Case Diagnosis: A 30-year-old male with congenital osteodystrophy presented with acute on chronic fractures which were managed non-operatively and operatively with total hip arthroplasty requiring acute on chronic pain management.
Case Description: A 30y.o. male with past medical history of congenital osteodystrophy with congenitally shortened left leg presented with left hip pain after mini-bike collision. Imaging was significant for comminuted nondisplaced left pubic ramus fracture; acute on chronic proximal left femoral fracture; chronic left hip superior dislocation; and comminuted left distal clavicle fracture. Due to chronic fractures, patient took Tylenol #3 every 6 hours as needed (prn) and ibuprofen 600mg every 8 hours prn at home. The patient underwent left total hip arthroplasty (THA) with orthopedic surgery. Postoperatively, he was started on methocarbamol 500mg every 6 hours, acetaminophen 500mg every 6 hours prn, morphine 4mg every 4 hours prn, and Norco 5-325 every 4 hours prn which was later increased to Norco 7.5-325 to manage acute on chronic pain. Weight bearing status was determined as non-weight bearing left upper extremity with sling, toe-touch weight bearing left lower extremity with hip abduction brace. The patient was able to participate in acute care physical therapy while on the new pain regimen and was discharged home on methocarbamol, Norco 7.5-325, and acetaminophen.
Discussion: This is the first reported case, to our knowledge, of acute on chronic pain management of fractures in a patient with congenital osteodystrophy requiring surgical and non-surgical intervention.
Setting: Tertiary care community hospital
Assessment/Results: At 17 weeks postoperative, the patient completed a course of outpatient physical therapy reaching rehabilitation goals as modified-independent at home with previous prosthesis. He had been weaned off acute pain medications and was back on his home pain regimen.
Conclusion: Individualized approach to pain management is needed in patients with congenital osteodystrophy who suffer from acute on chronic fractures needing surgical and non-surgical intervention.
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