Stress fracture of the proximal femur after screw removal.

We describe a case of stress fracture of the proximal femur occurring in a patient after removal of an internal fixation device for a comminuted subtrochanteric fracture. The presenting clinical picture resembled a late postoperative infection with a positive technetium and gallium bone scan and normal radiological findings. The stress fracture occurred after removal of the fixation device when the patient started full weight-bearing. The patient was treated initially as having osteomyelitis until a second X-radiograph some weeks later demonstrated a stress fracture through one of the previous screw holes. This case illustrates well the possible complication of a insufficiency fracture subsequent to the occurrence of stress risers through screw holes in a weakened bone when submitted to normal load. The clinical presentation may sometimes resemble late postoperative infection.