The patient was a previously healthy 20 year old female college student who was involved in a high speed motorcycle accident, in which the driver of the motorcycle was killed.
She sustained multiple injuries including a mild closed head injury, a splenic laceration, pneumothorax, a pelvic ring injury (SI joint disruption), right radius and ulna fracture, a left ipsilateral femoral shaft and neck fracture in which the shaft was open grade IIIA.
On the night of her injury,she went to the OR for splenectomy, irrigation and debridement of her open fracture, fixation of her femur and SI joint all fractures of immobilization.
The femoral neck fracture was treated with open reduction and screw fixation, and the femur was fixed with an antegrade intramedullary nail, after irrigation and debridement of the wound.
The SI joint was stabilized with percutaneous iliosacral screws. The reduction was felt to be excellent. Other orthopaedic injuries were treated with subsequent operations.
Within three months, radiographs revealed a loss of fixation with development of a varus deformity at the femoral neck and the diagnosis of femoral neck nonunion was made.