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Diaz Dilernia F, Estefan M, Zanotti G. Pathological femoral neck fracture in a male patient due to non-simultaneous bilateral transient hip osteoporosis: A case report: Statements and Declarations. J Clin Orthop Trauma 2023; 42:102207. [PMID: 37529549 PMCID: PMC10388589 DOI: 10.1016/j.jcot.2023.102207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 04/11/2023] [Accepted: 06/24/2023] [Indexed: 08/03/2023] Open
Abstract
We report a case of a 31-year-old man who developed a non-simultaneous bilateral transient hip osteoporosis (THO) complicated with an atraumatic undisplaced pathological femoral neck fracture (FNF) of his left hip. He was successfully treated with internal fixation on the left hip, and a follow-up Magnetic Resonance Imaging evidenced satisfactory resolution on the right side. Diagnosis and management of THO are usually challenging as symptoms before pathological FNFs might be misdiagnosed. This case highlights the importance of suspecting pathological FNFs when pain persists despite conservative treatment. Finally, surgical treatment is strongly recommended if a pathological FNF is confirmed. Level of evidence Level IV.
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Affiliation(s)
- Fernando Diaz Dilernia
- Adult Hip and Knee Reconstructive Surgery, Division of Orthopaedic Surgery, Department of Surgery, Queen's University & Kingston Health Sciences Centre, Kingston, Ontario, Canada, K7L 2V7
| | - Martin Estefan
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Buenos Aires, C1199ACK, Argentina
| | - Gerardo Zanotti
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Buenos Aires, C1199ACK, Argentina
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2
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Klimko A, Brandt A, Cirstoiu C, Iacobescu G. Unilateral Atraumatic Femoral Neck Fracture in the Peripartum Period: Case Report and Literature Review. Cureus 2021; 13:e19524. [PMID: 34934546 PMCID: PMC8668042 DOI: 10.7759/cureus.19524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/11/2022] Open
Abstract
Transient osteoporosis of the hip (TOH) refers to a temporary, focal reduction in bone mineral density that selectively affects bones in weight-bearing joints of young pregnant females. Due to inherent difficulties in diagnosing this pathology, it is difficult to estimate the incidence and it is conceivable that TOH is vastly underreported. In a rare subset of patients, TOH may progress to pathological fractures. We report a case of a 38-year-old pregnant woman who developed an atraumatic, displaced femoral neck fracture during her last trimester. Diagnosis and adequate management of TOH represents a clinical challenge as symptoms that precede the fracture are often non-specific, while the timing of the surgical treatment (i.e. before or after delivery) is debatable.
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Quaresima P, Angeletti M, Luziatelli D, Luziatelli S, Venturella R, Di Carlo C, Bernardo S. Pregnancy associated transient osteoporosis of the hip (PR-TOH): A non-obstetric indication to caesarean section. A case report with literature review. Eur J Obstet Gynecol Reprod Biol 2021; 262:28-35. [PMID: 33989941 DOI: 10.1016/j.ejogrb.2021.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
Pregnancy related transient osteoporosis of the hip (PR-TOH) is a rare condition that manifests with sudden pain located in the groin region, anterior thigh and buttocks. It is a benign and in the majority of cases self-limiting disease, related to bone marrow oedema. It occurs during the third trimester of pregnancy or less frequently during the post-partum period. Hip movements are usually restricted by pain and it often becomes a non-obstetric indication for Caesarean delivery. Here, we report a case of unilateral PR-TOH diagnosed by magnetic resonance imaging (MRI) and a literature review.
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Affiliation(s)
- Paola Quaresima
- Department of Obstetrics and Gynecology, "Magna Grecia" University, Viale Europa, Loc. Germaneto, 88100, Catanzaro, Italy.
| | - Marco Angeletti
- Nuova Villa Claudia, Radiology Department, Via Flaminia Nuova 280, 00191, Rome, Italy
| | - Davide Luziatelli
- Department of Orthopaedics, Tor Vergata University, Via Cracovia, 50, 00133, Rome, Italy
| | - Sandro Luziatelli
- Villa Letizia Strada Statale 80, 25/b, 67100 Preturo, L' Aquila-San Giuseppe Hospital, Via Aurelio Saffi, 33, 52100, Arezzo, Italy
| | - Roberta Venturella
- Department of Obstetrics and Gynecology, "Magna Grecia" University, Viale Europa, Loc. Germaneto, 88100, Catanzaro, Italy
| | - Costantino Di Carlo
- Department of Obstetrics and Gynecology, "Magna Grecia" University, Viale Europa, Loc. Germaneto, 88100, Catanzaro, Italy
| | - Silvia Bernardo
- Nuova Villa Claudia, Radiology Department, Via Flaminia Nuova 280, 00191, Rome, Italy; Polizia di Stato, Centro Clinico di Medicina Preventiva e Medicina Legale, Via Mamiani 2, Roma, Italy
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4
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[Reflex sympathetic dystrophy involving the ankle and the foot in a particular pathological pregnancy: Exceptional association]. Presse Med 2017; 46:1107-1110. [PMID: 28919273 DOI: 10.1016/j.lpm.2017.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/02/2017] [Indexed: 11/22/2022] Open
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Abstract
A 34-year-old Caucasian female presented during the third trimester of her pregnancy with bilateral hip pain that became progressively severe. Imaging of her pelvis and bilateral hips with MRI obtained during her third trimester of pregnancy demonstrated bilateral bone-marrow edema of the femoral heads and the sacrum at S1. Repeat MRI performed at 6 months postpartum revealed resolution of edema. MRI is considered the best diagnostic test for this condition in regards to sensitivity and specificity.
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Keriakos R, Bhatta SRC, Morris F, Mason S, Buckley S. Pelvic girdle pain during pregnancy and puerperium. J OBSTET GYNAECOL 2011; 31:572-80. [DOI: 10.3109/01443615.2011.598970] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Morris F, Keriakos R, Mason S, Buckley S. Spontaneous bilateral femoral neck fractures in a young primigravida. J OBSTET GYNAECOL 2011. [DOI: 10.3109/01443615.2011.589013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Osteoporosis transitoria del embarazo complicada con fractura subcapital de cadera: caso clínico y revisión de la literatura. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/j.recot.2011.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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9
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Transient osteoporosis complicated by a subcapital hip fracture in pregnancy: a clinical case and a literature review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/s1988-8856(11)70308-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Cohen I, Melamed E, Lipkin A, Robinson D. Transient Osteoporosis of Pregnancy Complicated by a Pathologic Subcapital Hip Fracture. ACTA ACUST UNITED AC 2007; 62:1281-3. [PMID: 17495737 DOI: 10.1097/01.ta.0000198206.60286.2f] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ilan Cohen
- Department of Orthopaedic Surgery, Rabin Medical Center, Petah-Tikva, Israel.
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Niimi R, Sudo A, Hasegawa M, Fukuda A, Uchida A. Changes in bone mineral density in transient osteoporosis of the hip. ACTA ACUST UNITED AC 2006; 88:1438-40. [PMID: 17075086 DOI: 10.1302/0301-620x.88b11.18063] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Transient osteoporosis of the hip is a disorder characterised by pain, and associated with temporary osteopaenia. Although osteopaenia is the essence of the condition, data do not exist about the local bone density of the femoral neck if no medication is administered. We describe three patients who were treated with limitation of weight-bearing only. Repeated bone mineral density measurements were obtained, and that at the femoral neck was lowest two months after the onset of the condition. The mean reduction in bone mineral density when compared with an age-matched control group was 13% (3% to 24%). Spontaneous recovery was observed in all patients.
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Affiliation(s)
- R Niimi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie 514-8507, Japan
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Wood ML, Larson CM, Dahners LE. Late presentation of a displaced subcapital fracture of the hip in transient osteoporosis of pregnancy. J Orthop Trauma 2003; 17:582-4. [PMID: 14504581 DOI: 10.1097/00005131-200309000-00008] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Transient osteoporosis of the hip is rare and has two demographic peaks, one during the third trimester of pregnancy and the other around the fifth to sixth decade of life. During pregnancy, osteoporosis presents with insidious onset of hip pain and antalgic limp with no antecedent infection or trauma. Radiographs show pronounced osteopenia of the femoral head and neck with preservation of the joint space. 1 Bone scan and magnetic resonance imaging are sensitive but not specific for diagnosis, and laboratory studies are typically normal. 2 We present the case of a patient with a displaced, grossly unstable subcapital hip fracture who presented 5 months postpartum and describe successful treatment by open reduction and internal fixation with a muscle-pedicle bone graft.
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Affiliation(s)
- Mark L Wood
- Department of Orthopaedic Surgery, UNC School of Medicine, University of North Carolina, Chapel Hill, NC 27599-7055, USA
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Arayssi TK, Tawbi HA, Usta IM, Hourani MH. Calcitonin in the treatment of transient osteoporosis of the hip. Semin Arthritis Rheum 2003; 32:388-97. [PMID: 12833247 DOI: 10.1053/sarh.2002.50014] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Transient osteoporosis of the hip (TOH) is a rare clinical disorder of unknown etiology characterized by hip pain and functional disability that resolve spontaneously in 6-24 months. OBJECTIVES To report 2 patients with TOH during pregnancy who had rapid resolution of their illness with the use of calcitonin. To review the literature on TOH with special emphasis on its treatment. METHODS A MEDLINE search of studies published from 1966 to 2002 was performed to review treatment options for TOH and their effect on the natural history of the disease. RESULTS Our 2 patients developed hip pain during pregnancy with classical changes of TOH on MRI. Both patients received calcitonin, 1 during pregnancy and 1 postpartum with resolution of their symptoms within 6 to 9 weeks. Previous reports in the literature of treatment of TOH showed that antiresorptive agents (bisphosphonates and calcitonin) had shortened the duration of the illness compared with the natural history of the disease. CONCLUSIONS TOH is an under-recognized entity associated with pain and disability. The use of antiresorptive agents may be of help in reducing the duration of the disease. RELEVANCE To increase the recognition of TOH and to consider therapeutic interventions to shorten the duration of the disease.
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Affiliation(s)
- Thurayya K Arayssi
- Departments of Internal Medicine, Obstetrics and Gynecology and Diagnostic Radiology, American University of Beirut, Beirut, Lebanon
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Sergent F, Mouroko D, Sellam R, Marpeau L. [Reflex sympathetic dystrophy involving the ankle in pregnancy: characteristics and therapeutic management]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2003; 31:543-5. [PMID: 12865194 DOI: 10.1016/s1297-9589(03)00124-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report the case of a multigravida presenting in the first trimester of pregnancy with reflex sympathetic dystrophy involving both ankles. Preferential location of reflex sympathetic dystrophy in pregnancy is classically the hip (9 times out of 10). Symptoms develop mostly with primipara in the third trimester of pregnancy or in post-partum. Fracture is the major risk of reflex sympathetic dystrophy. Peculiarities of reflex sympathetic dystrophy's treatment in the course of pregnancy are evoked. The end of the pregnancy can be shortened with the aim of stabilizing disease even to activate its healing. Pathophysiologic mechanisms of reflex sympathetic dystrophy in pregnancy seem multiple and complex. Our observation, by its atypical characteristics, recalls it.
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Affiliation(s)
- F Sergent
- Clinique gynécologique et obstétricale, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
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Hockings M, Surwaliwala KH. Hip pain in the third trimester of pregnancy. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 1999; 60:836-7. [PMID: 10707201 DOI: 10.12968/hosp.1999.60.11.1241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Transient osteoporosis of the hip (TOH) is characterized by disabling hip joint pain, a limited range of hip motion, focal loss of radiodensity on plain radiographs and increased tracer uptake in bone scintigraphy (Hoffman and Kramer, 1997).
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Affiliation(s)
- M Hockings
- Ormskirk District General Hospital, Lancashire
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Affiliation(s)
- N A Watson
- Department of Diagnostic Radiology, University of Manchester
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17
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Abstract
Over the past decade, imaging evaluation of orthopedic conditions of the pelvis and hips has become increasingly complex. Although the conventional radiograph remains the initial examination of choice, the decision between secondary tests, such as computed tomography, MR imaging, or scintigraphy is far from clear. A thorough understanding of current imaging technology is necessary for the clinician to choose the most appropriate examination for a given situation. This article reviews the current status of orthopedic imaging in the areas of acute trauma, stress injuries, osteonecrosis, arthropathies, tumors, and interventional imaging.
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Affiliation(s)
- C W Hayes
- Department of Radiology, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia 23298-0615, USA
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