title: Fractured neck of femur below long spinopelvic fixation for Charcot spine: a case report.
abstract: BACKGROUND
  We present a case of a patient with a previously undescribed complication: intertrochanteric femoral neck insufficiency fracture after long-segment instrumented spinopelvic fusion to the ilium for Charcot spine.
  
  
  METHODS
  A 42-year-old Caucasian man with post-traumatic complete T6 paraplegia presented to our institution after developing Charcot spinal arthropathy at L3 and L4 and symptoms of autonomic dysreflexia 21 years after his original spinal cord injury. Multiple anterior and posterior surgeries were required to eventually achieve stabilization of his thoracolumbar spine to his pelvis and resolution of symptoms. The most distal fixation point was two iliac wing screws bilaterally. At 10 weeks after the final spinal surgery and after posterior spinal bony consolidation had occurred, he sustained an intertrochanteric femoral neck fracture, distal to the iliac fixation, whilst bending forward in his wheelchair. His proximal femoral fracture was internally fixed with an intramedullary device.
  
  
  CONCLUSIONS
  Spinal Charcot's arthropathy is a rare condition that may occur in patients with post-traumatic spinal cord injury. Although associated with high risk of complications, circumferential instrumented fusion in Charcot spine can restore spinal stability. Insufficiency fractures of the proximal femur are possible complications of long spinopelvic fusions.
authors.affiliation: Department of Spinal Surgery, The Austin Hospital Melbourne, University of Melbourne, 8th Floor Harold Stokes Building, PO Box 5555, Heidelberg, VIC 3084, Australia. gerald.quan@austin.org.au.
authors.forename: Gerald My
authors.initials: GM
authors.lastname: Quan
authors.forename: Peter
authors.initials: P
authors.lastname: Wilde