PMC3893843_01
(a) Admission radiograph showing noncomminuted fracture with medial spike. (b) Radiograph taken 4 weeks prior to admission revealing subtle periosteal reaction on lateral cortex. (c) Radiograph 12 days postoperative repair.
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A radiograph of her right femur was requested on her admission to hospital, which revealed a noncomminuted spiral fracture with a medial spike (Figure 1(a)). Four weeks prior to this admission, a radiograph of her right femur had been requested which was reported to have no abnormality seen with correct positioning of the knee prosthesis and no sign of loosening or a stress reaction (Figure 1(b)). An intramedullary nail was inserted (Figure 1(c)) and she was transferred back to ICU where she continued to wean off the bilevel positive airways pressure support and was treated with antibiotics. The intramedullary nail maintains correct alignment, with moderate callus formation (Supplementary Figure 1(d) in Supplementary material available online at http://dx.doi.org/10.1155/2013/249872). There is cortical thickening in the contralateral femur (Supplementary Figure 1(e) in Supplementary material).