STRESS-FRACTURE OF THE PROXIMAL FEMUR AFTER SCREW REMOVAL

We describe a case of stress fracture of the proximal femur occurring in a patient after removal of an internal fixation device for a commin uted subtrochanteric fracture. The presenting clinical picture resembl ed a late postoperative infection with a positive technetium and galli um bone scan and normal radiological findings. The stress fracture occ urred after removal of the fixation device when the patient started fu ll weight-bearing. The patient was treated initially as having osteomy elitis until a second X-radiograph some weeks later demonstrated a str ess fracture through one of the previous screw holes. This case illust rates well the possible complication of a insufficiency fracture subse quent to the occurrence of stress risers through screw holes in a weak ened bone when submitted to normal load. The clinical presentation may sometimes resemble late postoperative infection.