Femoral neck fracture in association with low-energy pelvic ring fractures in an elderly patient.

Concomitant fractures of the pelvic ring and proximal femur in the setting of low-energy trauma are rare but not mutually exclusive. An 82-year-old woman, without prior hip pain, presented to our institution after a fall from standing height. Ipsilateral pubic rami and sacral ala fractures were diagnosed with plain radiographs and computed tomography scanning, respectively, and corroborated by physical examination. No further imaging was performed in the emergency department. However, with adequate in-house pain control, the patient's complaints and physical examination were also indicative of a hip fracture. A subsequent magnetic resonance imaging study revealed a nondisplaced ipsilateral intertrochanteric femur fracture. Previously, it has been reported that occult fractures of the hip and pelvic ring appear to be mutually exclusive. Moreover, if acute fractures of the pubic ramus are identified, it has been recommended that no further investigation is warranted to rule out fracture of the hip. This case report demonstrates that low-energy pelvic ring and hip fractures can occur together. Sound clinical acumen is imperative and must supercede literature reports when providing patient care.

Duke Scholars

Author Samuel Bruce Adams Jr. Orthopaedic Surgery