Femoral neck fracture symptoms11/12/2023 ![]() The authors noted that only severe cases warranted referral and further workup at their department, thus creating a selection bias against mild cases. When the search was expanded to include all retrospective cases in the last 15 years, only 12 patients were identified to have a definite pregnancy-related hip disease: six patients had TOH (three cases were bilateral) - first symptoms appeared on average on the seventh month of parity, with a minor proclivity for the left side. reported only three MRI-confirmed TOH cases out of 4900 pregnant female patients evaluated. ![]() In a two-year prospective study, Steib-Furno et al. There is a paucity of definitive prevalence statistics for TOH occurring during pregnancy, as no systemic analyses exist due to the rarity of this condition. TOH classically presents with sudden onset severe hip pain due to BME, which can predispose to femoral subchondral and neck fractures without notable trauma. Prevailing theory separates these entities from pregnancy-associated osteoporosis, which is denoted by global skeletal BMD resorption, which when severe, usually manifests with thoracolumbar vertebral compression fractures. In rare cases, the decrease in bone mineral density (BMD) is observed in atypical demographics, is transitory, and selectively affects bones of weight-bearing joints - TOH belongs to this group of multifactorial disorders, termed transient regional osteoporosis. Osteoporosis refers to compromised bone strength - classically affecting postmenopausal women, where an abrupt decrease in estrogen augments bone resorption. The most significant pregnancy-related hip disease includes entities such as TOH, osteonecrosis of the femoral head, and occult stress fractures. ![]() In this case report, we presented a patient who developed a spontaneous, atraumatic femoral hip fracture, five days prior to delivery via cesarean at term. ![]() Postoperative radiography confirmed prosthesis placement (Figure (Figure3) 3) antibiotic and anticoagulant prophylaxis was initiated with ampicillin/sulbactam and enoxaparin sodium, respectively. Hemiarthroplasty was considered but was ultimately discarded as the conversion rate to total hip arthroplasty in young patients remain relatively high and the fracture was subsequently treated with a total uncemented prosthesis (Figure (Figure2), 2), consisting of a 50 mm cup with 32 mm ultra-high-molecular-weight polyethylene insert and a 32 mm head with a 4 mm ceramic insert (Link Inc., Hamburg, Germany). Given the considerable delay between symptom presentation and treatment, we decided the case warrants total hip arthroplasty instead of native hip salvage. During our literature review, we encountered a similar case of femoral neck fracture with grade IV displacement that was treated with open reduction internal fixation - despite restoration of blood flow to the femoral head within 15 hours, the authors still encountered femoral head necrosis with collapse six months later. The significant degree of displacement (grade IV) of the fracture lasting over one week precluded open reduction with internal fixation due to fears of femoral head necrosis. Three days later the patient was transferred to our orthopedic surgery department for the treatment of the fracture. Five days later the patient experienced premature rupture of membranes, which was managed with emergency cesarean section (C-section) - no complications were encountered and a healthy 2300 g female was successfully delivered. Serologic tests for inflammatory markers, as lab tests for serum calcium, phosphate, alkaline phosphatase, parathyroid hormone, vitamin D, and D-dimer returned normal.ĭuring multidisciplinary rounds, it was decided that delaying surgery was the best course of action out of fear of causing either mechanical or fluoroscopy-induced damage to the fetus during total hip arthroplasty. Additionally, the patient was not malnourished, she underwent routine antenatal care, and took multivitamins. The patient denied falls or trauma during the pregnancy, nor was there any history of smoking, alcohol abuse, use of glucocorticoids, or presence of rheumatologic/oncologic disease. Hip radiography showing a right-sided displaced femoral neck fracture (A, red arrow) and normal lucency of the left hip (B, red arrow). ![]()
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