Bilateral sequential femoral neck stress fractures in young adult with HIV infection on antiretroviral therapy: A case report

Abstract

BACKGROUND Femoral neck stress fractures are rarely encountered among young adults and are often associated with either repetitive excessive loading or underlying bone pathology. Preliminary research has indicated human immunodeficiency virus (HIV)/antiretroviral therapy (ART) as predisposing agents to osteopenia and osteoporosis related complications. We report a case of HIV/ART induced insufficiency fracture in a resource limited setting in Central India. Our aim is to increase awareness and promote screening of HIV/ART related osteopenia and osteoporosis in order to prevent catastrophic orthopaedic complications. CASE SUMMARY A 35-year-old HIV positive male presented with a stress fracture of left femoral neck. The patient was on ART and reported no comorbidities. He went on to be successfully managed surgically. However, during work-up osteopenia of the contralateral proximal femur was recognised using Singh’s Index. Six months post-op the patient presented with right-sided femoral - neck stress fracture. At this stage the patient was nonconcordant with ART and denied surgical fixation. CONCLUSION In the absence of co-morbidities, several mechanisms of HIV/antiretroviral therapy may have played a role in predisposing our patient towards such a presentation. We recommend routine screening all HIV-infected patients for osteopenia, especially in younger individuals. In low resource settings and district hospitals, pelvis radiograph & Singh’s index can be used for screening.

Bilateral femoral neck stress fractures in elderly individuals: A case report and literature review

“…To the best of our knowledge, the literature reports related to femoral neck stress fractures are mostly case reports on soldiers and athletes, and there are few reports on femoral neck stress fractures in elderly patients. [ 5 – 7 ] However, we found that these patients are the most accessible in the clinical setting. Therefore, it is crucial to diagnose these patients promptly and to intervene early and correctly.…”

“…One type is a normal or abnormal stress repeatedly acting on a normal quality femoral neck, which can also be called a fatigue fracture and is usually seen in athletes and soldiers. [3,5,[28][29][30][31][32] Fatigue fractures may also be secondary to patients with abnormal femoral neck anatomy. [11,[33][34][35] The other type of fracture is an insufficiency fracture, in which the quality of the bone is reduced for various reasons, such as senile osteoporosis, postmenopausal osteoporosis, renal bone disease, vitamin D deficiency and other metabolic bone diseases, cortisol use, neurological sexual anorexia, and the use of certain drugs.…”

“…Osteoporosis and connective tissue tumor Bilateral nondisplaced fracture (compression side) Bilateral expectant treatment after tumor resection Saisunder [5] Male 35 ART treatment L: displaced fracture L: DHS R: nondisplaced fracture (compression side) R: expectant treatment Nagao [24] Male 36 Osteoporosis and vitamin D deficiency Bilateral displaced fracture Bilateral hemiarthroplasty Kiyokazu [25] Male 51 Vitamin D deficiency and osteoporosis Bilateral nondisplaced fracture (compression side) Bilateral internal fixation with cannulated screw Narra [26] Male 52 Osteoporosis and HAART treatment Bilateral displaced fracture L: hemiarthroplasty R: expectant treatment Tan [27] Male…”

Bilateral symmetrical stress fractures of femoral neck in HIV patient: case report and brief review of literature

“…On review of literature, very few case reports describing bilateral sequential neck fractures of femoral neck have been reported. Chaganty et al 8 reported a bilateral sequential femoral neck fracture in a 35-year-old HIV patient on ART.…”

Low-velocity simultaneous bilateral femoral neck fracture following long-term antiepileptic therapy: A case report

“…Association with seizure disorders and electric shock injuries has also been reported[10-11]. Finally, this fracture pattern has been seen with long-term use of bisphosphonates, narcotic drug abuse, anti-retroviral therapy, and psychosomatic disorders, like anorexia nervosa[12-15].…”