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 74-year-old man with a past medical history of myasthenia gravis treated with chronic corticosteroids, but never treated with radiation therapy, presents with osteoporosis, likely secondary to his chronic steroid use. About 3 months prior, he was referred to an orthopedic surgeon for evaluation of severe left hip pain and bilateral knee pain. The patient is on alendronic acid (70 mg orally, once a week) and has been for over 10 years. He is a current smoker; his smoking history exceeds 50 years.
At the time of presentation for hip and knee pain, the patient had left groin pain and decreased range of motion in his left hip. Plain radiography of the pelvis and left and right hip revealed severe arthritic changes, and his left femoral head was shattered. On the right side, a fracture of the proximal femur was noted (Figure 1). His initial treatment was surgical stabilization of his left hip with total hip arthroplasty, and he also had an intramedullary nail placed in his right femur. Today, he presents to a metabolic bone clinic for advice on how to treat his osteoporosis.
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Cite this: Monique Bethel, Laura D. Carbone. Bilateral Hip Fractures in an Elderly Man - Medscape - Jun 14, 2016.