DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20204259

Pathological fracture of subtrochanter femur, soft tissue infection along the fracture site, shaft femur bone cortex thickening and blastic lession on contralateral shaft femur due to renal osteodystrophy on the end stage renal disease patient: a case report

Gde Dedy Andika, Gede Ketut Alit Satria Nugraha, I. Made Sunaria, Putu Astawa, I Gede Eka Wiratnaya, Made Agus Maharjana

Abstract


Renal osteodystrophy (ROD) is a skeletal complication resulting from pathologic alterations in calcium, phosphate, and bone metabolism. The potential link between bone turnover and bone quality is an important question meriting study because of the relatively high incidence of fractures reported. In this case presents a pathological fracture on a routinely hemodialyzed woman. She complained pain on her left subtrochanteric area after low energy trauma accident. A thickening of the shaft femoral bone cortex was also found, reflecting the osteosclerosis event due to imbalance of proliferation and differentiation of osteoblast with increase bone formation. She also had a blastic lesion on her contralateral shaft femoral during the bone survey, but this finding remains asymptomatic. Decreased osteoclastic activity may contribute to cortical thickening, resulting in overall bone mass increase, which may lead to decreased elasticity of the bone or impaired repair capabilities, therefore increasing the risk of fracture. The blastic lesion that occurred on contralateral side may indicated effect of ROD or primary bone lesion. Careful assessment and holistic management of patients with kidney disease is necessary to achieve optimal outcome. The prevention of falls is also an important strategy to prevent pathological fractures. End stage renal disease (ESRD) have reduced bone mineral density, a risk factor for fracture incidence. Careful anamnesis and clinical examination are needed for diagnosis and management.


Keywords


Case report, End stage renal disease, Pathological fracture, Renal osteodystrophy

Full Text:

PDF

References


Kazama JJ. Chronic Kidney Disease and Fragility Fracture. Clin Exp Nephrol. 2017; 21 (1):S46-52.

Pimentel A, Torres P, Zillikens MC, Bover J, Solal MC. Fractures in Patient With CKD-Diagnosis, Treatment and Prevention: A Review by Members of The European Calcified Tissue Society and The European Renal Association of Nephrology Dialysis and Transplantation. Kidney Int. 2017;92:1343-55.

Wong K, Lin W, Chien CS, Wul CD. Femoral Neck Fracture in End Stage Renal Disease Treated with Osteosynthesis. Formosan J Musculoskeletal Disorders. 2012:56-60.

Salduz A, Polat G, Akgul T, Ergin ON, Şahin K, Yazicioglu O. Complication and Midterm Outcome of Hemiarthroplasty in Hemodialysis Patients. Acta Ortop Bras. 2017;25(5):220-3.

Drueke T, Massy Z. Changing Bone Patterns with Progression of Chronic Kidney Disease. Kidney Int. 2016(89):289-302.

Fusaro M, Gallieni M, Jamal S. Fractures in Chronic Kidney Disease: Neglected, Common and Associated with Sickness and Death. Kidney Int. 2013;85:20-22.

Moe S, Nickolas T. Fractures in Patient with CKD: Time for Action. Clin J Am Soc Nephrol. 2016;11:1-3.

Sprague SM, Bellorin-Font E, Jorgetti V, Carvalho AB, Malluche HH, Ferreira A et al. Diagnostic accuracy of bone turnover markers and bone histology in patients with CKD treated by dialysis. Am J Kidney Dis. 2016;67:559-66.

McCloskey EV, Ode’n A, Harvey NC, Leslie WD, Hans D, Johansson H et al. A meta-analysis of Trabecular Bone Score in Fracture Risk Prediction and its Relationship to FRAX. J Bone Miner Res. 2016;31:940-48.

Naylor KL, McArthur E, Leslie WD, Fraser LA, Jamal SA, Cadarette SM et al. The three-year Incidence of Fracture in Chronic Kidney Disease. Kidney Int. 2014;86:810-18.

Anpalahan M, Venkatesan S, Anpalahan A. Fragility Fractures in Chronic Kidney Disease: Assessment and Pharmacologic Management. Advances in Nephrology. 2014;1-7.

Xie Y, Ma XB, Lun Li Xie, Jian Li, Jun Zhu, Jun Yang et al. Management Strategies for Femoral Head Replacement Arthroplasty in Uremia Patients: Case Report. Biomed J Sci & Tech Res. 2018;4(1):1-4.

Bahad A, Kabbaj D, Benyahia M. Prevalence of Renal Osteodystrophy in African Hemodialysis Patients. Nephro Urol Mon. 2013;5(3):852-3.

Moorthi R, Moe S. Recent Advances in the Non-Invasive Diagnosis of Renal Osteodystrophy. Kidney Int. 2013; 84 (5):886-94.

J Jat JA, Mal P, Kumar D. Renal Osteodystrophy in End Stage Renal Failure Patients on Maintenance Hemodialysis. J Clin Exp Nephrol. 2016;1:25.

Malluche H, Mawad H, Faugere MCM. Renal Osteodystrophy in First Decade of the New Millenium : Analysis of 630 Bone Biopsies in Black and White Patients. J Bone and Mineral Res. 2011; 26(6);1368-76.

Kishawi A, Nahas AM. Renal Osteodystrophy: Review of the Disease and its Treatment. Saudi J Kidney Dis Transplant. 2016;17(3):373-82.

Elder G. Review Pathophysiology and Recent Advances in the Management of Renal Osteodystrophy. J Bone and Mineral Res. 2012;17(12):2094-5.

Sathyanarayana, Patel MT. Simultaneous Bilateral Femur Neck Fracture in A Young Adult with Chronic Renal Failure -A Case Report and Review of Literature. J Orthop Case Reports. 2015;5(4):24-6.

John R, Kumar P, Aggarwal S, Rajnish RK, Agarwal S, Vatsyan K. Simultaneous, Non-Traumatic, Bilateral Neck Femur Fracture in Uremic Renal Osteodystrophy: A Repost of Three Cases and Literature Review. J Orthop Case Reports. 2018;8(2):90-94.