Extensive Gouty Tophus in Neglected Femoral Neck Fracture: A Case Report

Abstract

Femoral neck fractures are extremely common injuries, especially in the elderly, who often have multiple associated comorbidities. Despite advances in surgical technique and implant technology, neglected fractures are still a reality in developing countries due to the lack of access to healthcare services or socioeconomic conditions of patients. This case report presents a 61-year-old male patient referred from a rural area to a trauma referral hospital with a neglected femoral neck fracture. The patient had multiple comorbidities, and during the surgical approach for total hip arthroplasty, the intraoperative finding of an extensive gouty tophus led to an increase in surgical time and modifications in the surgical procedure. The epidemiological profile of the patient in question fits the pattern of patients with diffuse gouty arthropathy, warranting suspicion of hip involvement when manifested in other joints. Performing complementary exams in patients preoperatively with proximal femur fractures and coxarthrosis can be an indispensable tool for the successful implementation of the therapeutic plan. This report presents these findings and the outcome of the method used.

Keywords: femoral neck fracture; gout; gouty tophus; neglected fracture; total hip arthroplasty.

Figure 1. (A) Diffuse gouty tophi in phalanges, metacarpophalangeal joints, and wrists; (B) Presence of gouty lesions in the right elbow; (C) Gouty tophus in the left elbow

Figure 2. Anteroposterior pelvic radiograph, performed with traction and internal rotation of the limbs, showing an old left femoral neck fracture

Figure 3. Gouty tophus occupying the incision area in posterolateral hip access

Figure 4. The aspect of the dried gouty tophus and devitalized femoral head

Figure 5. (A) Postoperative X-ray immediately after surgery; (B) Follow-up X-ray, with 12 weeks of progression.