L1 Fracture Subluxation in Patient with Diffuse Idiopathic Skeletal Hyperostosis Diagnosed After Hip Fracture Nail

Case: An 86-year-old man underwent closed reduction and internal fixation of a comminuted intertrochanteric hip fracture with a cephalomedullary nail on a Hana table. Postoperatively, a displaced fracture subluxation of L1 was detected, resulting in complete loss of motor and sensory function below L1. Urgent posterior decompression and fusion from T10-L4 was performed. Diffuse idiopathic skeletal hyperostosis (DISH) was only diagnosed after the incident. Conclusion: A diagnosis of DISH, with increased risk of occult fracture and/or iatrogenic spine injury during hip fixation, may be unknown before surgery. Multiple fractures may prompt consideration of a trauma workup even in assumed low-energy injuries.