case_images: PMC6664517_01
case_images: AP view of left hip injury radiographs showing periprosthetic femur fracture with evidence of a potential stress riser at the distal DHS/bone junction, with a significant amount of bony overgrowth of the DHS.
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case_images: PMC6664517_01_CRIOR2019-6814375.001.jpg
case_images: fig1
case_images: Close inspection of imaging at the time of repeat injury showed evidence of a potential stress riser at the distal DHS/bone junction, with a significant amount of bony overgrowth of the DHS (Figure 1).
case_images: AP view of bilateral proximal femurs taken years prior to injury, showing evidence of stress shielding with significant bony overgrowth of the DHS.
case_images: CRIOR2019-6814375.002.jpg
case_images: PMC6664517_01_CRIOR2019-6814375.002.jpg
case_images: fig2
case_images: Additionally, there was evidence of stress shielding with significant cortical thickening involving the entire lateral cortex seen on radiographs taken prior to injury (Figure 2).
case_images: Intraoperative images of the left femur showing extensive bony overgrowth of the implant.
case_images: CRIOR2019-6814375.003.jpg
case_images: PMC6664517_01_CRIOR2019-6814375.003.jpg
case_images: fig3
case_images: Gross intraoperative inspection showed extensive bony overgrowth of the implant (Figure 3).
case_images: Intraoperative images of the left femur after removal of bony overgrowth and lateral plate with osteotomies. The hip screw is still in place.
case_images: CRIOR2019-6814375.004.jpg
case_images: PMC6664517_01_CRIOR2019-6814375.004.jpg
case_images: fig4
case_images: Osteotomies were utilized to remove the bony overgrowth to extract the hardware (Figures 4 and 5).
case_images: Intraoperative C-arm image of the left femur following implant removal. Notice the thin lateral cortex.
case_images: CRIOR2019-6814375.005.jpg
case_images: PMC6664517_01_CRIOR2019-6814375.005.jpg
case_images: fig5
case_images: Osteotomies were utilized to remove the bony overgrowth to extract the hardware (Figures 4 and 5).
case_images: (a-c) Intraoperative C-arm images of the left femur demonstrating a long-reamed cephalomedullary nail with distal interlocking screws.
case_images: CRIOR2019-6814375.006.jpg
case_images: PMC6664517_01_CRIOR2019-6814375.006.jpg
case_images: fig6
case_images: After successful removal of the previous sliding hip screw, the fracture was exposed, reduced, and a long reamed cephalomedullary nail was placed with distal interlocking screws without difficulty (Figures 6(a)-6(c)).
case_images: (a and b) Postoperative radiographs showing a healing fracture with abundant callus along the cortex.
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case_images: PMC6664517_01_CRIOR2019-6814375.007.jpg
case_images: fig7
case_images: At subsequent postoperative follow-up visits, radiographic imaging revealed complete union of the previous fracture with an abundant amount of bridging callus (Figures 7(a) and 7(b)).