Subcapital fracture due to transient osteoporosis of hip

Case contributed by Dr Yaïr Glick

Presentation

Admitted to high-risk pregnancy unit due to fetal growth deceleration. Had been suffering for 2 weeks from left hip pain radiating to the thigh, but had been able to walk with a limp. Vaginal delivery at 36 weeks gestation.

Patient Data

Age: 30 years
Gender: Female

Left femoral neck fracture, subcapital, with displacement (Garden IV). There appears to be a comminuted fracture of the femoral head, its cortex is all but invisible.

Left femoral neck subcapital fracture with inferior displacement, posterior angulation, and femoral head impaction. Comminuted fracture of the femoral head not involving the acetabular (weight-bearing) surface.

The uterus is massively enlarged (1 day postpartum), thrombi in the cervical and vaginal canal.
Soft tissue emphysema tracking into the lumbar erector spinae on the right, most probably due to recent spinal block.

Internal fixation with 3 cannulated screws.

Case Discussion

Although idiopathic transient osteoporosis of the hip (ITOH) is considerably more common in middle-aged men, it is classically associated with young women in third-trimester pregnancy.

In this case, the woman sustained a Garden IV fracture due to the porotic bone. Despite the resultant comminuted femoral head fracture, the woman opted for a closed reduction rather than hip replacement surgery. The latter can always be performed if the former fails.

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