Abstract
Femoral neck stress fractures in middle-aged individuals are usually associated with underlying metabolic bone disease. There is increased abnormal loading on femoral neck with associated coxa-vara and obesity in a female. Bilateral presentation of such fractures is rarely reported. Their management poses significant challenges. We present a case of bilateral femoral neck stress fracture in a 58-year-old obese housewife with compression type of the left hip fracture and tension type of the right hip fracture with non-union following an operated femoral neck stress fracture. She presented two months from the onset of symptoms and was treated with simultaneous bilateral total hip replacement for the management of her painful hips. Follow-up at 18 months revealed excellent outcome and return to independent painless daily routine activity. This report highlights the importance of early recognition of femoral neck stress fracture and challenges in the management of their late presentation. Total hip arthroplasty allows early mobilization with a favorable functional outcome.
Highlights
Femoral neck stress fractures (FNSFs) account for 5% of all stress fractures [1,2]
We present a case of bilateral femoral neck stress fracture in an obese female with osteomalacia and coxavara with an operated tension type stress fracture of the right hip with non-union and a compression type stress fracture of the left hip presenting with displacement, managed by simultaneous bilateral total hip arthroplasty (THA)
We felt that an attempt to retain the patient’s femoral head in a femoral neck fracture with coexistent coxa-vara, osteopenia, and obesity in a 58-year old female with a corrective valgus osteotomy will predispose her to further prolonged period of limited mobilization and weight-bearing potential
Summary
Femoral neck stress fractures (FNSFs) account for 5% of all stress fractures [1,2]. Most of the reported FNSFs are unilateral [2,3,4]. We present a case of bilateral femoral neck stress fracture in an obese female with osteomalacia and coxavara with an operated tension type stress fracture of the right hip with non-union and a compression type stress fracture of the left hip presenting with displacement, managed by simultaneous bilateral total hip arthroplasty (THA). A 58-year-old obese middle-aged housewife had a history of insidious pain in her right hip with difficulty in walking for the past three years She went to a surgical centre for management in her native town and was diagnosed with a right femoral neck fracture. Though she was unable to ambulate without support since surgery, the ambulatory status further deteriorated in two months with a progressive left hip pain She was no longer able to walk for daily routine activities. Wellpositioned replacement components with no evidence of loosening or failure (Figures 6-7)
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