PDF(Pubmed)
Abstract：
A case involving a patient with an impacted and angulated femoral neck fracture presenting to a chiropractic physician is rare. This unique case contributes an account of a challenging differential diagnosis to the literature. A 65-year-old female, reporting no history of trauma, presented with a two-week history of right lower back and right anterior hip pain radiating down the front of the right thigh in the L2-L4 dermatome. The differential diagnosis included lumbar spine disc herniation and nerve root compression or a right hip abnormality. An MRI of the lumbar spine revealed L3-L4 and L4-L5 posterior disc bulges and right foraminal narrowing. She was subsequently referred to pain management and diagnosed with lumbar radiculopathy and neural foraminal stenosis. After three lumbar spine epidural injections and a period of conservative care, the patient\'s symptoms were 90% improved but not fully resolved. Subsequently, right hip X-rays were ordered. The x-rays revealed an impacted and angulated right femoral neck base fracture. At this time, the patient recalled a possible traumatic incident. The patient was immediately referred to an orthopedic surgeon. After a month\'s delay waiting for further advanced imaging, a total right hip replacement was performed. This case underscores the importance for physicians to recognize that patients may not be aware of their own history of trauma. It also highlights the need for physicians to consider the possibility of multiple concurrent pathologies and to order imaging for all areas of pain.
摘要：
很少有涉及患者的股骨颈骨折受累和成角度的患者出现脊椎指压医师。这个独特的病例为文献提供了一个具有挑战性的鉴别诊断。一位65岁的女性,报告没有外伤史,在L2-L4皮刀中，右下背部和右前髋部疼痛在右大腿前部向下放射，有两周的病史。鉴别诊断包括腰椎间盘突出症和神经根受压或右髋异常。腰椎MRI显示L3-L4和L4-L5后椎间盘凸起和右椎间孔狭窄。随后，她接受了疼痛治疗，并被诊断为腰椎神经根病和椎间孔狭窄。经过三次腰椎硬膜外注射和一段时间的保守护理，患者的症状改善了90%，但未完全缓解。随后，右髋部X光片被订购。X线检查显示右股骨颈基部骨折。此时,病人回忆起一起可能的创伤事件。患者立即转诊至整形外科医生。经过一个月的延迟等待进一步的高级成像，进行了全髋关节置换术.这种情况强调了医生认识到患者可能没有意识到自己的创伤史的重要性。它还强调了医生需要考虑多种并发病理的可能性，并对所有疼痛区域进行成像。
