PMC10387672_01
Hip X-ray on 23 December 2020, indicating a left femoral neck fracture (red arrow).
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Following X-rays and computed tomography (CT) scans performed at a local hospital, a left femoral neck fracture was revealed (Figures 1 and 2).
CT scan of the hip on 23 December 2020, showing left femoral neck fracture with marked displacement (red arrows).
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Following X-rays and computed tomography (CT) scans performed at a local hospital, a left femoral neck fracture was revealed (Figures 1 and 2).
CT scan on 26 December 2020, used to evaluate lung condition before hip surgery. It shows that the bilateral coracoid process was continuous (a and b, red arrows) with no sign of fracture and no pleural effusion (c).
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The patient wanted hip surgery to relieve left hip pain. Therefore, on 26 December 2020, CT scan was used to evaluate the condition of the lungs before hip surgery, and it showed no coracoid process fracture (Figure 3).
CT scan on 8 January 2021, indicating bilateral pleural effusion (a, red arrows) and bilateral coracoid process fracture, with no obvious bone destruction at the fracture end (b, red arrows).
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However, a subsequent in-hospital CT scan done on 8 January 2021 to reevaluate the lung condition revealed bilateral coracoid process fracture, with no obvious bone lesion at the fracture end (Figure 4).
CT scan on 13 January 2021, revealing the presence of a slightly increased bilateral pleural effusion (a, red arrows) and bilateral coracoid process fracture with no obvious bone destruction at the fracture end (b, red arrows).
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Bilateral coracoid process fracture was still present when a CT scan was repeated for the third time on 13 January 2021 (Figure 5).
Photomicrographs of H&E staining of the broken end of the left femoral neck fracture showing some new but very few bone tissues with massive fibrous tissues (a and b, red arrows) and a thin and loose trabecular bone (c and d, red arrows), but no tumor cells. (x40 (a and c); x100 (b and d).)
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Histological examination of the broken end of the left femoral neck fracture through hematoxylin and eosin (H&E) staining revealed some new but very few bone tissues with massive fibrous structure and a thin and loose trabecular bone, but no tumor cells (Figure 6).
Hip X-ray on 25 January 2021, showing that the left femoral head replacement surgery was successful, with the cemented prosthesis in good position (red arrow).
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A plain radiograph of the pelvis after surgery showed that the hip replacement arthroplasty was very successful (Figure 7).
CT scan on 7 February 2021. The bilateral pleural effusion (a, red arrows) and bilateral coracoid process fracture are still present, with no obvious bone destruction at the fracture end (b and c, red arrows).
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The scan still indicated bilateral coracoid fracture (Figure 8).
Functional status of the patient at discharge on 6 February 2021. The patient could walk with the help of a walker (a). He was able to raise his two upper limbs (b).
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There was no tenderness in bilateral coracoid processes, and bilateral shoulder joints could also be abducted upward (Figure 9).
Anteroposterior radiograph of the pelvis on 20 October 2021. The left femoral head was surgically replaced (red arrow).
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It was not until 20 October 2021 that he permitted a hip X-ray which indicated that the left femoral head prosthesis was still correctly positioned (Figure 10).
CT scan on 20 October 2021, indicating bilateral pleural effusion (a) and bilateral coracoid process fracture. The fracture did not heal, and sclerosis was present at the broken ends without bone destruction (b and c red arrows).
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Furthermore, a chest CT scan revealed that there was still a bilateral pleural effusion, in addition to presence of bilateral coracoid process fracture (Figure 11).
After 10 months of follow-up (20 October 2021), functions in both shoulders were fair enough to meet daily requirements (a and b).
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However, the patient still felt no pain at the fracture site, and both upper limbs were functional (Figure 12).
CT scan on 20 December 2021, yet indicating bilateral pleural effusion (a, red arrows) and bilateral coracoid process fracture. The fracture did not heal (nonunion), and sclerosis was present at the broken ends without bone destruction (b and c, red arrows).
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On the 20 December 2021, a reexamination of his shoulder function, as well as CT scan, showed similarity with the conditions in October (Figures 13 and 14).
On 20 December 2021, the two shoulders were fairly functional, and they met daily requirements (a and b).
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On the 20 December 2021, a reexamination of his shoulder function, as well as CT scan, showed similarity with the conditions in October (Figures 13 and 14).
CT scan on 13 January 2022, still indicating bilateral pleural effusion (a, red arrows), and bilateral coracoid process fracture which failed to heal (b and c, red arrows).
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Moreover, there was sclerosis at the broken ends, while bone destruction was absent (Figure 15).