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December 27, 1965

Femoral-Shaft Fracture Below Hip Prosthesis

Author Affiliations

From the Fracture Clinic, Massachusetts General Hospital, Boston.; Dr. Wyman is instructor in orthopedic surgery, Harvard Medical School, and assistant in orthopedic surgery, Massachusetts General Hospital.

JAMA. 1965;194(13):1378-1381. doi:10.1001/jama.1965.03090260038012

Dr. Turner: An 80-year-old woman fell and injured her left hip. Prior to her fall, she had been an active nursing-home resident who was able to walk about freely and care for her basic needs. She was treated initially by bed rest, but was referred to the Massachusetts General Hospital 21 days following her injury because of progressively severe left hip pain.

Physical examination showed a healthy 80-yearold woman who was generally cooperative, but demonstrated occasional episodes of disorientation and confusion, especially after sundown. General medical evaluation, laboratory data, electrocardiogram, and chest x-ray were all normal. Hip x-rays revealed a displaced fracture of the left femoral neck with some early heterotopic new bone superior and lateral to the hip joint (Fig 1).

A Moore prosthesis was inserted through a lateral approach on the day following admission (Fig 2). Postoperatively the patient required considerable attention to pulmonary hygiene, and a Foley