Abstract
Background: A persistent infection triggered by Mycobacterium leprae is also known as leprosy or Hansen's disease, transmitting by tiny droplets of the nose and mouth to the skin and peripheral nerves, producing disability. Leprosy therapy is based on the combination of the rifampicin, dispone and clofazimine (MDT) three-drug regimen. In patients who undergo hormone therapy, avascular femoral necrosis (ANFH) or femoral head osteonecrosis (ONFH) may occur, causing steroid-induced femoral head avascular necrosis (SANFH) Core decompression (CD) reduces bone pressure, opens the hardening area, prevents osteonecrosis repair, promotes blood vessel development through the tunnel for decompression, increases bone replacement and delays osteonecrosis.
 Patient information, diagnosis and therapeutic interventions: In this case, we found a 20 years old girl known case of leprosy, was on corticosteroids for two and half years. After an increase in dosage of corticosteroids she began difficult for her walk and do her activities of daily living. She visited Acharya Vinoba Bhave Rural Hospital (AVBRH), DMIMS (DU) Sawangi Meghe, Wardha, Maharashtra, India where she got to know about necrosis of head of femur of both lower limbs. She underwent core decompression surgery of bilateral femoral head. For further management she was referred to Physiotherapy Department.
 Outcomes and Conclusion: this case, we found that a patient who is young who had Midshaft femur fracture with interlock nailing and sever kinesiophobia, affecting rehabilitation, was able to resume her ADLs independently.
Highlights
A persistent infection triggered by Mycobacterium leprae is known as leprosy or Hansen's disease, transmitting by tiny droplets of the nose and mouth to the skin and peripheral nerves, producing disability [1]
Leprosy therapy is based on the combination of the rifampicin, dapsone and clofazimine(MDT) three-drug regimen [2]
Avascular femoral head is known as femoral head osteonecrosis [5]. in which bone reshaping and cell death induced by insufficient blood supply [6] to head of femoral, triggers deterioration as well as associated bone cell recompense with marrow of bone, resulting to change in structure of the head of femur and head of femur collapse [5]
Summary
A persistent infection triggered by Mycobacterium leprae is known as leprosy or Hansen's disease, transmitting by tiny droplets of the nose and mouth to the skin and peripheral nerves, producing disability [1]. The standard therapy for reverse reactions is glucocorticoids [3]. In patients who undergo hormone therapy, avascular femoral necrosis(ANFH) may occur, causing steroid-induced femoral head avascular necrosis(SANFH) [4]. The non-traumatic risk factors for AVNFH include radiation therapy, haematologic problems, excessive glucocorticoid use and overuse of alcohol [6]. The symptom of these patients typically consists of pain, frequently found in their groin; this pain can impair movement (ROM), in particular passive internal rotation, dramatically decreasing regular daily living activities and the quality of life [7]. Increased blood viscosity may contribute to femoral head vasospasm, deficient blood oxygen in the head of femoral and a loss of osteocyte function and cell death. Core decompression (CD) reduces bone pressure, opens the hardening area, prevents osteonecrosis repair, promotes blood vessel development through the tunnel for decompression, increases bone replacement and delays osteonecrosis [5]
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