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

## TL;DR

A patient with a neglected femoral neck fracture also had an extensive gouty tophus, complicating surgery and highlighting the need for preoperative evaluation.

## Contribution

This case highlights the importance of considering gout in patients with proximal femur fractures to avoid surgical complications.

## Key findings

- An extensive gouty tophus was found intraoperatively in a patient with a neglected femoral neck fracture.
- Preoperative complementary exams can help identify gout-related complications in patients with hip fractures.

## 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.