Successful treatment for bilateral femoral neck insufficiency fractures: a rare lesion case report and an updated review of the literature
Tóm tắt
The incidence of insufficiency fracture (IF) at femoral neck is low, accounting for about 5% of all insufficiency fractures, and IF at bilateral femoral neck is less common with more occurrence in athlete or serviceman. With the aging of populations, more cases of bilateral femoral neck IF have occurred recently, while the standard clinical treatment still remains lacking due to the complexity of these patients. A 55-year-old male patient complained pain in his bilateral hip, with no history of trauma, glucocorticoid hormone consumption or radiotherapy, and imaging examination revealed fracture nonunion and shortening in his left femoral neck, and double fracture line on the right femoral neck. The patient received a cementless THA for the left femoral neck fracture and conservative treatment for the right side, followed by Elcatonin injection and oral administration of Carbonate D3 Granules. After 4 months of fellow-up, the patient presented improved functional scorings in bilateral hip joints, with no signs of prothesis infection or loosening. We present a rare case of bilateral femoral neck IF in a middle-aged male and the treatment is successful. The timely CT and MRI examinations of bilateral hip joints for patients was necessary for orthopedists to select proper therapeutic regimen. In addition, the choice for therapeutic regimen of bilateral femoral IF should not only be based on the professional judgement of orthopedists, but also on the wishes of patients.
Tài liệu tham khảo
Pentecost RL, Murray RA, Brindley HH. Fatigue, insufficiency, and pathologic fractures. Jama. 1964;187(13):1001–4.
Vaishya R, Agarwal AK, Banka PK, Vijay V, Vaish A. Insufficiency fractures at unusual sites: a case series. J Orthop Case Rep. 2017;7(4):76.
Matcuk GR, Mahanty SR, Skalski MR, Patel DB, White EA, Gottsegen CJ. Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options. Emerg Radiol. 2016;23(4):365–75.
Wild A, Jaeger M, Haak H, Mehdian S. Sacral insufficiency fracture, an unsuspected cause of low-back pain in elderly women. Arch Orthop Trauma Surg. 2002;122(1):58–60.
Bailie DS, Lamprecht DE. Bilateral femoral neck stress fractures in an adolescent male runner: a case report. Am J Sports Med. 2001;29(6):811–3.
Bakker G, Hattingen J, Stuetzer H, Isenberg J. Sacral insufficiency fractures : how to classify? J Korean Neurosurg Soc. 2018;61(2):258–66.
Melton LJ 3rd, Sampson JM, Morrey BF, Ilstrup DM. Epidemiologic features of pelvic fractures. Clin Orthop Relat Res. 1981;155:43–7.
O'Connor TJ, Cole PA. Pelvic insufficiency fractures. Geriatr Orthop Surg Rehabil. 2014;5(4):178–90.
Iba K, Wada T, Takada J, Yamashita T. Multiple insufficiency fractures with severe osteoporosis. J Orthop Sci. 2003;8(5):717–20.
Seraphim A, Al-Hadithy N, Mordecai SC, Al-Nammari S. Do bisphosphonates cause femoral insufficiency fractures? J Orthop traumatol. 2012;13(4):171–7.
강수용, 오정희, 최경원, 백지훈, 하용찬. Sequential Bilateral Insufficiency Fractures of the Femur Neck in Patients Treated with Prolonged Bisphosphonate Therapy - A Case Report. J Bone Metab 2011; 18(1):65–68.
Capeci CM, Tejwani NC. Bilateral low-energy simultaneous or sequential femoral fractures in patients on long-term alendronate therapy. J Bone Joint Surg Am Vol. 2009;91A(11):2556–61.
Krestan CR, Nemec U, Nemec S. Imaging of insufficiency fractures. Semin Musculoskelet Radiol. 2011;15(3):198–207.
Kalaci A, Yanat AN, Sevinc TT, Dogramaci Y. Insufficiency fractures of both femoral necks in a young adult caused by osteoporosis: a case report. Arch Orthop Trauma Surg. 2008;128(8):865–8.
Baki ME, Uygun H, Ari B, Aydin H. Bilateral femoral neck insufficiency fractures in pregnancy. Eklem Hastalik Cerrahisi. 2014;25(1):60–2.
Ahn D-K, Kim J-H, Lee J-I, Kim J-W. Bilateral femoral neck insufficiency fractures after use of a long-term anti-resorptive drug therapy for osteoporosis: a case report. Hip Pelvis. 2015;27(2):115–9.
Carpintero P, Lopez-Soroche E, Carpintero R, Morales R. Bilateral insufficiency fracture of the femoral neck in a male patient with anorexia nervosa. Acta Orthop Belg. 2013;79(1):111–3.