A Neck of Femur Fracture Associated With Electric Scooter Use in a Young Patient.

Since the launch of electric scooter (e-scooter) trials in the UK by the Department for Transport (DfT), there has been an upward trend in injuries involving e-scooters. We report a case of a significant orthopaedic injury in a male patient following a fall from an e-scooter. He sustained a right-sided neck of femur fracture. He was treated successfully with a dynamic hip screw. Hip fracture in the young population is rare and is often associated with higher complication rates. We emphasise the importance of prompt identification and operative management of traumatic hip fractures in young patients and raising safety awareness about the use of e-scooters.

Intra-articular Knee Neurofibroma in a Patient with Neurofibromatosis: A Case Report and Review of Literature.

Introduction: Neurofibromatosis type I (NF1) is an autosomal dominant disorder that typically results in Café-au-lait macules and peripheral nerve sheath tumors (i. e, neurofibromas). While peripheral neurofibromas are common, intra-articular knee neurofibromas are rarely described in the literature. To date, there only have been two other case reports noting intra-articular knee neurofibromas. The authors present the case of a patient with NF1 who was found to have an intra-articular knee neurofibroma incidentally discovered during the surgical approach to a retrograde femoral nail. Case Report: The patient is a 65-year-old female who presented to the emergency room after a fall from standing height with left distal thigh pain. X-rays were obtained and demonstrated a left supracondylar, extra-articular distal femur fracture. The patient had known NF1 with widespread cutaneous neurofibromas and was noted to have a large palpable soft-tissue mass over the anterior aspect of the knee on pre-operative examination. After an incision was made for a retrograde femoral intramedullary nail, the large soft-tissue mass prevented adequate surgical visualization. The mass was noted to track laterally around the patellar tendon, into the knee joint, communicating with Hoffa's fat pad. The mass was resected and sent for pathology. The case proceeded uneventfully. The mass sent for pathology was positive for a neurofibroma. Clinical features alongside radiographic, computed tomography, and histopathological findings are presented. Conclusion: Intra-articular knee neurofibromas are rare and there is a paucity of literature on the topic. While found incidentally in our patient, the discovery of an intra-articular neurofibroma underscores the need for further investigation into its potential association with neuropathic arthropathy and other associated joint disorders.

Treatment of Bisphosphonate-Associated Atypical Femur Fracture With a Combination of Teriparatide and a Novel Surgical Technique.

Background/Objective: Atypical femur fractures (AFFs) caused by long-term bisphosphonate use are associated with high rates of delayed healing and nonunion. Case Report: A 64-year-old woman with osteopenia on alendronate for 15 years sustained a displaced left AFF following a fall from standing height. Imaging showed an acute displaced transverse diaphyseal left femur fracture with lateral cortical thickening and beaking. She underwent an open reduction and internal fixation with insertion of a cephalomedullary nail placed in compression mode, utilizing a novel technique involving intraoperative removal of the endosteal hypertrophied cortical bone at the fracture site. Alendronate was stopped and teriparatide was initiated postoperatively. Radiographs at 3.5 months postsurgery showed evidence of normal fracture union with mature callus formation. Discussion: AFFs caused by prolonged bisphosphonate use have a high rate of delayed healing and nonunion due to abnormal bone remodeling. Use of teriparatide postoperatively has been shown to reduce healing time in small observational studies in surgically treated patients. Our case demonstrates an expedited healing time of 3.5 months using teriparatide combined with a novel surgical technique involving removal of a portion of the abnormally remodeled bone and placement of an intramedullary nail in compression mode. Conclusion: Our case demonstrates an expedited healing time of 3.5 months compared to the average reported healing time for AFF of 10.7 months, supporting the use of the combination of teriparatide and a novel surgical technique.

Multiple fractures of the femur: Case report, literature review, and proposal for a shared algorithm of treatment.

Multiple fractures of the femur, defined for the purposes of this study as the association of three or more non-contiguous fractures on the same bone segment, is an exceedingly rare condition with an unknown incidence in the literature. A limited number of studies, mainly consisting of case reports or small case series, have addressed this topic, and no shared consensus or guidelines exist on what the ideal timing and sequence of multiple fracture fixation is. The present paper reports the clinical case of a 36 years old man who sustained a blunt chest injury, a non-concussive head injury, a displaced intracapsular fracture of the left femur (AO 31B2), a left diaphyseal multifragmentary fracture (AO 32B3), a supradiacondylar fracture of the distal end of the left femur (AO 33C1.1), a Hoffa fracture of the lateral left femoral condyle (AO 33B3.2 f), and a multifragmentary fracture of the left patella with bone loss (AO 34C3) due to a vehicular high-energy trauma. The patient was surgically treated by open reduction and internal fixation according to a proposed algorithm of treatment and reported excellent clinical and radiological outcomes at 32 months follow-up. The primary aim of this study is to describe our experience in the treatment of such complex fractures, by presenting our clinical and radiological results, and to propose a treatment algorithm. The secondary aim is to provide a comprehensive review of the literature on this topic.

Prospective study on functional outcome of distal femur fracture treated by open reduction and internal fixation using distal femur locking plate in Tibebe Ghion Specialized Hospital, Bahirdar, North West Ethiopia.

BACKGROUND: Distal femur fractures account for 6% of femur fractures. The treatment of distal femur fractures is challenging. Historically, nonoperative management has been the mainstay of management, which has evolved to operative management. There is no single implant used for all types of distal femur fractures. The implant evolves with time. The introduction of a distal femur locking plate (DF LCP) has had a great impact on the treatment. In developing countries like Ethiopia, there is scarcity of studies on functional outcome of operative treatment. So, this study aimed to assess the functional outcome of distal femur fractures treatment using distal femur locking plate. METHODS: This prospective cohort study was carried out among adult patients with distal femur fractures treated using distal femur locking plate at Tibebe Ghion Specialized Hospital from august 2022 to July 2023. A total of 60 patients with AO Type A and Type C fracture were included. All patients were followed for 6 months. Functional outcomes were assessed using Neer's scoring system. Data was entered and analyzed using SPSS 27. Frequency, mean and cross tabulation were used to summarize descriptive statistics. Multinomial logistic regression was used to test the associations. RESULTS: In our study out of 60 patients ,48.3% (29) had excellent functional outcomes, 30% (18) had good functional outcomes, 10% (6) had fair functional outcomes and 11.7% (7) had unsatisfactory functional outcomes according to Neer's scoring system. Patients with closed distal femur fractures had 5 times higher probability of excellent functional outcome than those patients with open distal femur fractures (AOR (2.49(5.8 ,1.07)). Patients who had regular follow up had 7 times higher probability of excellent functional outcome than those who had no regular follow up (AOR 7.16(1.11,46.22)). The average union period was 4.63 months, with only 2 patients experiencing delayed union. CONCLUSION: Closed fracture and regular follow up were determining factors for better functional outcomes. Closed fractures preserve the biological environment, which facilitates early fracture healing. The regular follow up helped patients to assess their rehabilitation status and pick any complication early.

Treatment of Pathological Proximal Femur Fracture in a Child With a Unicameral Bone Cyst: A Case Report.

Pathological proximal femur fractures secondary to unicameral bone cysts in the pediatric age group are uncommon. Despite the development of modern surgical treatments and implant choices, it is still debatable what the gold standard of treatment is for a unicameral bone cyst with pathological proximal femur fractures. We report a case of an eight-year-old child with a unicameral bone cyst and pathological fracture of the proximal right femur who was surgically treated with curettage, synthetic bone graft, and a pediatric hip plate as the choice of implant for osteosynthesis and stability.

Classification of AO/OTA 31A/B femur fractures in X-ray images using YOLOv8 and advanced data augmentation techniques.

Femur fractures are a significant worldwide public health concern that affects patients as well as their families because of their high frequency, morbidity, and mortality. When employing computer-aided diagnostic (CAD) technologies, promising results have been shown in the efficiency and accuracy of fracture classification, particularly with the growing use of Deep Learning (DL) approaches. Nevertheless, the complexity is further increased by the need to collect enough input data to train these algorithms and the challenge of interpreting the findings. By improving on the results of the most recent deep learning-based Arbeitsgemeinschaft für Osteosynthesefragen and Orthopaedic Trauma Association (AO/OTA) system classification of femur fractures, this study intends to support physicians in making correct and timely decisions regarding patient care. A state-of-the-art architecture, YOLOv8, was used and refined while paying close attention to the interpretability of the model. Furthermore, data augmentation techniques were involved during preprocessing, increasing the dataset samples through image processing alterations. The fine-tuned YOLOv8 model achieved remarkable results, with 0.9 accuracy, 0.85 precision, 0.85 recall, and 0.85 F1-score, computed by averaging the values among all the individual classes for each metric. This study shows the proposed architecture's effectiveness in enhancing the AO/OTA system's classification of femur fractures, assisting physicians in making prompt and accurate diagnoses.

Perioperative and Postoperative Outcomes of Proximal Hip Fracture: A Comparison of Orthopedic and Geriatric Care Models.

Introduction Orthogeriatric patients with femur fractures, despite their multiple comorbidities and associated healthcare costs, have a promising new approach. This approach suggests that most patients should be hospitalized in the geriatric department, with daily orthopedic follow-up. The potential for lower mortality rates through orthogeriatric co-management and dual care is a reason for hope in our field. Methods This study is retrospective and involved 285 patients with proximal hip fractures. Two treatment models were compared: hospitalization in orthopedic and geriatric departments with different treatment protocols. The study analyzed demographic data and postoperative outcomes. It also included an analysis of 26 patients who received conservative treatment. Results Our study revealed significant differences between patients hospitalized in the orthopedic and geriatric departments. Geriatric department patients, who were significantly older and had higher comorbidities, experienced extended hospitalization and higher mortality rates during hospitalization, at 30 days, and at one-year follow-up (p<0.05). Notably, a significantly higher proportion of geriatric patients were discharged to home rehabilitation at the end of hospitalization compared to orthopedic patients (17.5% vs. 7.4%; p<0.01). Among non-operated patients, the mortality rate was 57.7% compared to 16.5% in patients who underwent surgery during the one-year follow-up. Discussion Our study suggests that elderly patients with hip fractures may benefit from management in the geriatric department. Despite experiencing significantly longer hospital stays, these patients have a higher likelihood of being discharged home compared to those managed in the orthopedic department. These findings have important implications for the care of orthogeriatric patients and may help guide future treatment strategies.

Fracture-Related Infection of a Distal Femur Open Fracture Treated With a Supracutaneous Locking Plate.

Fracture-related infection (FRI) is a challenging complication in open fractures. It can cause major disability to patients and a burden to the public health sector. A multidisciplinary approach is required to eradicate infection and improve the quality of life for patients. We present a case of an FRI in an open fracture of the distal femur treated using a supracutaneous locking plate, which is an uncommon technique. This technique yields excellent outcomes in controlling local infection and providing satisfactory stability, especially for a peri-articular distal femur fracture with FRI. Therefore, supracutaneous plating using a locking plate can be considered an alternative option to conventional external fixations in managing FRIs.

Hip fracture projections up to the year 2060: an analysis based on data from the National Hip Fracture Database (NHFD) for England, Wales, and Northern Ireland.

INTRODUCTION: Hip fractures are common and cause a huge socioeconomic burden to patients, their carers, and healthcare services worldwide. Our aim was to examine how much hip fracture numbers would be expected to rise over coming decades, simply as a consequence of the ageing of the population. METHODS: We used data from the National Hip Fracture Database on the volume of hip fractures occurring in England, Wales and Northern Ireland in the year 2019 (n = 67,210). We projected future numbers of hip fractures by applying this number, assuming stable rates, to population growth forecast data provided by the Office for National Statistics up to the year 2060. RESULTS: By 2060, the number of hip fractures occurring in England, Wales and Northern Ireland are projected to increase by 107 % (n = 139,105). In males, there was an estimated increase of 130 % compared with 97 % in females. There was an estimated increase across all age ranges, however the oldest age groups demonstrated the largest relative increases. The estimated increase for those aged 90 years or over was as high as 348 % and 198 % for males and females, respectively. CONCLUSION: As a consequence of future ageing of the population, the demand on the health service posed by people with hip fracture is projected to more than double by the year 2060. Policymakers should be striving to mitigate against the huge public health impact of these projections by maximising fracture prevention strategies as far as possible and by improving the quality of hip fracture care.

Evaluation of Seasonal and Climatic Variations Associated With Femoral Fracture Incidence Among the Elderly Population in Brazil.

INTRODUCTION: Femur fractures represent a significant public health concern for individuals over 60 years of age. In Brazil, the incidence of these fractures has shown a rising trend in line with population aging. Besides intrinsic risk factors like osteoporosis, seasonal and climatic variables have been suggested to significantly influence the occurrence of these fractures. METHODS: Epidemiological data were sourced from the Hospital Information System of the Unified Health System (SIH-SUS) using the TABNET tool provided by the Department of Informatics of the Unified Health System (DATASUS). Information on hospital admissions for femur fractures in individuals over 60 years, categorized by diagnosis, region, and month, was collected from 2008 to 2023. Climatic data were obtained from the Brazilian National Institute of Meteorology (INMET) for the period from 1991 to 2020. Monthly average temperatures were compared with epidemiological data and analyzed to uncover correlations using ANOVA and Tukey's honestly significant difference (HSD) test. RESULTS: During Brazil's winter months (June to August: 22.8 to 23.5º Celsius), average temperatures are at their lowest. This period also coincides with the peak incidence of femur fractures among the elderly. ANOVA revealed significant differences in fracture rates across various temperature ranges. Subsequent analysis using Tukey's HSD test identified significant differences between temperature ranges of 22-23°C and 25-26°C, as well as 23-24°C and 25-26°C. These results indicate that lower temperatures are associated with a higher incidence of femur fractures among the elderly. CONCLUSION: The analysis reveals a seasonal pattern in fracture incidence among older adults, with a notable increase during the colder months. To mitigate this risk, it is recommended to implement strategies such as heightened surveillance during colder months, targeted fall prevention measures, and effective osteoporosis management. These interventions aim to reduce the incidence of fractures in this vulnerable population.

Who Is Treating Periprosthetic Femur Fractures? An Analysis of the Periprosthetic Research Consortium.

Background: Periprosthetic femur fractures (PPFFs) following total hip arthroplasty (THA) have increased in the past decade as the demand for primary surgery continues to grow. Although there is now more evidence to describe the treatment of Vancouver B fractures, there is still limited knowledge regarding factors that cause surgeons to perform either an open reduction and internal fixation (ORIF) or revision THA (rTHA). The purpose of this study was to determine what type of surgeons treat Vancouver B PPFFs at 11 major academic institutions and if there are trends in treatment decision-making regarding the use of ORIF or rTHA based on surgical training or patient factors. Methods: This multicenter retrospective study evaluated patients surgically treated for Vancouver B PPFF after THA between 2014 and 2019. Patients from 11 academic centers located in the United States were included in this study. Surgical outcomes and patient demographics were evaluated based on surgeon training, surgical treatment type, and institution. Results: Presence of Vancouver B2 (odds ratio [OR]: 0.02, P < .001) or B3 (OR: 0.04, P < .001) fractures were independent risk factors for treatment with rTHA. Treatment by a trauma (OR: 12.49, P < .001) or other-specified surgeon (OR: 13.63, P < .001) were independent risk factors for ORIF repair of Vancouver B fractures. There were no differences in outcomes based on surgeon subspecialty training. Conclusions: This study showed the trends in surgeons who surgically manage Vancouver B fractures at 11 major academic institutions and highlighted that regardless of surgical training or surgical treatment type, postoperative outcomes following management of PPFF were similar.

Geriatric femur fractures: Index fracture pattern is associated with the risk of subsequent peri-implant fracture.

Introduction: Following an index femoral fragility fracture, patients are at risk of a subsequent peri-implant fracture. Management of these injuries are further complicated by patient factors and multi-institutional care. This study quantifies such events and compare rate of identification between in-system and out-of-system patients. Methods: A retrospective chart review of index operative femoral fragility fractures at a level I trauma center from January 1, 2005 to January 1, 2018 identified 840 patients with twenty-two subsequent peri-implant fractures. Kaplan Meier survival analyses assessed associations between patient and injury characteristics with the subsequent fracture while accounting for differential follow-up. Cumulative incidence curves were reported, and Cox regression analyses estimated hazard ratios for statistically significant associations. In-system and out-of-system patients were compared with absolute rate of identifying subsequent fracture and follow-up time. Results: Cumulative incidence of subsequent fracture was 2.1 % at 2 years, 3.4 % at 4 years, and 4.6 % at 6 years. The index fracture pattern (intertrochanteric vs other) was associated with a cumulative incidence of subsequent peri-implant fracture (0.8 % at 2 years, 1.4 % at 4 years, and 2.7 % at 6 years for intertrochanteric fractures vs 3.4 % at 2 years, 5.3 % at 4 years, and 6.4 % at 6 years for non-intertrochanteric fractures), p = 0.029. Follow-up was shorter for out-of-system patients (median 6 versus 28 months, p < 0.001), and only 1 of 348 out-of-system patients (0.3 %) vs. 21 of 492 in-system patients (4.3 %) were diagnosed with a subsequent peri-implant fracture (p < 0.001). There was no association of subsequent peri-implant fracture with patient demographics or comorbidity burden. Conclusion: Cumulative incidence of subsequent peri-implant fracture was higher for non-intertrochanteric (femoral neck, shaft and distal femur) fractures than intertrochanteric fractures. Out-of-system patients had shorter follow-up and were less likely to be diagnosed with a subsequent peri-implant fracture, indicating ascertainment bias and underscoring the importance of accounting for loss to follow-up. Level of evidence: Therapeutic Level III.

Does gait influence biomechanics in a distal femoral osteotomy? An early post operative fracture after DFO above a Tomofix® plate in a multiple sclerosis and low-density bone affected patient: choose a longer plate-a case report.

BACKGROUND: Distal femur osteotomies are a well known and valuable treatment option to manage valgus malalignment with unicompartmental arthritis. Early postoperative complications are well known, and risk factors, such as pulmonary diseases, smoke, high dependent functional status, and body mass index, have been studied, but no study is available about osteotomies when gait is abnormal because of neurodegenerative conditions or when mineral density is below the normal rate. CASE PRESENTATION: We report the case of a 44 year-old female Mediterranean patient who underwent a biplanar distal femur opening wedge osteotomy surgery following a lateral meniscus total removal, which led to the subsequent development of lateral compartment osteoarthritis and pain, despite general comorbidities, such as multiple sclerosis. Additionally, 2 months later a supracondylar femur fracture above the previously applied Tomofix® plate was reported. Fracture was treated by applying a LCP condylar 16 hole (336 mm) plate, a structural fibular graft, and strut fibular graft on the opposite side. CONCLUSION: The overall aim of this case report is to provide a lesson to surgeons who want to perform a realignment surgery of the lower limb in patients with abnormal gait. Not only mechanical axes are to be considered, but also bone density, patient's gait, and load force distribution along the bone stock. Emerging literature on three-dimensional cutting guides fails to account for these factors, thus promoting a standardized approach to surgery across all patients. The present case highlights a patient with low bone density and abnormal force distribution resulting from a pathologic neurodegenerative gait. In such cases, treatment decisions must carefully consider the biomechanical vulnerabilities of the native bone and the distribution of vector forces. These conditions must lead the choice toward a longer plate if an osteotomy is indicated, because surgery is more likely to fail.

A case of recurrent proximal femoral fracture after open reduction and internal fixation with bilateral locking plates for a Rorabeck type II periprosthetic fracture.

INTRODUCTION AND IMPORTANCE: Periprosthetic distal femur fractures (PDFFs) are rare complications that may occur during or after total knee arthroplasty (TKA). The incidence of PDFFs is increasing. Plate internal fixation has demonstrated positive results. However, there is limited research available on the recurrence of periimplant fractures following open reduction and internal fixation with bilateral locking plates. CASE PRESENTATION: A 70-year-old female patient was diagnosed with a Rorabeck type II fracture. Based on the patient's physical condition and available surgical options, minimally invasive open reduction, bilateral plate fixation, and allograft artificial bone grafting were chosen. The postoperative recovery was successful. However, the patient experienced a fall 2 months after the surgery, resulting in a proximal femoral fracture. After considering the patient's condition and family preferences, conservative treatment was ultimately decided upon. CLINICAL DISCUSSION: Minimally invasive bilateral Locking Compression Plate (LCP) as a surgical approach can effectively reduce surgical risks prior to the procedure. Careful selection of screws and the use of C-arm fluoroscopy during plate contouring and fixation are essential to prevent screw penetration through the contralateral cortex. Treatment outcomes were not impacted in patients with normal bone mass; however, in this particular case, the patient had severe osteoporosis, significantly increasing the risk of refracture. It is crucial to improve postoperative monitoring and raise awareness about safety among patients and their families. CONCLUSION: The management of periprosthetic distal femur fractures (PDFFs) is influenced by the type of fracture and bone quality. Mechanical stability and stress dispersion of internal fixation are key factors to consider. In the perioperative setting, involving experienced clinicians is essential to reduce the risk of secondary injuries that may impact treatment outcomes, especially when choosing screws for fixation in patients with low bone density.

Current Concepts in Management of Distal Femur Fractures.

Recent studies report the overall incidence of distal femur fractures as 8.7/100,000/year. This incidence is expected to rise with high energy motor vehicle collisions and elderly osteoporotic fractures in native and prosthetic knees keep increasing. These fractures are more common in males in the younger age spectrum while females predominate for elderly osteoporotic fractures. Surgical treatment is recommended for these fractures to maintain articular congruity, enable early joint motion and assisted ambulation. Over the last two decades, development of minimally invasive and quadriceps sparing surgical approaches, availability of angle stable implants have helped achieve predictable healing and early return to function in these patients. Currently, laterally positioned locked plate is the implant of choice across all fracture patterns. Retrograde with capital implantation of intramedullary nails with provision for multiplanar distal locking is preferred for extra-articular and partial articular fractures. Even with these advancements, nonunion after distal femur fracture fixation can be as high as 19%. Further recent research has helped us understand the biomechanical limitations and healing problems with lateral locked plate fixation and intramedullary nails. This has lead to development of more robust constructs such as nail-plate and double plate constructs aiming for improved construct strength and to minimise failures. Early results with these combination constructs have shown promise in high risk situations such as fractures with extensive metaphyseal fragmentation, osteoporosis and periprosthetic fractures. These constructs however, run the risk of being over stiff and can inhibit healing if not kept balanced. The ideal stiffness that is needed for fracture healing is not clearly known and current research in this domain has lead to the development of smart implants which are expected to evolve and may help improve clinical results in future.

Cemented Bipolar Hemiarthroplasty as a Treatment Modality for Pathological Fracture in the Proximal Femur Metastasis Without the Recurrence of Primary Breast Cancer: A Case Report.

Metastatic lesions in the proximal femur are well-known in the literature and are important since they can progress to pathological fractures and impair the patient's mobility. We present the case of a middle-aged female with a history of breast carcinoma 20 years ago, who experienced diffuse chronic hip pain for the past two months. Radiographs, MRI, and PET scans revealed a metastatic lesion in her proximal femur. After consulting with an oncologist, it was determined that adjuvant chemoradiotherapy was unnecessary. The treatment strategy was dependent on the preoperative general health condition, the life expectancy, amount of metastasis, bone quality, pathological fractures and factors affecting the union and capacity to ambulate the patient postoperatively. The patient underwent a cemented bipolar hemiarthroplasty to excise all metastatic tissue and provide a painless, functional, and mobile joint. Bipolar hemiarthroplasties articulate at two levels, and this dual-bearing design is believed to reduce acetabular wear. The bipolar hemiarthroplasty also eliminated the risk of complications associated with the acetabular component, which would necessitate early revision surgery. Modular bipolar hemiarthroplasty is a good modality of replacement associated with fewer complications and improves quality of life.

Obese adolescents have higher risk for femur fracture after motor vehicle collision.

Background: Previous reports identified an association between obese adolescents (OAs) and lower extremity (LE) fractures after blunt trauma. However, the type of LE fracture remains unclear. We hypothesized that OAs presenting after motor vehicle collision (MVC) have a higher risk of severe LE fracture and will require a longer length of stay (LOS) and more support services upon discharge, compared to non-OAs. Methods: The 2017-2019 Trauma Quality Improvement Program database was queried for adolescents (12-17-years-old) presenting after MVC. The primary outcome was LE fracture. A severe fracture was defined by abbreviated injury scale ≥3. OAs were defined by a body mass index (BMI) ≥30. Results: From 22,610 MVCs, 3325 (14.7 %) included OAs. The rate of any LE fracture was higher for OAs (21.6 % vs. 18.8 %, p < 0.001). On subset analysis the only LE fracture at higher risk in OAs was a femur fracture (13 % vs. 9.1 %, p < 0.001). After adjusting for sex and age, the risk for severe LE fracture (OR 1.34, CI 1.18-1.53, p < 0.001) was higher for OAs. OAs with a femur fracture had a longer median LOS (5 vs. 4 days, p = 0.003) and were more likely discharged with additional support services including home-health or inpatient rehabilitation (30.6 % vs. 21.4 %, p < 0.001). Conclusion: OAs sustaining MVCs have increased associated risk of femur fractures. OAs are more likely to have a higher-grade LE injury, experience a longer LOS, and require additional support services upon discharge. Future research is needed to determine if early disposition planning with social work assistance can help shorten LOS.

Atypical Presentation of Multiple Myeloma Affecting Appendicular Skeleton Associated with Pathological Neck of Femur and Proximal Humerus Fractures - A Case Report.

Introduction: The increasing incidence of atraumatic neck of femur (NOF) fractures, often linked to age-related bone weakening, is a notable clinical trend. This case report highlights a 72-year-old male presenting with NOF and proximal humerus fractures post-trivial fall, revealing lytic lesions suggestive of multiple myeloma (MM). Despite inconclusive skeletal and metabolic evaluations, a comprehensive surgical approach confirmed MM, emphasizing the importance of thorough diagnostic and therapeutic management in complex cases. Case Report: A 72-year-old male presented with a trivial fall resulting in hip and shoulder trauma, revealing right transcervical NOF and proximal humerus fractures on X-rays, alongside multiple lytic lesions suggesting MM. Despite inconclusive metabolic evaluations, conservative management was pursued for the humerus fracture, while a complex surgical approach involving curettage and cemented bipolar hemiarthroplasty was undertaken for the femur fracture, confirming MM on histopathology. Conclusion: Evaluating atypical MM manifestations in the appendicular skeleton requires comprehensive assessment and diagnostic procedures to influence outcomes and improve quality of life. Managing suspected pathological fractures involves detailed evaluation and surgical planning, highlighting the importance of collaboration among different specialties.