Occult proximal femoral fracture with radiating leg pain masquerading as sciatica: a case report
Abstract Background Occult proximal femoral fractures do not appear as fracture lines in radiographs, causing misdiagnosis and delayed diagnosis unless additional imaging studies, such as computed tomography or magnetic resonance imaging, are performed. Here, we present a 51-year-old male with an oc...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-05-01
|
| Series: | Journal of Medical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13256-023-03951-9 |
| _version_ | 1797818006846308352 |
|---|---|
| author | Ji-yeon Lee Akihito Oya Osahiko Tsuji Taro Umezu Arihiko Kanaji Yasuo Niki Masaya Nakamura Morio Matsumoto |
| author_facet | Ji-yeon Lee Akihito Oya Osahiko Tsuji Taro Umezu Arihiko Kanaji Yasuo Niki Masaya Nakamura Morio Matsumoto |
| author_sort | Ji-yeon Lee |
| collection | DOAJ |
| description | Abstract Background Occult proximal femoral fractures do not appear as fracture lines in radiographs, causing misdiagnosis and delayed diagnosis unless additional imaging studies, such as computed tomography or magnetic resonance imaging, are performed. Here, we present a 51-year-old male with an occult proximal femoral fracture who experienced radiating unilateral leg pain that took 3 months to be diagnosed because his symptoms mimicked lumbar spine disease. Case presentation A 51-year-old Japanese male experienced persistent lower back and left thigh pain after falling off a bicycle, and was referred to our hospital 3 months thereafter. Whole-spine computed tomography and magnetic resonance imaging revealed minute ossification of the ligamentum flavum at T5/6 without spinal nerve compression, but this did not explain his leg pain. Additional magnetic resonance imaging of the hip joint revealed a fresh left proximal femoral fracture without displacement. He underwent surgery for in situ fixation using a compression hip screw. Post-surgical pain relief was immediate. Conclusions Misdiagnosis of occult femoral fractures as lumbar spinal disease may occur if distally radiating referred pain is present. Hip joint disease should be considered as a differential diagnosis in cases of sciatica-like pain with an unknown spinal origin and no specific findings on spinal computed tomography or magnetic resonance imaging accounting for the leg pain, especially following trauma. |
| first_indexed | 2024-03-13T09:01:55Z |
| format | Article |
| id | doaj.art-b1274f70c36345b9bd96186f87ca125d |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-03-13T09:01:55Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-b1274f70c36345b9bd96186f87ca125d2023-05-28T11:17:49ZengBMCJournal of Medical Case Reports1752-19472023-05-011711610.1186/s13256-023-03951-9Occult proximal femoral fracture with radiating leg pain masquerading as sciatica: a case reportJi-yeon Lee0Akihito Oya1Osahiko Tsuji2Taro Umezu3Arihiko Kanaji4Yasuo Niki5Masaya Nakamura6Morio Matsumoto7Department of Orthopaedic Surgery, Keio University School of MedicineDepartment of Orthopaedic Surgery, Keio University School of MedicineDepartment of Orthopaedic Surgery, Keio University School of MedicineDepartment of Orthopaedic Surgery, Keio University School of MedicineDepartment of Orthopaedic Surgery, Keio University School of MedicineDepartment of Orthopaedic Surgery, Keio University School of MedicineDepartment of Orthopaedic Surgery, Keio University School of MedicineDepartment of Orthopaedic Surgery, Keio University School of MedicineAbstract Background Occult proximal femoral fractures do not appear as fracture lines in radiographs, causing misdiagnosis and delayed diagnosis unless additional imaging studies, such as computed tomography or magnetic resonance imaging, are performed. Here, we present a 51-year-old male with an occult proximal femoral fracture who experienced radiating unilateral leg pain that took 3 months to be diagnosed because his symptoms mimicked lumbar spine disease. Case presentation A 51-year-old Japanese male experienced persistent lower back and left thigh pain after falling off a bicycle, and was referred to our hospital 3 months thereafter. Whole-spine computed tomography and magnetic resonance imaging revealed minute ossification of the ligamentum flavum at T5/6 without spinal nerve compression, but this did not explain his leg pain. Additional magnetic resonance imaging of the hip joint revealed a fresh left proximal femoral fracture without displacement. He underwent surgery for in situ fixation using a compression hip screw. Post-surgical pain relief was immediate. Conclusions Misdiagnosis of occult femoral fractures as lumbar spinal disease may occur if distally radiating referred pain is present. Hip joint disease should be considered as a differential diagnosis in cases of sciatica-like pain with an unknown spinal origin and no specific findings on spinal computed tomography or magnetic resonance imaging accounting for the leg pain, especially following trauma.https://doi.org/10.1186/s13256-023-03951-9Occult fractureFemur neckEarly diagnosisSciatica |
| spellingShingle | Ji-yeon Lee Akihito Oya Osahiko Tsuji Taro Umezu Arihiko Kanaji Yasuo Niki Masaya Nakamura Morio Matsumoto Occult proximal femoral fracture with radiating leg pain masquerading as sciatica: a case report Journal of Medical Case Reports Occult fracture Femur neck Early diagnosis Sciatica |
| title | Occult proximal femoral fracture with radiating leg pain masquerading as sciatica: a case report |
| title_full | Occult proximal femoral fracture with radiating leg pain masquerading as sciatica: a case report |
| title_fullStr | Occult proximal femoral fracture with radiating leg pain masquerading as sciatica: a case report |
| title_full_unstemmed | Occult proximal femoral fracture with radiating leg pain masquerading as sciatica: a case report |
| title_short | Occult proximal femoral fracture with radiating leg pain masquerading as sciatica: a case report |
| title_sort | occult proximal femoral fracture with radiating leg pain masquerading as sciatica a case report |
| topic | Occult fracture Femur neck Early diagnosis Sciatica |
| url | https://doi.org/10.1186/s13256-023-03951-9 |
| work_keys_str_mv | AT jiyeonlee occultproximalfemoralfracturewithradiatinglegpainmasqueradingassciaticaacasereport AT akihitooya occultproximalfemoralfracturewithradiatinglegpainmasqueradingassciaticaacasereport AT osahikotsuji occultproximalfemoralfracturewithradiatinglegpainmasqueradingassciaticaacasereport AT taroumezu occultproximalfemoralfracturewithradiatinglegpainmasqueradingassciaticaacasereport AT arihikokanaji occultproximalfemoralfracturewithradiatinglegpainmasqueradingassciaticaacasereport AT yasuoniki occultproximalfemoralfracturewithradiatinglegpainmasqueradingassciaticaacasereport AT masayanakamura occultproximalfemoralfracturewithradiatinglegpainmasqueradingassciaticaacasereport AT moriomatsumoto occultproximalfemoralfracturewithradiatinglegpainmasqueradingassciaticaacasereport |