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Forum Name: Spinal problems and back pain

Question: Limp,hip & sacral pain


 AB Leever - Thu Dec 03, 2009 5:07 pm

I had a hard fall onto a tile floor 1 yr ago landing directly onto my right hip. FYI I am an active ( or was) 64 yr old.

Now one year later I have developed a limp ( my husband describes it like Grandpa Amos of the Real McCoys). If I take pressure off my right leg (ie when I use the grocery cart in a store as a "walker) I can walk with less pain.

Pain is primarily sacral, mid buttock and a tad anterior (groin area). It is constant and will at times prevent sleep a/o wake me from sleep as well. It does not cause me discomfort to sit upright in a hard backed chair but I am extremely limited on rising to standing and begining my stride to walk. Pain eases a bit with walking but never goes away. I have full back flexibility ( front bend to floor). Lateral hip raise causes some pain (sacral and hip joint). Lying down the position of comfort is external rotation of the hip with slight bend of the knee.

Pain has progressively worsened over this last year. I get relief from Ibuprofin and hot water bottle application. I rarely medicate, endure the pain...thus the limp gets worse.

I'd appreciate your advice on direction for me
 Dr.M.Aroon kamath - Mon Dec 28, 2009 1:08 am

User avatar Hi,
The one possibility that first comes to my mind is a 'missed'/old 'impacted fracture' of the neck of your right femur.

A fracture may be considered 'impacted' when the broken ends do not displace during movement.

This type of fracture (also known as Type 2 fracture of the femoral neck), can occur in following minor falls generally in older individuals (osteoporosis is a risk factor).

Whereas most people with a displaced hip fractures cannot walk or stand, many with impacted fractures may be able to stand up or even walk.

Impacted femoral neck fracures have been considered generally to be simple to treat and complicated rarely by non-union or avascular necrosis.

The optimal method of treatment of 'fresh' impacted fractures of the femoral neck is still debated.

Proponents of conservative treatment point out that because most of these will unite under proper supervision
without internal fixation & the hazards involved in operation (disimpaction,displacement & avascular necrosis of the femoral head) and the displacement that occurs in only a small proportion of cases.

Others are of the opinion that because impacted fractures often displace spontaneously in the recumbent position or on early weight-bearing, and also because it is impossible to predict which of the fractures will do so, an internal fixation is warrented.

As it is more than a year since your trauma, your pain may be due to
- avascular necrosis of the femoral head or
- secondary osteoarthritis of the hip joint.

You need to consult your orthopedic surgeon to have you examined to exclude this posibility.
Best wishes!
 AB Leever - Mon Dec 28, 2009 3:21 pm

Dear Doc
Thanks! All of what you have told me I have considered. I will definatley let you know what the diagnosis is after I see an orthopedist. I am retired and living in the country of Panama. Fearing the worst ( being an orthopedic nurse myself) I have put off seeking help. I do need this to be checked out. My hunch is you have it correct.

Thanks again!
AB Leever
 Dr.M.Aroon kamath - Mon Jan 04, 2010 9:28 am

User avatar Hi AB Leever,
I hope everything turns out alright. It is probably an impending re-fracture or disimpaction. With early management you should do well. Surgery may not be needed (hopefully).Good luck and thanks for the update.

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