Fracturas Por Estress
Páginas: 9 (2146 palabras)
Publicado: 14 de agosto de 2011
C A S E R E P O R T
Concurrent bilateral femoral neck stress fractures and unilateral osteonecrosis of the hip: a case report
Jun-Dong Chang, Je-Hyun Yoo, Abhijit S. Agashe and Suk-Hoon Cho
INTRODUCTION
emoral neck stress fractures are unusual but not rare. They occur as a result of repetitive loading that leads to mechanical failure and fracture of the bone. They have been reported withsome frequency mainly in runners, military recruits and older adults.1,2 On the other hand, bilateral stress fractures of the femoral neck are very rare injuries, and only a few patients have been reported to date.3--5 Moreover, the concurrent occurrence of osteonecrosis of the femoral head in the same patient is even rarer, and only one patient has been reported, to our knowledge.6 We presentan unusual case of concurrent bilateral femoral neck stress fractures and unilateral osteonecrosis of the femoral head, review the pertinent literature, and call attention to the importance of accurate diagnosis and appropriate treatment to avoid complications.
F
with marginal sclerosis within the right femoral head and some collapse on the anterosuperior aspect of it, but only scleroticchange on medial side of the left femoral neck (Figure 1). The cervicodiaphyseal angle of both hips was 1271. Bone scintigraphy showed diffuse uptake in the right femoral head and neck, and focal uptake in the inferomedial aspect of the left femoral neck (Figure 2). CT of the pelvis revealed osteonecrosis in the anterosuperior aspect of right femoral head with subchondral fracture and collapse(Figure 3). MRI demonstrated incomplete, low-signal lines extending
CASE REPORT
A 23-year-old male military recruit presented to our hospital with a 3-month history of bilateral groin pain and right hip pain. The recruit had been involved in an intense conditioning program involving excessive marching for 2 weeks before the symptoms developed. He had taken a rest, and nonsteroidal anti-inflammatorymedications with protected weightbearing for 1 month recommended at a local clinic. Thereafter, his pain had been somewhat relieved. However, the pain was aggravated again after continuous weightbearing for 2 weeks before his presentation to us. On presentation, it was noted that his pain was worse during walking and exercise. He had neither a recent history of any trauma, steroid use, ormedical illness, nor any relevant family medical history. Routine laboratory data were normal. His height was 170 cm, body weight 63 kg, and body mass index (BMI) 21.8 kg/m2. Physical examination revealed limitation of motion in both hip joints: flexion 951, internal rotation 201, external rotation 251, abduction 351, and adduction 201 in the right hip; flexion 1101, internal rotation 401, externalrotation 451, abduction to 451, and adduction 301 in the left hip. The results of the neurovascular examination were normal bilaterally. Standard radiographs of both hips demonstrated a large osteolytic lesion
Department of Orthopaedic Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea Correspondence to Je-Hyun Yoo, MD, PhD, Department ofOrthopaedic Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, 94-200, Youngdeungpo-dong, Youngdeungpo-gu, Seoul 150-719, Republic of Korea Tel: þ 82 2 2639 5860; fax: þ 82 2 2677 0336; e-mail: oships@hallym.ac.kr
1940-7041 ß 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
FIGURE 1. Plain radiographs of both hips show a large osteolytic lesion with marginalsclerosis on the anterosuperior aspect of the right femoral head (black arrow), but only sclerotic change on medial side of the left femoral neck (white arrow). (A) Anteroposterior radiograph. (B) Frog-leg lateral radiograph.
Volume 21 Number 3 May/June 2010
Current Orthopaedic Practice
E13
E14 | www.c-orthopaedicpractice.com
Volume 21 Number 3 May/June 2010
FIGURE 2. Bone...
Concurrent bilateral femoral neck stress fractures and unilateral osteonecrosis of the hip: a case report
Jun-Dong Chang, Je-Hyun Yoo, Abhijit S. Agashe and Suk-Hoon Cho
INTRODUCTION
emoral neck stress fractures are unusual but not rare. They occur as a result of repetitive loading that leads to mechanical failure and fracture of the bone. They have been reported withsome frequency mainly in runners, military recruits and older adults.1,2 On the other hand, bilateral stress fractures of the femoral neck are very rare injuries, and only a few patients have been reported to date.3--5 Moreover, the concurrent occurrence of osteonecrosis of the femoral head in the same patient is even rarer, and only one patient has been reported, to our knowledge.6 We presentan unusual case of concurrent bilateral femoral neck stress fractures and unilateral osteonecrosis of the femoral head, review the pertinent literature, and call attention to the importance of accurate diagnosis and appropriate treatment to avoid complications.
F
with marginal sclerosis within the right femoral head and some collapse on the anterosuperior aspect of it, but only scleroticchange on medial side of the left femoral neck (Figure 1). The cervicodiaphyseal angle of both hips was 1271. Bone scintigraphy showed diffuse uptake in the right femoral head and neck, and focal uptake in the inferomedial aspect of the left femoral neck (Figure 2). CT of the pelvis revealed osteonecrosis in the anterosuperior aspect of right femoral head with subchondral fracture and collapse(Figure 3). MRI demonstrated incomplete, low-signal lines extending
CASE REPORT
A 23-year-old male military recruit presented to our hospital with a 3-month history of bilateral groin pain and right hip pain. The recruit had been involved in an intense conditioning program involving excessive marching for 2 weeks before the symptoms developed. He had taken a rest, and nonsteroidal anti-inflammatorymedications with protected weightbearing for 1 month recommended at a local clinic. Thereafter, his pain had been somewhat relieved. However, the pain was aggravated again after continuous weightbearing for 2 weeks before his presentation to us. On presentation, it was noted that his pain was worse during walking and exercise. He had neither a recent history of any trauma, steroid use, ormedical illness, nor any relevant family medical history. Routine laboratory data were normal. His height was 170 cm, body weight 63 kg, and body mass index (BMI) 21.8 kg/m2. Physical examination revealed limitation of motion in both hip joints: flexion 951, internal rotation 201, external rotation 251, abduction 351, and adduction 201 in the right hip; flexion 1101, internal rotation 401, externalrotation 451, abduction to 451, and adduction 301 in the left hip. The results of the neurovascular examination were normal bilaterally. Standard radiographs of both hips demonstrated a large osteolytic lesion
Department of Orthopaedic Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea Correspondence to Je-Hyun Yoo, MD, PhD, Department ofOrthopaedic Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, 94-200, Youngdeungpo-dong, Youngdeungpo-gu, Seoul 150-719, Republic of Korea Tel: þ 82 2 2639 5860; fax: þ 82 2 2677 0336; e-mail: oships@hallym.ac.kr
1940-7041 ß 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
FIGURE 1. Plain radiographs of both hips show a large osteolytic lesion with marginalsclerosis on the anterosuperior aspect of the right femoral head (black arrow), but only sclerotic change on medial side of the left femoral neck (white arrow). (A) Anteroposterior radiograph. (B) Frog-leg lateral radiograph.
Volume 21 Number 3 May/June 2010
Current Orthopaedic Practice
E13
E14 | www.c-orthopaedicpractice.com
Volume 21 Number 3 May/June 2010
FIGURE 2. Bone...
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