Management of femoral neck fracture on prolonged steroid

Abstract

Femoral neck fractures are among the most troublesome and problematic of all fractures. The patient, most commonly are elderly woman, has a trivial mishap such as losing her footing on a slippery surface or tripping over an object. As she
tries to "catch herself," she may suddenly put a torsional force on one hip that fractures the neck of the femur and then she falls so fragile the femoral neck in the elderly. If the fracture is displaced, as 95% are, the patient is unable to get up because of pain and complete instability at the fracture site, Examination reveals that the entire lower limb lies in external rotation, although not usually so complete as that seen in patients with an intertrochanteric fracture. Steroids have major effects on how the body uses calcium and vitamin D to build bones. Steroids can lead to bone loss, osteoporosis, and broken bones. When steroid medications are used in high doses, bone loss can happen rapidly. Fracture risk increases as the daily doses of steroids increase. Various techniques including the use of radioopaque dyes and radioactive isotope scintigraphy have been developed to assess the circulation of the femoral head at the time of operation. The results of these techniques serve as a useful guide to treatment, because, if the femoral head of a middle aged or elderly patient is completely avascular, it is better excised and replaced by a hemiarthroplasty using a bipolar endoprosthesis rather than reduced and nailed. The case study that will be discussed is a 53-year-old woman with a
history of steroid consumption for 30 years (chalmethasone oral twice a day) on indications of rheumatoid arthritis falling in a sitting position and causing fractures in the neck of the left femur bone, decided to undergo immediate action prosthetic hemiarthroplasty bipolar. Results show that until now the patient has had no patient complaints related to instability in walking, Limitation in performing activities, and pain in his prosthetic bone