Occult Acetabular Fracture in Elderly Patients
An eighty-year-old female patient presented with pain in her left hip. She had a clinical history of ipsilateral hip fracture treated with a proximal femoral nail (PFN, Synthes) 2 years previously, and had no other related medical condition. No antecedent of any further traumatic event was known, and she was not on any treatment for bone disease. Clinical examination of hip mobility increased the pain, which was particularly painful in internal and external rotations. No abnormalities were seen in the AP pelvis X-ray (Fig. ).\nThe patient was sent home with pain medication. At the one-month evaluation she still had groin and thigh pain, and a left transverse acetabular fracture with mild medial protrusion of the femoral head was observed radiologically (Fig. – arrow-).\nCareful examination of the initial X-rays revealed that the ilio-ischial line was interrupted at the greater sciatic notch (Fig. ). Bed rest without traction for one month was prescribed, followed by sitting and walking without weight bearing for a further month. A subsequent x-ray, 2 months later, showed that the fracture had probably healed (Fig. ). This conclusion was consistent with the fact that the patient had much less pain under passive and active hip motion. She could walk with a slight limp and the help of a walker.