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Impacted neck of femur fracture

Case contributed by Martin Saenz Aguirre
Diagnosis certain

Presentation

Referred for left hip pain and walking inability following a fall in the street.

Patient Data

Age: 60 years
Gender: Female
x-ray

An impacted left subcapital neck of femur fracture is suspected on the frontal X-ray of the pelvis. 

Metalic post-embolization material is seen in the pelvis secondary to a previous hemorrhage years ago.

Coronal CT images demonstrate the presence of an impacted fracture in the subcapital region of the left femur. There is neither bone fragment displacement nor loss of the articular congruence.

Post-processed color-coded VNCa bone marrow map, superimposed on the calcium images, shows bone marrow edema in the same location of the fracture.

x-ray

Frontal X-ray of the pelvis after surgical fixation of the fracture.

Case Discussion

Bone marrow edema detection is one of the many potential applications of the Dual-energy CT 1.

Bone marrow edema detection can be useful in the search of occult fractures, especially in the emergency setting when MRI is not available.

In this case, the fracture was already visible on the conventional X-ray and non-contrast CT images. Nonetheless, bone marrow edema is nicely depicted on post-processed color-coded VNCa images and shows a perfect spacial correlation with the fracture location.

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