Long-term results of a post-partum bilateral Garden 4 femoral neck fracture in a young woman with transient osteoporosis treated with closed reduction and internal fixation
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20231189Keywords:
Bilateral femoral neck fracture, Transient osteoporosis, Internal fixation, Long-term resultsAbstract
Bilateral femoral neck fractures are very rare conditions. In our knowledge, only five cases were reported of bilateral acute femoral neck fracture secondary to transient osteoporosis. The present case is the first with a long-term follow up after treatment with closed reduction and internal fixation. A 32-year-old women was admitted to the emergency orthopedic clinic due to severe pain in both hips and an inability to walk one-day post-partum. Clinical examination revealed bilateral externally rotated legs and X-ray showed bilateral Garden 4 displaced subcapital fracture of the neck of the femur. The patient was operated on urgently by closed reduction and internal fixation. Osteoporosis was found in the measurements of bone mineral density and bisphosphonate with vitamin D medication was started. 6 years after surgery the patient can carry out her daily activities without limitation. His Harris hip score was 97 points/right and 95 points/left; and the X-ray was normal regarding osteoarthritis and avascular necrosis. Internal fixation should be the primary choice for the treatment of a bilateral femoral neck fractures with a high degree of displacement in young adults even with reversible poor bone quality condition such transient osteoporosis.
References
Chadha M, Balain B, Maini L, Dhal A. Spontaneous bilateral displaced femoral neck fractures in nutritional osteomalacia-a case report. Acta Orthop Scand. 2001;72(1):94-6.
Popescu D, Trandabat C, Puha B, Veliceasa B, Alexa O. Management of bilateral femoral neck fracture in a nonagenarian patient-case report. Rev Med Chir Soc Med Nat. 2016;120(2):376-9.
Gerster JC, Charhon SA, Jaeger P. Bilateral fractures of femoral neck in patients with moderate renal failure receiving fluoride for spinal osteoporosis. Br Med J. 1983;287(6394):723-5.
Carter T, Nutt J, Simons A. Bilateral femoral neck insufficiency fractures secondary to vitamin D deficiency and concurrent corticosteroid use-a case report. Arch Osteoporos. 2014;9(1):172.
McGoldrick N, Dodds M, Green C, Synnott K. Management of simultaneous bilateral neck of femur fractures in an elderly patient. Geriatr Orthop Surg Rehabil. 2013;4(3):71-3.
Marsh JP, Leiter JR, Macdonald P. Bilateral femoral neck fractures resulting from a grand mal seizure in an elderly man with Down syndrome. Orthop Rev. 2010;2(1):e10.
Brennan SA, O’Neill CJ, Tarazi M, Moran R. Bilateral neck of femur fractures secondary to seizure. Pract Neurol. 2013;13(6):420-1.
Tompkins GS, Henderson RC, Peterson HD. Bilateral simultaneous fractures of the femoral neck: case report. J Trauma. 1990;30(11):1415-6.
Sohal HS, Goyal D. Simultaneous bilateral femoral neck fractures after electrical shock injury: a case report. Chin J Traumatol. 2013;16(2):126-8.
Chan S, Rowbottom L, McDonald R, David E, Chung H, Yee A et al. Pelvic insufficiency fractures in women following radiation treatment: a case series. Ann Palliat Med. 2016;5(3):233-7.
Austin JC, Chrissos M. Displaced bilateral femoral neck fractures in a woman with a history of oral steroid use. Orthopedics. 2005;28(8):795-7.
Marttini Abarca J, Carrillo García P, Mora-Fernandez J. Atraumatic bilateral femoral neck fractures in an octogenarian male associated with androgen deprivation therapy: A case report. Eur Geriatric Med. 2017;8(1):77-8.
Kasahara K, Kita N, Kawasaki T, Morisaki S, Yomo H, Murakami T. Bilateral femoral neck fractures resulting from pregnancy-associated osteoporosis showed bone marrow edema on magnetic resonance imaging. J Obstet Gynaecol Res. 2017;43(6):1067-70.
Münker R, Niedhart C, Niethard FU, Schmidt-Rohlfing B. Bilateral fracture of the femoral neck following transient osteoporosis in pregnancy. Z Orthop Ihre Grenzgeb. 2007;145(1):88-90.
Bircher C, Afors K, Bircher M. Transient osteoporosis of the hip in pregnancy resulting in bilateral fracture of the neck of the femur. Int J Gynaecol Obstet. 2012;116(2):176-7.
Lidder S, Lang KJ, Lee HJ, Masterson S, Kankate RK. Bilateral hip fractures associated with transient osteoporosis of pregnancy. J R Army Med Corps. 2011;157(2):176-8.
Wright EV, Naqvi AZ, Syed S, Zaw H. Transient osteoporosis of the hip in pregnancy: the orthopaedic management of bilateral neck of femur fractures in the third trimester. BMJ Case Rep. 2021;14(3):e238659.
Nikolopulos KE, Papadakis SA, Kateros KT, Themistocleous GS, Vlamis JA, Papagelopoulos PJ. Patients with Long-term outcome of avascular necrosis, after internal fixation of femoral neck fractures, Injury. 2003;32:525-8.
Vijayvargiya M, Shetty V, Makwana K, Agarwal N. Bilateral simultaneous neck femur fracture following domestic fall in an elderly patient: a rare case report. Rev Bras Ortop. 2016;52(3):363-5.
Grimaldi M, Vouaillat H, Tonetti J, Merloz P. Simultaneous bilateral femoral neck fractures secondary to epileptic seizures: treatment by bilateral total hip arthroplasty. Orthop Traumatol Surg Res. 2009;95(7):555-7.
Ferguson RJ, Palmer AJ, Taylor A, Porter ML, Malchau H, Glyn-Jones S. Hip replacement. Lancet. 2018;392(10158):1662-71.
Fujita S, Morihara T, Arai Y. Absence of osteonecrosis of the femoral head following bilateral femoral neck fracture with a high degree of displacement. J Orthop Sci. 2006;11:628-31.
