Fine, so I accept someone somewhere has reported a stress fracture of the
femoral neck, but nowhere near 50%! And perhaps the problem is slightly
bigger than most people consider, but it is my experience and my
understanding that most orthopods don't consider that this is an issue at
all! But I will look out for this in the future...
AF
----- Original Message -----
From: "Rowley Cottingham"
Subject: Re: Hip protectors are ineffective
> As usual when Adrian pops his head up I struggle to find the paper that
matters! However, a
> little searching on things like "spontaneous subcapital fracture" throws
up a few gems, such as
> this:
>
> "Clin Orthop. 1993 Jul;(292):202-9.
>
> Insufficiency stress fractures of the femoral neck in elderly women.
>
> Tountas AA.
>
> Division of Orthopaedic Surgery, Northwestern General Hospital, Toronto,
Ontario, Canada.
>
> Thirteen insufficiency stress fractures of the femoral neck in 13 elderly
patients (average age, 82
> years) were studied retrospectively. All occurred in Caucasian women with
severe
> osteoporosis. A vague pain about the hip, of spontaneous onset, was the
main symptom on
> first visit. The diagnosis was delayed in most cases because the clinical
findings were minimal
> and the early roentgenographic features were absent or subtle. Bone
scintigraphy was found
> more useful than roentgenography for diagnosing this entity. A completely
displaced stress
> fracture of the femoral neck could not be distinguished clinically or
roentgenographically from a
> traumatic subcapital femoral fracture. Internal fixation was the treatment
method associated with
> the more favorable results. The histologic examination of removed femoral
heads indicated that
> this entity is a dynamic metabolic process. Insufficiency stress fractures
of the femoral neck in
> the elderly are not uncommon, but unless suspected, the condition can be
easily overlooked,
> and if displaced, mistaken for trauma-induced subcapital femoral
fractures."
>
> The stress fracture of the femoral neck is also seen in younger patients,
with athletes and
> amenorrhoeic women at particular risk, as well as those with bone cysts,
renal bone disease and
> so on.
>
> I encourage you all today to seek out some patients with hip fractures and
ask then if they had
> pain and then the leg couldn't bear the weight and how many were fine
until a mechanical or
> other collapse. You will find a fair few who fall off their femur. As I
can't find a paper directed
> specifically to that question, "Did you fall off your hip?" sounds like a
wonderful title for a
> paper.
>
> Best wishes,
>
>
> Rowley Cottingham
>
> [log in to unmask]
> http://www.emergencyunit.com
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