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Pseudopathologic Fracture of the Neck of the FemurA Case Report
Mitchell T. Keschner, MD1; Matthew R. Bong, MD1; James C. Wittig, MD1; Nirmal Tejwani, MD1
1 New York University-Hospital for Joint Diseases, 301 East 17th Street, 14th Floor, New York, NY 10003. E-mail address for M.T. Keschner: mkesch@aol.com
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The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, New York University-Hospital for Joint Diseases, New York, NY

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Jul 01;86(7):1534-1537
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The most common site for a pathologic fracture due to metastatic disease is the proximal aspect of the femur1. Recognition of the radiographic characteristics of a fracture that occurs through a primary malignant or metastatic lesion is crucial for proper diagnosis. Failure to recognize radiographic clues can lead to mismanagement of the patient and nontreatment of an underlying malignant disease. Likewise, being overly suspicious about findings on the radiographs can lead to unnecessary testing and can delay prompt surgical treatment. A preexisting lesion should be suspected when a patient who does not have osteoporosis has sustained a femoral neck fracture during normal activity or after minor trauma or when a patient who has a known primary malignant disease has sustained such a fracture. We present the case of a fifty-four-year-old female smoker with no prior medical problems for whom radiographs made after a fall were suggestive of a pathologic subcapital fracture of the right femoral neck. The appropriate evaluation for patients with a pseudopathologic fracture of the femoral neck is reviewed. Our patient was informed that data concerning the case would be submitted for publication.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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