Disclosures: Shelby E. Johnson, MD: Nothing to disclose

Case Description: The patient presented with 2 months of atraumatic left groin pain that started after discontinuing his oral corticosteroid regimen. Pain worsened with weight-bearing and improved with rest. Tylenol and oxycodone did not relieve his pain. He reported decreased range of motion, but denied weakness, paresthesias, or radiating pain. Exam demonstrated pain with minimal hip flexion and internal rotation. Stinchfield and FAIR maneuvers were markedly positive. Hip radiograph was read for degenerative changes of bilateral hips, greater on the left. He was diagnosed with left hip osteoarthritis and referred for an ultrasound-guided corticosteroid injection. Upon pre-scanning, however, a large atypical appearing cleft was noted across the majority of the anterior surface of the femoral head-neck junction. With concern for pathologic fracture, risk of impending fracture, or active myelomatous lesion, the injection was postponed and MRI was requested.

Setting: Tertiary outpatient clinic

Patient: 65-year-old male with history of refractory multiple myeloma who presented with left groin pain.

Assessment/Results: MRI pelvis demonstrated a subacute appearing fracture of the left femoral neck with mild displacement of the femoral head. He was admitted to the hospital for orthopedic evaluation and discussion of surgical options. Surgery, however, would delay chemotherapy due to his thrombocytopenia and neutropenia, and the patient thus opted for non-operative management. Toe-touch weight-bearing with a walker and follow-up in 1 month was advised.

Discussion: The differential of groin pain in adults is broad, but this individual’s history of multiple myeloma and corticosteroid use increased his fracture risk. Occult fractures occur in 2-10% of hip fractures, and MRI is considered the next best imaging modality. Use of ultrasound is not well described but may be helpful for screening purposes, as was evident in this case.

Conclusion: This case emphasizes the importance of a complete evaluation of a patient’s symptoms, especially when significant risk factors are present.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/pathologic-hip-fracture-demonstrated-on-ultrasound/