Parker et al. Journal of Medical Case Reports 2011, 5:219 http://www.jmedicalcasereports.com/content/5/1/219 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Proximal femoral fracture in a man resulting from modern clipless pedals: a case report James Parker*, Neil Patel and Ganesh Devarajan Abstract Introduction: The use of clipless pedals amongst recreational cyclists has become increasingly popular in recent years. We describe a hip fracture, that was sustained due to inadequate set up of such pedals. To the best of our knowledge, this has only been described once before, and this was in the non-English language medical literature. Case Report: A 38-year-old Caucasian man who was a club cyclist sustained a displaced intracapsular fracture of the hip whilst cycling. As a direct result of the incorrect set-up of his clipless pedals he was unable to release his feet whilst slowing to a halt. This resulted in a loss of balance and subsequent fall with a direct impact onto his left hip. The resulting fracture was managed successfully with early closed reduction and fixation. At six month review he was walking unaided without pain but, as yet, has been unable to return to cycling. Conclusion: This case highlights the dangers of clipless pedals even in experienced cyclists, and underlines the importance of proper information for their correct setup to minimise the risk of potentially serious injuries, especially in the region of the hip. Introduction Intra-capsular fractures of the femoral neck are extre- mely common in the elderly population and may be associated with relatively minor trauma. In the younger population, however, intra-capsular fractures are usually the result of high energy trauma with serious conse- quences of avascular necrosis of the femoral head. We report a case of a displaced intra-capsular hip fracture in an otherwise fit and well 38-year-old Cauca- sian man as a direct result of his bicycle pedals being set too tight. Case presentation A previously healthy 38-year-old Caucasian man and competitive amateur cyclist sustained a displaced frac- ture of his left femoral neck following a fall from his racing bicycle whilst at rest. Having slowed gradually to a halt, our patient attempted to unclip his feet from the pedals. He was unable to unclip his feet and when the bicycle slipped on some ice, he was unable to remove his feet to steady himself. As a result he sus- tained a direct trauma to his left hip, resulting in a * Correspondence: jimpark99@hotmail.com Hull and East Yorkshire NHS Trust, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK displaced intra-capsular fracture of the right femoral neck (Figure 1, 2). Once other injuries had been excluded and adequate imaging had been obtained, our patient was admitted to our orthopedic ward and a closed reduction and internal fixation was performed later the same day. Reduction was obtained using the Leadbetter maneuver [1], and fixation performed with three 6.5 mm cannulated screws (Figure 3, 4). The surgical treatment was completed within 12 hours of the injury. Subsequent to the fixation our patient progressed well with no immediate compli- cations and was discharged two days following the injury. Toe touch weight bearing was commenced for a period of six weeks and, following satisfactory radio- graphs, partial weight bearing was allowed for a further six weeks. Although our patient had no risk factors for osteo- porosis, given the relatively low energy of the injury, a bone density scan was performed along with other metabolic bone disease screening tests. These were all within normal limits. At a subsequent review four months after the injury, our patient had no pain in the hip, a good range of movement and is walking unaided. Radiographic appear- ances are satisfactory and show no evidence of avascular © 2011 Parker et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.