Complication of an insufficiency fracture of the acetabulum

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ABSTRACT:An 83-year-old woman presented to the emergency department with a history of pain in the left hip of gradual onset over several days. There was no history of trauma and the X rays showed degenerative changes in the hip joint but no apparent fracture. She was sent home after being given reassurance, analgesics and a cane.Three weeks later she returned unable to mobilise after falling while getting out of bed and injuring the left hip. On this occasion the X-rays showed an acetabular fracture with femoral head protrusio. A CT scan confirmed the diagnosis and also demonstrated the absence of a haematoma in the surrounding soft tissues. The latter is characteristic of insufficiency fractures.Orthopaedic surgeons require a high index of suspicion for insufficiency fractures of the pelvis, femoral head and femoral neck in elderly osteoporotic patients who complain of hip pain without any history of trauma. (Hip International 2008; 18: 236-8)

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