Bilateral femoral neck fracture in pregnancy- outcome of conservative and operative treatment: a case report

Vol 5 | Issue 2 | May-Dec 2019 | Hemjit Das, Shyam Sunder. S

DOI 10.13107/ti.2019.v05i01.086


Author: Hemjit Das [1], Shyam Sunder. S [1]

1 Department Of Orthopaedics, Assam Medical college and hospital,
Dibrugarh, Assam, India-786002. India.

Address of Correspondence
Dr. Shyam Sunder. S,
Department Of Orthopaedics, Assam Medical college and hospital,
Dibrugarh, Assam, India-786002.
E-mail: shyam.arun90@gmail.com


Abstract

Introduction: Transient osteoporosis of pregnancy is usually benign in nature. Rarely serious complication like fragility fracture of neck of femur can occur. Usually idiopathic in nature and self-limiting. So far only 12 such cases and bilateral in only 2 patients have been reported in literature. Since, X-rays are usually avoided in pregnancy this condition is usually missed leading to late diagnosis.
Case report: A 26-year-old primigravida was referred to our institute on her 7th month of gestation with bilateral hip pain and limp. She developed bilateral hip pain on her 5th month of gestation which was progressive in nature. Her radiograph showed bilateral femoral neck fracture. To avoid radiation hazard to the fetus fracture fixation was delayed till caesarean section on her 38th week of gestation. Closed reduction and internal fixation with three CC screws was done for left femur neck fracture. Fixation was planned for right side fracture simultaneously but since the patient did not consent for bilateral surgery she was asked to review after one month for right femur neck fracture fixation. The patient who lost to follow-up showed up after 6 months walking comfortably. Radiological examination showed that in the nonoperated side the fracture united in Varus with shortening of 0.5 cm.
Conclusion: Musculoskeletal problems during pregnancy should not be overlooked. MRI should be used for early diagnosis whenever feasible. Fracture Neck of femur in pregnancy in-spite of delayed diagnosis and treatment has a better prognosis even with conservative treatment.
Keywords: transient osteoporosis, pregnancy, femoral neck fracture, spontaneous healing


References

1. Lakhanpal s, Ginsburg W, Luthra H, Hunder G. Transient regional osteoporosis, a study of 56 cases and review of the literature. Ann Intern Med. 1987;(106: 444-450).
2. Aynaci O, Kerimoglu S, Ozturk C, Sarcoglu M. Bilateral non-traumatic acetabular and femoral neck fractures due to pregnancy-assosiated osteoporosis. Arch Orthop Trauma Surg. 2008;(128 :313-316).
3. Munker R, Niedart C, Niedart F, Schmidt RB. Bilateral fracture of the femoral neck following transient osteoporosis in pregnancy. Z Orthop thre Grenzgeb. 2007;(145:88-90).
4. Willis-Owen C, Daurka J, Chen A, Lewis L. Bilateral femoral neck fractures due to transient osteoporosis of pregnancy. Cases J. 2008;(1:120).
5. Kyoko K, Nobuyuki K. Bilateral femoral neck fractures resulting from pregnancy assosiated osteoporosis showed bone marrow edema on magnetic resonance imaging. The journal of obstetrics and gynaecology research. 2017 jun; 43((6 )1067-1070).
6. Cohen I, Melamed E, Lipkin A, Robinson D. Transient osteoporosis of pregnancy complicated by a pathologic sub-capital hip fracture. J Trauma. 2007; 62(1281-3).
7. Rishi V, Wahi P, Mahajan A. Transient osteoporosis of hip (migratory ). JK Science. 2008; 10(194-6).
8. Smith R, Athanosou NA, Ostlere SJ, Viponf SE. pregnnacy assosisted osteoporosis. QJM. 1995; 88(865-878).
9. Alioune GB, Lamine S, Badara D, Alioune DB, Andre DS, Charles DB. Bilateral fracture of femoral neck during pregnancy:A case of spontaneous Healing. SM journal of orthopaedics. 2017.
10. British tF. thyroid disorders and osteoporosis ,revised 2018. ; 2018.
11. Dominika T, Marek B. the influence of thyroid disfunction on bone metabolism. thyroid research. 2014;(7:12).
12. CDC. CDC guidelines. US Govt emergency.cdc.gov.
13. Vakil C. Radiation and medical procedures.how do we do no harm? Canadian family physician. 2017 oct; 63((10)774-775).
14. Lu-Yao GL ,Keller RB, Littenberg B. Outcomes after displaced fractures of the femoral neck. a meta analysis of one hundred and six published reports. J bone Joint Surg Am. 1994; 76(15-25).


How to Cite this article:  Das H, Sunder Shyam. S.  Bilateral femoral neck fracture in pregnancyoutcome of conservative and operative treatment: a case report. Trauma International May – Dec 2019: 5(2):

 



(Abstract)(Full Text HTML)   (Download PDF)