J Yeungnam Med Sci.  2023 Apr;40(2):212-217. 10.12701/jyms.2022.00479.

Transient osteoporosis of the hip with a femoral neck fracture during follow-up: a case report

• Tabata Y
• Matsui S
• Miyamoto M
• Omori K
• Tabata Y
• Majima T

• KMID: 2541950
• DOI: http://doi.org/10.12701/jyms.2022.00479

Abstract

We report a case of transient osteoporosis of the hip with a femoral neck fracture found during follow-up. A 53-year-old man presented with left hip pain without trauma. The pain did not improve after 2 weeks and he was brought to our hospital by ambulance. Magnetic resonance imaging (MRI) of the left hip joint showed diffuse edema in the bone marrow, which was identified by low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and increased signal intensity on short tau inversion recovery. This edema extended from the femoral head and neck to the intertrochanteric area. He was diagnosed with transient osteoporosis of the left hip. Rest gradually improved his pain; however, 3 weeks later, his left hip pain worsened without trauma. X-ray, computed tomography, and MRI results of the hip joint demonstrated a left femoral neck fracture, and osteosynthesis was performed. Differential diagnoses included avascular necrosis of the femoral head, infection, complex regional pain syndrome, rheumatoid arthritis, leukemia, and other cancers. Transient osteoporosis of the hip generally has a good prognosis with spontaneous remission within a few months to 1 year. However, a sufficient length of follow-up from condition onset to full recovery is necessary to avoid all probable complications such as fractures.

Keyword

Complications; Femoral neck fractures; Magnetic resonance imaging; Surgery; Transient osteoporosis of the hip

Figure

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  Fig. 1. X-ray and computed tomography (CT) reveal no obvious fractures. (A) X-ray anterior view. (B) CT coronal view. (C) CT axial view.

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  Fig. 2. The magnetic resonance imaging coronal views of the left transient osteoporosis of the hip. (A) Short tau inversion recovery image. (B) T2-weighted image. (C) T1-weighted image.

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  Fig. 3. Magnetic resonance imaging (MRI) axial view of the left transient osteoporosis of the hip. MRI shows diffuse edema in the bone marrow, extending from the femoral head and neck to the intertrochanteric area. (A) Short tau inversion recovery image. (B) T2-weighted image. (C) T1-weighted image.

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  Fig. 4. The left femoral neck fracture (arrows). It is difficult to find the fracture line of the femoral neck, by either X-ray or computed tomography (CT). (A) X-ray anterior view. (B) X-ray lateral view. (C) CT axial view. (D) CT coronal view.

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  Fig. 5. Magnetic resonance imaging coronal view of the left femoral neck fracture (arrows). (A) Short tau inversion recovery image. (B) T1-weighted image.

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  Fig. 6. Magnetic resonance imaging (MRI) axial view of the left femoral neck fracture (arrows). MRI shows a clear fracture line in the left femoral neck. (A) Short tau inversion recovery image. (B) T1-weighted image.

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  Fig. 7. Osteosynthesis with three Prima Hip screws (Japan Medical Dynamic Marketing, Inc., Tokyo, Japan). (A) X-ray anterior view. (B) X-ray lateral view.

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