Non-traumatic, bilateral subcapital femoral fractures postpartum

Abstract

A 28-year-old Romanian woman, presented 2 weeks postnatally with pain in her left hip. Plain radiography suggested a left intracapsular, subcapital hip fracture. A CT scan of the pelvis showed diffuse osteopaenia with bilateral subcapital fractures of both femurs. From this imaging and subsequent investigation, a diagnosis of transient osteoporosis of pregnancy was made. The patient was treated with a closed reduction and cannulated screw fixation. Rehabilitative treatment, vitamin D, calcium and bisphosphonate therapy were initiated. She remains under close follow-up from orthopaedic, rheumatological and endocrine teams. Multiple opportunities were missed to identify the source of the patient's pain and inability to weight bear. Early detection and management of this condition is crucial because of the associated morbidity, including debilitating pain, reduced mobility, fractures and avascular necrosis. Cessation of breastfeeding, adequate pain relief, early use of bisphosphonates and rehabilitative treatment are essential.

Figure 1

Admission radiograph of hips.

Figure 2

A CT of hips demonstrating bilateral subcapital fractures.

Figure 3

Post-closed reduction and cannulated screw fixation.