A Fragile Balance: Managing Femoral Neck Fracture, Transient Osteoporosis, and COVID-19 in Late Pregnancy

Transient osteoporosis of the hip (TOH) during pregnancy is a rare, self-limiting condition that frequently goes undiagnosed. However, if not managed properly, TOH can lead to significant complications, such as pathological fractures. We report a case of a 29-year-old primigravida at 33 weeks and four days of gestation who presented with a right femoral neck fracture following a fall. She had experienced prodromal hip pain for one month, initially misdiagnosed as pelvic girdle pain. Radiological evaluation revealed osteopenia and a sub-capital femoral neck fracture. Blood investigations were unremarkable. During hospitalisation, the patient was also diagnosed with asymptomatic COVID-19 infection, complicating the management approach. A multidisciplinary team decided on an elective caesarean section followed by closed manipulative reduction (CMR) and percutaneous screw fixation. Therefore, TOH in pregnancy requires timely diagnosis and intervention to prevent complications such as fractures. In cases complicated by concurrent conditions like COVID-19, multidisciplinary management is essential to ensure optimal outcomes for both mother and child.