Hip Pelvis.  2019 Dec;31(4):238-241. 10.5371/hp.2019.31.4.238.

Pathological Fracture of the Femoral Neck due to Tophaceous Gout: An Unusual Case of Gout

• Jeon YS
• Hwang DS
• Hwang JM
• Lee JK
• Park YC

• KMID: 2464241
• DOI: http://doi.org/10.5371/hp.2019.31.4.238

Abstract

A 48-year-old man visited the emergency room with right hip pain that started abruptly while walking out of the bathroom. Computed tomography showed an intraosseous mass in the femoral neck. The patient had a 15-year history of gout and had numerous bilateral tophi in his hands, feet, knees, and elbows. After operation, we diagnosed a pathological fracture due to intraosseous tophi. Patients with hip pain who have many subcutaneous tophi and long-standing gout should be diagnosed carefully. Peri-hip joint pain caused by gout is uncommon, however, if a patient complains of pain, a simple X-ray may be required. If intraosseous tophi are present, appropriate treatment (e.g., strict hyperuricemia control with or without prophylactic internal fixation), may be required before fracture occurs.

Keyword

Gout arthritis; Femoral neck fracture; Intraosseous tophi; Subcutaneous tophi

MeSH Terms

Arthralgia
Elbow
Emergency Service, Hospital
Femoral Neck Fractures
Femur Neck*
Foot
Fractures, Spontaneous*
Gout*
Hand
Hip
Humans
Hyperuricemia
Knee
Middle Aged
Walking

Figure

• 

  Fig. 1 Initial X-ray and computed tomography (CT) scan at the emergency room. (A) Simple X-ray reveals an oval, sclerotic marginal cystic mass and fracture line around the femoral neck. (B) CT scan reveals an intraosseous mass in the femoral neck.

• 

  Fig. 2 Gross photos and simple X-rays. (A) Gross photos of hands and feet. The patient has many subcutaneous tophi. (B) Both hands and feet X-rays. Typical punched-out lesions (arrows) and overhanging margins (arrowheads) are seen. Elbow (C) and knee (D) X-rays. Arrowhead indicates subcutaneous tophi of left elbow and arrow indicates intra-articular tophi.

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  Fig. 3 (A) Gross photo obtained during operation. A chalky and paste-like mass is shown. (B) Photograph of pathology. Fibrotic and necrotic changes are seen around tophi. And only few normal cells are seen (H&E, ×100). (C) The mass shows negative birefringence on the polarized microscope. (D) The last follow-up X-ray. There was no pain in either hip joint for two years postoperatively.

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