Cracking the Case: Post-pregnancy Bilateral Femoral Fragility, a Rare Clinical Challenge

Abstract

Pregnancy-associated musculoskeletal disorders are relatively rare but can present significant diagnostic and therapeutic challenges. We present a rare case of a 37-year-old woman with a twin pregnancy complicated by type 2 diabetes mellitus and obstetric cholestasis, who developed bilateral hip insufficiency fractures. Despite initial conservative management, her condition worsened, requiring surgical intervention in the form of core decompression and internal fixation. Postoperative recovery was successful, with significant pain relief and improved mobility. This case underscores the complexity of pregnancy-related musculoskeletal disorders and the need for timely diagnosis and appropriate treatment, especially in high-risk pregnancies.

Keywords: avascular necrosis; bilateral hip insufficiency fractures; femoral fragility; pregnancy-associated musculoskeletal disorders; pregnancy-associated osteoporosis.

Figure 1. MRI of the lumbosacral spine showing bilateral femoral head STIR hyperintensities

MRI, magnetic resonance imaging; STIR, short tau inversion recovery.

Figure 2. Pelvic X-ray showing no obvious subchondral or subcapital fracture lines

Figure 3. MRI of the hips with contrast showing (1) synovitis and (2) a fracture line

MRI, magnetic resonance imaging.

Figure 4. MRI of the hips without contrast showing (1) STIR bright signals and (2) hip joint effusion

MRI, magnetic resonance imaging; STIR, short tau inversion recovery.

Figure 5. X-ray of the left hip showing (1) subcapital sclerotic fracture line

Figure 6. Postoperative X-ray