Femoral Neck Fracture in a Hemodialysis Patient after Liver Transplantation: A Case Report

Abstract

Background: Surgical treatment of femoral neck fractures is usually performed as an urgent procedure so that restoration of the ability to stand and walk can be achieved as quickly as possible. However, orthopedic surgeons need to be aware of undertreated or untreated diseases in their patients. Organ transplant recipients require immunosuppressive agents and steroids postoperatively. Hemodialysis patients also exhibit immunological deterioration and are included among immunocompromised patients. We report a case in which conservative treatment was chosen for a hepatic transplant recipient on hemodialysis who suffered a femoral neck fracture because signs of inflammation of unknown etiology were intermittently seen.

Case: The patient was a 70-year-old man who had undergone liver transplantation from a living donor as treatment for hepatocellular cancer and hepatic failure with cirrhosis. Dialysis for end-stage renal failure was initiated at approximately 1 year postoperatively. Cyclosporine was administered as an immunosuppressive agent. The patient subsequently fell off a bicycle and was unable to walk because of right hip pain. He was brought to our hospital by ambulance, and a right hip radiograph revealed a femoral neck fracture. His white blood cell count and C-reactive protein levels were intermittently elevated with unknown etiology. Conservative treatment was finally adopted, although a bipolar hip arthroplasty was planned. At 5 months after the injury, the patient was able to walk alone in a stable manner using a pair of crutches and was discharged.

Discussion: Conservative treatment for a femoral neck fracture, which generally requires surgery, may be acceptable in organ transplant recipients on hemodialysis.

Keywords: conservative treatment; femoral neck fracture; hemodialysis; organ transplantation.

Fig. 1.

Radiograph of the hips at the time of the injury. An anteroposterior hip radiograph showed a right femoral neck fracture classified as type 3 according to the Garden classification. A bipolar hip arthroplasty was planned just after admission.

Fig. 2.

Time-dependent changes in body temperature and signs of inflammation. (A) Body temperature was intermittently higher than 37 °C and often exceeded 37.5 °C. (B) White blood cell counts were intermittently increased. The counts did not exceed 8600/μl, the upper limit of normal in the authors’ institution. (C) C-reactive protein levels were markedly increased. The levels did not decrease below 0.14 mg/dL, the upper limit of normal in the authors’ institution, but did decrease from about 2 months after the injury.

Fig. 3.

Photograph of the patient walking during rehabilitation. The patient was able to walk on his own using a pair of crutches at about 3 months after the injury.

Fig. 4.

Radiograph of the hips at 11 months after the injury. An anteroposterior hip radiograph showed that part of the right femoral neck fracture had not achieved bone union.