Presentation
Thigh pain.
Patient Data
Complete fracture of the mid proximal femoral shaft with a transverse orientation of the fracture line medial "beaking". Distal rotation and displacement.
Cortical thickening of the anterolateral aspect of the proximal mid femoral shaft.
Case Discussion
This patient had a history of long-term bisphosphonate use, and these are the characteristic patterns of complete and incomplete femoral fractures. Imaging of the contralateral femur is recommended as it can show an early/incomplete insufficiency fracture such as in this case. These are at higher risk of complete fracture, and are sometimes prophylactically treated with an IM nail.