Occult Acetabular Fracture in Elderly Patients
A seventy-five-year-old female patient, operated on three years previously for a left hip fracture using a proximal femoral nail (PFN, Synthes), started to feel left groin pain with no traumatic antecedent; she was otherwise healthy. She was not using any drug interfering with bone metabolism. Clinical examination revealed that the pain was exacerbated by internal and external rotation of her hip. X-ray examination of the left hip revealed a consolidated hip fracture with lateral migration of the screw. There were no signs of acetabular fracture on this AP projection (Fig. ).\nSince the pain continued, two months later further x-rays were obtained, revealing a transverse acetabular fracture according to Letournel’s classification [] with the femoral head medially protruding onto the anterior acetabular wall; probably because of this, the femoral head had an anteriorsuperior notch, and was collapsed (Fig. ).\nA cemented total hip replacement was performed, with no osteosynthesis or bone graft of the acetabular fracture (Fig. ); bone and soft tissue samples obtained intraopera-tively were negative for bacteriological cultures. The pathology biopsy presented no noteworthy findings, apart from acute inflammation cellularity. A chest X-ray revealed no sign of a former pulmonary tuberculosis. The patient improved clinically after the operation. Six year follow-up X-rays showed proximal migration and medialization of the acetabular component (Figs. , ).\nThe pain eased and the patient continued to be clinically well at the 7 year follow-up. Although she walked with a slight limp and needed the help of a crutch, daily activities such as short-distance walking and climbing stairs were well tolerated. Painkillers were needed occasionally.