Mysterious Femur Fracture in a Middle-Aged Man

George T. Griffing, MD; Naga Neelima Nallapaneni, MB BS


April 06, 2018

Editorial Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 49-year-old man with a history of osteopenia and HIV infection presents for follow-up. He had been seen in the emergency department about 8 months ago after several days of dull thigh pain followed by a sudden, intense pain after making a twisting motion when walking. He was diagnosed with a midshaft femoral fracture. He has had no previous bone fractures.

He has long-standing HIV infection and is taking antiretroviral medications. He is also on supplemental calcium, vitamin D, and 8 years of alendronate therapy as part of a clinical HIV study. He has no known history of cancer. The patient does not have any known allergies and the family medical history is unremarkable.


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