Concurrent Bilateral Femoral Neck Stress Fractures and Osteonecrosis of the Hip: A Case Report

Abstract

Although bilateral osteonecrosis of the femoral head and bilateral stress fracture of the femoral neck are well-documented conditions, the occurrence of both conditions in the same patient has not been reported, to our knowledge. We present the case of a patient with both entities who was managed with internal fixation of both hips, which provided stabilization of the stress fractures as well as treatment of the osteonecrosis with core decompression. Two years after treatment, the stress fractures had healed and there was no evidence of progression of the osteonecrosis. The patient granted permission for the publication of data concerning the case. Aforty-six-year-old woman presented to us with a six-month history of bilateral groin pain. The right hip was more painful than the left. There was no history of trauma. The medical history included interstitial nephritis, diagnosed on the basis of a renal biopsy performed five years earlier, and osteopenia, diagnosed on the basis of a bone mineral densitometry value that was -1.25 standard deviations below the mean for age and sex-matched controls. The nephritis was treated with a three-month course of prednisone at the time of the initial diagnosis. The serum creatinine level remained elevated at 2.0 to 3.2 mg/dL (176.8 to 282.9 μmol/L), but that level had remained stable since the diagnosis of interstitial nephritis five years earlier. The patient had not received medical treatment for the osteopenia although it was recommended to her at the time that the densitometry was performed. The patient had a history of drug and alcohol abuse more than twenty years previously, but she stated that she had not used drugs or alcohol since that time. There was no history of amenorrhea or an eating disorder. The patient stated that she was an “avid” runner, running >5 mi (>8 km) every morning, prior to …