SCI
Let It Go, Let It Go: The Frozen Hip Bothers Me Everyday - A Case of Unusual Callus Formation at the Femoral Neck in Spinal Cord Injury
Chi Lam Kwok, DO
PM&R Resident
Nassau University Medical Center
Rego Park, New York, United States
Ricky Jung, n/a
OMS IV
NYITCOM
BROOKLYN, New York, United States
Brent Fogel, DO
PM&R Resident
Nassau University Medical Center
Melville, New York, United States
Forrest Butensky, DO
PM&R Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
Justin Wang, MD
PM&R Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
Walter Gaudino, MD
Attending physician
Nassau University Medical Center
East Meadow, New York, United States
Ricky Jung
NYITCOM
BROOKLYN, New York, United States
A 46-year-old male with a history of cervical spinal cord injury (SCI) from a 2022 diving accident, status post C3–C6 anterior cervical discectomy and fusion (ACDF), presented with persistent right hip stiffness despite one year of physical and occupational therapy. He is wheelchair-bound, requires maximal assistance for transfers, and has no sensation below the umbilicus. Given severe restriction in right hip motion, radiographs were obtained. Imaging revealed a large callus around the right femoral neck, extensive heterotopic ossification, and ankylosis to the ilium, likely from an unrecognized prior injury. Degenerative changes with decreased femoral head coverage were also present. SCI patients are at high risk for rapid bone loss and fragility fractures, most commonly at the distal femur and proximal tibia. Proximal femoral pathology is less frequently reported. Missed femoral neck fractures can progress to nonunion with exuberant callus formation, especially in sensory-deficient individuals. This case demonstrates an unusual presentation of femoral neck callus with ankylosis in an SCI patient, likely due to a prior undiagnosed fracture. It emphasizes the importance of early imaging in SCI patients with unexplained hip stiffness to prevent irreversible joint ankylosis. This case underscores the need for vigilance in assessing proximal femoral pathology in SCI patients and highlights early imaging as a key step in prevention and management.
He denied pain but reported that therapists were unable to flex his right hip during therapy. On examination, there was bilateral lower extremity weakness (4/5), bilateral hip flexion limitation (right 0°, left 30°), upper extremity contractures, and positive bilateral Babinski signs.
Case Description:
The patient was counseled regarding the chronic nature of these findings. CT pelvis was ordered for further characterization, and surgical consultation was discussed. He was advised to continue therapy focusing on transfers and compensatory mobility.
Discussions:
Conclusions:
