Ipsilateral hip pain and femoral shaft fractures: is there any relationship?

BACKGROUND: High-energy traumas are common occurrences worldwide. The rate of overlooked neck fractures in polytrauma cases is also high. Previous studies have shown that articular hip pathologies, particularly neck fractures, are associated with fractures of the femoral shaft. This study sets out to describe cases of intra-articular hip pathology following traumatic femoral shaft fracture. Thus, the present study aims to investigate the relationship between ipsilateral hip pain and femoral shaft fractures.
METHODS: Patients who were diagnosed with a fracture of the femur shaft and who were operated on (intramedullary fixation or plate) were included in this study. Patients with pathologic fractures, femoral neck fractures, femoral intertrochanteric fractures, or pelvic fractures were excluded. Patients with at least six months of follow-up and who were capable of independent walking without support were grouped according to AO/OTA fracture classification. Patients were questioned for deep anterior groin pain, and physical examination tests and hip imaging (X-ray and MR arthrography) were performed by calling patients with the indicated complaints.
RESULTS: The presence of labral tears were noted in two patients. The incidence of osseous bump of the femoral neck identified by MR arthrography (MRA) was found in three of 16 hips. Assessment of the presence of gluteal tendinosis or tear and herniation pit identified three of 16 hips. The presence of osteophytes was noted in one patient. MRA identified three of 16 hips with more than one type of intra-articular pathology. Two patients with an osseous bump of the femoral neck were also diagnosed with additional hip pathology as herniation pit.
CONCLUSION: Anterior groin pain in patients with a history of femoral shaft fracture is not always related to implants. Orthopedic surgeons should become suspicious in cases of intra-articular hip pathology in patients who have persistent hip pain after severe lower extremity trauma.

Ýpsilateral kalça aðrýsý ve femur þaft kýrýklarý: Herhangi bir iliþki var mý?

AMAÇ: Yüksek enerjili travmalar dünya çapýnda yaygýn karþýlaþýlan olaylardýr. Politravma olgularýnda gözden kaçan boyun kýrýklarýnýn oraný da yüksektir. Daha önce yapýlan çalýþmalar artiküler (eklem içi) kalça patolojilerinin, özellikle de boyun kýrýklarýnýn femoral þaft kýrýklarý ile iliþkili olduðunu göstermiþtir. Bu çalýþmanýn amacý travmatik femoral þaft kýrýðýný takiben eklem içi kalça patolojisi olgularýný tanýmlamaktýr. Bu çalýþmanýn araþtýrma sorusu “Femur þaft kýrýklarýndan sonra femur boynu kýrýlmayan hastalarýn kalça eklemlerinde ne oluyor?” dur.
GEREÇ VE YÖNTEM: Femur þaft kýrýðý tanýsý konan ve ameliyat edilen hastalar (intramedüller fiksasyon veya plak uygulamasý) çalýþmaya alýndý. En az altý ay takip edilen ve desteksiz baðýmsýz yürüme yeteneðine sahip hastalar AO/OTA kýrýk sýnýflamasýna göre gruplandýrýldý. Hastalara derin anterior kasýk aðrýsý soruldu ve belirtilen þikayetleri olan hastalar aranarak fizik muayene ve kalça görüntüleme (X-ray ve manyetik rezonans artrografi [MRA]) yapýldý.
BULGULAR: Ýki hastada labral yýrtýk tespit edildi. MRA ile femur boynu osseöz bump 16 kalçadan üçünde bulundu. Gluteal tendinosis veya gözyaþý ve herniasyon pit (çukurunun) varlýðýnýn deðerlendirilmesi, 16 kalçadan üçünde tespit edilmiþtir. Bir hastada osteofit varlýðý belirlendi. MRA ile, 16 kalçadan üçünde birden fazla tipte intra-artiküler (eklem içi) patoloji tanýmlandý. Femur boynu osseöz bumpý olan iki hastaya da herniasyon pit olarak ek kalça patolojisi tanýsý konuldu.
TARTIÞMA: Femur þaft kýrýðý öyküsü olan hastalarda kasýk önü aðrýsý her zaman implantlarla iliþkili deðildir. Ortopedik cerrahlar, þiddetli alt ekstremite travmasý sonrasý kalýcý kalça aðrýsý olan hastalarda eklem içi kalça patolojilerinden þüphelenmelidirler.