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

Maria Romanova, MD


January 14, 2016

Physical Examination and Workup

Upon physical examination, the patient has an overall ill appearance, with a heart rate of 110 beats/min, blood pressure of 120/65 mm Hg, respiratory rate of 12 breaths/min, and temperature of 98.6°F. He has a normal oxygen saturation of 100% while breathing room air. The cardiac and pulmonary examinations are within normal limits.

Figure 1.

Figure 2.

Examination of the right leg reveals a healed scar over the lateral thigh, with diffuse tenderness to palpation of the proximal femur. Mild limitation in hip flexion to 100° and severe limitation in knee flexion to 30° are noted, as well as muscle stiffness and atrophy. The lower leg and foot of the affected extremity are well-perfused, with bounding distal pulses. No overlying, chronic skin changes are noted except for a well-healed scar over the site of the previous operative repair. The neurologic examination findings, including motor strength and deep tendon reflexes, are normal in the affected leg.

A complete blood cell count and other trauma-related laboratory investigations (including a coagulation profile) are within normal limits. The alkaline phosphatase level is slightly elevated at 131 mg/dL, with an erythrocyte sedimentation rate of 16 mm/h. Plain radiographs of the femur and pelvis are obtained (Figures 1 and 2).


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