A 49-Year-Old Man With Pain at the Site of a Previous Fracture

Maria Romanova, MD

Disclosures

January 14, 2016

Editor's 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 you would like to suggest for a future Case Challenge, please contact us.

Background

A 49-year-old man with a medical history of cervical spine fracture, diabetes mellitus, and hearing loss presents to the emergency department with increasing pain at the site of a previous complicated right femoral fracture after a minor fall onto the affected area earlier in the day. No other trauma is noted, and the fall itself is thought to have been mechanical, with no antecedent symptoms (such as lightheadedness).

The patient has no significant history of alcohol use or illicit substance use. He had sustained a displaced transverse fracture of the right proximal femur 6 months ago as a result of a car accident. The fracture had been treated with operative reduction and internal fixation; the hardware was removed prematurely 2 months after the accident at an outside facility for unknown reasons (although it was thought to be because of increased pain). Despite an aggressive physical therapy regimen, the patient remained bedridden, with continued pain in the injured extremity.

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