Case report 549: Case 1: Ischemic necrosis femoral heads with pathological fracture right femur. Case 2: Ischemic necrosis femoral heads with fracture bilaterally.

Abstract

This 66-year-old woman with a history of biopsy-proved squamous cell carcinoma of the lung, presented with pain in the right hip (Fig. 1 A). No history of trauma was elicited. In the past, she had intermittently required up to 20 mg prednisone daily for asthma. Alcohol abuse was also recorded in the history. Radiographs 5 months later, when she had a sudden increase in pain, revealed a right subcapital femoral fracture (Fig. 1 B). Metastatic disease was strongly suspected. A 99mTc-MDP radionuclide bone scan demonstrated increased activity only in the right femoral head (Fig. 1 C). A Tl-weighted coronal MRI (SE/500/28) (Fig. 1 D) was performed, which showed areas of diminished signal in both femoral heads and an adjacent region of lower signal intensity around the fracture site. Metastatic disease was still considered the likely cause for the fracture. Therefore, management at that time was radiotherapy and medications for pain. Several ill-defined radiolucencies within the proximal segment of the right femoral shaft were noted two months later. Four months later, the patient experienced a sudden increase in pain in the right hip, and radiographs revealed 75% displacement of the femoral neck with subluxation of the femoral head from the aeetabulum. At that time, she underwent right hip hemiarthroplasty.