Case Report: Management strategy of rare case first-generation antipsychotic drug induced neglected femoral neck fracture in schizophrenia patients

Abstract

Background: The early onset of femoral neck fracture is commonly treated by bone grafting surgery. However rare cases of neglected femoral neck fractures in schizophrenic patients need to be treated by arthroplasty because of the rapid destruction of the femoral head within the acetabulum. Case presentation: We report a rare unique case of first-generation antipsychotic drug-induced neglected femoral neck fracture in a 41-year-old man presenting after a month complaining of not being able to walk due to falling in a ditch. X-ray examination findings revealed total destruction of the femoral head within the acetabulum with no acetabulum dysplasia detected. Ordinarily, it should be treated with a bone grafting procedure since no dysplasia was detected and it was an early onset case. However,  arthroplasty was chosen because the femoral head was destructed. Three months post-surgery x-ray shows the acetabulum dysplasia and lytic lesion that confirm drug-induced bone destruction by the first-generation antipsychotic drug. Conclusions: We suggest that even though rare, first-generation antipsychotic drugs neglected femoral neck fractures in schizophrenia patients can be successfully treated by arthroplasty supported by the patient’s compliance. Bone mineral density (BMD) test is also suggested to monitor the bone density of schizophrenia patients.