(Kiosk 1) Break a Leg! a Case of Functional Rehabilitation in a Completely Displaced Femoral Neck Fracture

Case Diagnosis: 63-year-old female with a completely displaced femoral neck fracture and chronic inflammatory demyelinating neuropathy (CIDP)

Case Description: Patient presented to clinic for follow-up management of right hip pain due to long-standing CIDP and history of right hip fracture. At the time of the hip fracture 2 years ago, imaging showed completely displaced femoral neck fracture. Initially, the patient was placed on non-weight-bearing (NWB) to the right leg awaiting surgery, but orthopedics did not consider her a candidate for surgery due to severe osteoporosis and neuropathy. Her status was changed to weight-bearing as tolerated (WBAT) to facilitate transfers and activities of daily living (ADL). She has been weight-bearing on the right leg for 2 years without gross instability.

Discussion: This case study proposes an alternative approach to treat completely displaced hip fractures in high-risk patients, demonstrated by this patient’s weight-bearing capability despite absence of intact skeletal system. It also raises questions about mechanisms enabling weight-bearing in patients with skeletal disruptions and highlights importance of considering patients' medical history and functional abilities in managing hip fractures when surgery is not appropriate.

Setting: Academic Outpatient Rehabilitation Clinic

Assessment/Results: Examination revealed bilateral leg atrophy, tibial subluxation, and right hip pain. Notably, the patient demonstrated WBAT capability between transfers using soft tissue even without a skeletal connection between right femur and acetabulum. Follow-up films show stable position of femoral head. Using a walker and knee brace, the patient was able to perform ADLs with help from a home health aide. She reported good pain control with current treatment regimen, which included physical therapy, intravenous immunoglobulins, and analgesic.

Conclusion: Patients with completely displaced hip fractures who are not candidates for operative repair may be able to have functional weight-bearing relying solely on soft tissues of pseudojoints. Further research is needed to better understand mechanisms underlying weight-bearing in patients without a contiguous skeletal system.