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F3
The patient had a complex past medical and surgical history as summarized in Fig. (3).
Coronal (A) and Axial (B) CT images at the time of
presentation.
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F4
While in the emergency room, the patient initially had a CT scan of her right hip that revealed a minimally displaced femoral neck fracture as seen in Fig. (4).
AP (A) and lateral (B, C) intraoperative fluoroscopic
views during pinning surgery.
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F5
Gentle closed reduction with a Leadbetter manuerver was performed and a percutaneous pinning of the right hip was done on a fracture table utilizing 6.5 mm cannulated screws in a reverse-triangle orientation (see Fig. 5).
AP (A) & lateral (B) x-rays at 6 months post operatively.
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F6
Some mild settling of the fracture was seen on serial radiographs, however, no signs of avascular necrosis of the femoral head were appreciated (see Fig. 6).
AP (A) & lateral (B) views 7 months post op showing
mottled bone within the femoral neck.
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F7
By the seven month post operative visit, the patient reported increasing pain and radiographs at that time were concerning for either a nonunion or infectious process (see Fig. 7).
A Coronal T2 weighted STIR image demonstrating an 8.9
cm by 3.8 cm marrow replacing lesion of the proximal right femur.
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F8
An MRI was ordered and can be seen in Fig. (8).