Bilateral Spontaneous Displaced Femoral Neck Fractures During Pregnancy

Csotye, J.; Sisák, Krisztián; Bardócz, Loránt; Tóth, Kálmán

doi:10.1097/ta.0b013e31817daccf

Cited by 14 publications

(12 citation statements)

References 5 publications

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“…Hip fracture secondary to transient osteoporosis is an exceptional and dangerous complication with 17 reported patients in the literature since 1995 to date; in four cases, the hip fractures were bilateral, as in our case (Aynaci et al 2008;Munker et al 2007;Brodell et al 1989;Wood et al 2003;Montella et al 1999;Spinarelli et al 2009;Fokter and Vengust 1997;Cohen et al 2007;Willis-Owen et al 2008;Fingeroth 1995;Csotye et al 2010;Shenker et al 2010;Pai et al 2009;Guryel et al 2010;Junk 1996;Wattanawong et al 2001). However, its real incidence seems to be underestimated.…”

Section: Discussionsupporting

confidence: 51%

Spontaneous bilateral femoral neck fractures in a young primigravida

Morris

Keriakos

Mason

et al. 2011

Journal of Obstetrics and Gynaecology

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A 26-year-old woman attended A&E. She was 37 weeks into her fi rst pregnancy, with pain in both groin areas and across her lower abdomen. She gave a history that she had been cleaning her teeth on the morning of her presentation when she heard and felt a loud click from her groin areas and slumped to the ground in pain. She was subsequently unable to weight-bear. She denied sustaining any injury during the fall.Review of her obstetric notes revealed that she had been diagnosed with symphysis pubis dysfunction (pelvic girdle pain, PGP) 4 weeks earlier when she attended the antenatal clinic, and had been using crutches to mobilise due to the extent of the pain she was experiencing. She declined admission to the hospital in the 2 weeks prior to presentation, however she had been largely bed-bound as a result of the pain and discomfort.At the time of booking, she was noted to be fi t and healthy with a BMI of 24.5. She was a non-smoker, was not taking any regular medications, and there was no relevant past medical history.Following discussion with the obstetricians, she was admitted to hospital for obstetric and physiotherapy assessment, Enoxaparin (Clexane) injections and pain relief. Four days later she was assessed for induction and was found to be suitable, with reasonable leg abduction, to achieve vaginal birth. Th ree days later she had an artifi cial rupture of the membranes and later gave birth normally to a healthy boy. She sustained a 2nd degree tear which had to be repaired in theatre under spinal anaesthetic, as abduction of her hips continued to be limited by pain.Post-delivery, her mobility and pain did not improve and therefore an X-ray of her pelvis was performed. Th e X-ray is shown in Figure 1. Th e X-ray revealed subcapital fractures of both femoral necks and she was referred to the orthopaedic team. Further investigation showed her bone biochemistry to be normal. Th e hip fractures were reduced and fi xed with cannulated hip screws 48 h later under a spinal anaesthetic. Postoperatively, there were no complications. Th e postoperative fi lms are shown in Figure 2.Th e rehabilitation regimen included 6 weeks non-weight-bearing, followed by gentle mobilisation and physiotherapy.She was also reviewed by the osteoporosis team who felt that she had sustained bilateral insuffi ciency fractures. No discrete metabolic abnormality was detected except for biochemical thyrotoxicosis, though she remained clinically euthyroid. Her slightly raised alkaline phosphatase was attributed to her recent pregnancy. Vitamin B levels and her parathyroid status were normal.

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Section: Discussionsupporting

confidence: 51%

Spontaneous bilateral femoral neck fractures in a young primigravida

Morris

Keriakos

Mason

et al. 2011

Journal of Obstetrics and Gynaecology

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“…Bilateral fractures are rare. [9][10][11][12][13][14] Most such patients are Asian people 9,10,12 Pre-existing osteoporosis, old age, and loss of bone mass 2 months after the onset are risk factors. 25 Osteoporosis induced by long-term use of heparin has been reported.…”

Section: Figurementioning

confidence: 99%

“…8 Only 6 cases of bilateral femoral neck fractures secondary to transient osteoporosis have been reported. [9][10][11][12][13][14] case report…”

mentioning

confidence: 99%

Bilateral Subcapital Femoral Neck Fractures Secondary to Transient Osteoporosis during Pregnancy: A Case Report

Emami

Abdollahpour

Kazemi

et al. 2012

J Orthop Surg (Hong Kong)

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Transient osteoporosis during pregnancy is a rare, self-limiting disease. We report on a 36-year-old woman who had bilateral subcapital femoral neck fractures during the 6th month of pregnancy. The diagnosis was made 4 days after delivery, because radiography was declined by the patient for fear of radiation. Fixation was not feasible owing to bone resorption, and 2-stage bipolar hemiarthroplasty was therefore performed. Magnetic resonance imaging is the best non-invasive investigative tool for pregnant women with hip pain. Early detection can prevent complications and resorting to major surgeries.

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“…The clinical picture progressively worsens, and the pain, which initially improves with rest, will persist at all times and become so invalidating to condition the use of a wheel-chair. The patient may suffer bilateral reduction in bone mineral density (BMD) and/or hip fracture [4][5][6][7]9,11].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…The original description defined the process as transient osteoporosis of the hip (TOH) during pregnancy [3]. The succeeding case reports revealed that TOH may be bilateral [4][5][6][7][8][9][10][11][12] and that may affect not only the hip, but also other joints in the lower extremities, like knee or ankle [13][14][15]. Moreover, it soon became clear that cases were not restricted to pregnancy [16][17][18], or even to women, since the disease was also observed in men, usually in their fifties or sixties [19][20][21].…”

Section: Introductionmentioning

confidence: 99%