Ostéonécrose de la tête fémorale survenant 15 ans après une fracture du col fémoral chez une patiente traitée au long cours par corticothérapie inhalée à faible dose

Abstract

Post-traumatic avascular necrosis of the femoral head typically occurs immediately or within a few years after a femoral neck injury, and nontraumatic avascular necrosis is often related to systemic glucocorticoid therapy. We report an unusual case in which avascular necrosis of the femoral head occurred 15 years after a transcervical femoral fracture in a woman with a 20-years history of daily inhaled glucocorticoid therapy for chronic bronchitis. She had not taken glucocorticoids by any other route and had no other risk factors for osteonecrosis. To our knowledge, this is the first report of osteonecrosis associated with inhaled glucocorticoid therapy in a patient with a local cause of diminished vascular reserve. Inhaled glucocorticoid therapy should be added to the list of risk factors for osteonecrosis.