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

Figure 1 Preoperative anteroposterior and lateral X-rays demonstrating transcervical stress fracture of left femoral neck, with Singh’s grade III osteopenia noted on the right proximal femur.

Figure 2 Postoperative AP and lateral radiographs of left proximal femur valgus Osteotomy demonstrating sliding hip screw fixation.

Figure 3 Three months postop follow up with sound union

Figure 4 Six months post operative follow up with stress fracture non union of the Right femur neck

Figure 5 Suspected mechanisms. A: Human immunodeficiency virus and mediated osteopenia; B: Highly active antiretroviral therapy associated osteopenia. HIV: Human immunodeficiency virus; TNF alpha: Tumor necrosis factor alpha; HAART: Highly active antiretroviral therapy; Vit D: Vitamin D; Hep C: Hepatitis C; NRTIs: Nucleoside reverse transcriptase inhibitors ;OPG: Osteoprotegerin.