Plain abdominal radiography in the diagnosis of the "body packer".

Our patient had no evidence of any underlying bony abnormality predisposing to fracture and the radiological appearances of the healing fracture were also entirely normal. Pregnancy can be associated with a generalised decreased bone density usually causing back pain and possibly vertebral compression fractures but this is uncommon.' The transient osteoporosis of the hip in pregnancy is also rare but can lead to pathological femoral neck fractures but this is usually late in the third trimester.4 Stress fractures are also found but usually involve the pubis in late. pregnancy, often related to childbirth.5 Our patient had no evidence to suggest any such predisposing factors. The diagnosis of a femoral shaft fracture with ultrasound in our patient was fortuitous for several reasons. Firstly a femoral shaft fracture in a young adult usually requires significant trauma and the index of suspicion for such an injury in our patient was low. Secondly the patient was pregnant so ultrasound was used to establish the diagnosis and subsequent x ray irradiation of the fetus was minimised. Thirdly, the patient could not localise an area of focal tenderness and the pelvic radiograph initially requested to exclude a hip injury would have missed the femoral shaft fracture, unnecessarily irradiated the fetus, and incorrectly reassured the casualty staff.