A 46-year-old woman presented to her primary care physician with a 3-week history of right forefoot pain. The pain had begun spontaneously, worsened with weight bearing, and was not preceded by trauma. 🔗 https://nej.md/4zOIkwu

A plain radiograph of the right proximal femur and hip showed no abnormalities. MRI was scheduled. One week before the planned MRI, the patient felt a “crack” in her right leg, followed by a fall and severe pain, and was transported to the emergency department. Radiography revealed transverse and impending mid-diaphyseal femoral fractures. She underwent uneventful fixation with a long intramedullary nail.

Four months after placement of the long intramedullary nail in the right femur, the patient sustained a periprosthetic fracture in the left femur after a fall from standing height (seen in image). The previously implanted proximal femoral nail was replaced with a long intramedullary nail, and she was referred to our metabolic bone disease center.

Read the full case details and authors’ commentary in the Clinical Problem-Solving feature “Break a Leg” by M. Wijnen et al.: https://nej.md/4zOIkwu