Bilateral femoral neck fractures after an epileptic attack: A case report

Bilateral Intertrochanteric Femur Fractures in a Paraplegic Patient: A Case Report

Bilateral intertrochanteric (IT) femur fractures are rare, and appropriate evaluation and treatment can vary depending on concurrent patient comorbidities. Even less has been described for patients with bilateral IT fractures with pre-existing paraplegia. This case report describes the unique case of a 72-year-old paraplegic female who presented with bilateral IT femur fractures due to a wheelchair accident. The patient was treated with single-stage bilateral cephalomedullary nail fixation so she could effectively transfer to and from the wheelchair with less pain and a greater chance of fracture union. At the last follow-up, the patient's pain had resolved and she was able to transfer as effectively and safely as her pre-injury baseline. Single-stage cephalomedullary fixation of bilateral IT femur fractures is indicated in the paraplegic population to relieve pain and improve effective safe transfers for daily activities.

Spontaneous bilateral femur neck fracture secondary to grand mal seizure: A case report

BACKGROUND

Spontaneous bilateral femur neck fracture is a rare entity in the general population.

CASE SUMMARY

A 17-year-old immobile, developmentally delayed male with the sequelae of cerebral palsy fractured both femoral necks during a grand mal epileptic seizure. He had been treated with valproic acid as an antiseizure medication for about 10 years; otherwise, he had no history of drug use. The laboratory analysis was normal except a marked vitamin D deficiency. Closed reduction and osteosynthesis with percutaneous cannulated screws were performed. Solid union was observed at 6 mo, and rapid postoperative rehabilitation was started.

CONCLUSION

A femoral neck fracture may occur in a person with epilepsy presenting with hip pain in the emergency department.

Bilateral simultaneous asymmetric hip fracture without major trauma in an elderly patient: a case report

BACKGROUND

Simultaneous bilateral hip fractures without major trauma in the elderly are rare and usually symmetrical. To the best of our knowledge, only two cases of bilateral simultaneous asymmetric hip fracture in the elderly without major trauma have been reported.

CASE PRESENTATION

We present the case of a 90-year-old Japanese man with simultaneous bilateral asymmetric hip fractures with trochanteric fracture on the right side and greater trochanteric fracture on the left side. He complained of dyspnea at midnight and was referred to our emergency department. He was admitted to the internal medicine department for bacterial pneumonia treatment. On the 8th day of hospitalization, he was referred to our orthopedic surgery department for hip pain and was found to have fractures of both hips. Computed tomography findings showed that the left femoral neck fracture was an old fracture, while the left greater trochanteric fracture and the right trochanteric fracture were fresh fractures. He was surgically treated through open reduction and internal fixation with an intramedullary nail on the right and hemiarthroplasty on the left in supine position, performed during the same surgical sessions on the 12th day of hospitalization.

CONCLUSIONS

We report a new form of simultaneous bilateral asymmetric hip fracture in the elderly. The fracture types of the case were femoral trochanteric fracture and greater trochanteric fracture of the femur, which were different from the fracture types in the previously reported two cases. Clinicians should be aware of the possibility of simultaneous bilateral hip fractures, especially in the elderly.

Bilateral femoral neck fracture following a convulsion in the presence of chronic kidney disease. A case report

Introduction and importance

Bilateral femoral neck fractures in young adults are a rare entity. It is usually associated with pre-existing metabolic diseases, such as osteoporosis, renal osteodystrophy, or hypocalcemic seizures. Hence, it is essential in such cases to look for other associated injuries following a traumatic event. Missing associated injuries may lead to significant morbidities and poor functional outcomes.

Case presentation

A 37 years old male, who had chronic renal failure secondary to hypertension, and presented to the emergency room following a seizure episode, in which he developed a generalized tonic-clonic convulsion secondary to electrolyte imbalances with metabolic acidosis. As a result, he developed bilateral neck of femur fracture.

Intervention and outcome

The medical team optimized electrolytes imbalance and then the patient underwent surgical stabilization of both femur neck fracture, 1 year following the surgical fixation the patient had full range of motion of both hips with radiological evidence of complete healing of the fracture.

Conclusion

In cases of fractures secondary to metabolic conditions, bilateral femoral neck fractures should be suspected and investigated; especially in young patients who develop a generalized tonic-clonic seizure. The etiology is multifactorial, and the treating surgeon should be aware of predisposing factors which may affect bone quality, thereby raising the risk of fractures even with low-energy atraumatic events. Hip preservation should always be the primary target when treating these patients.

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Non-traumatic Bilateral femoral neck fractures in young adults following a generalized tonic-clonic is a rare entity.

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Pre-disposing metabolic disease such as hypocalcemia seizure are usually associated with this injury pattern

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Other associated fractures involving upper and lower extremities may co-exist.

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Ideal control of seizure disorder in pre-existing metabolic bone disorder may reduce risk of such injuries.

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Hip preservation should always be the primary target when treating these young patients.

A rare case of low voltage electrical injury leading to bilateral femur fractures and vertebral body fractures: A case report and review of the literature

Introduction and importance

Low voltage electrical injuries (less than 1000 V) can produce enough tetany to cause fractures, usually of the upper extremities. Simultaneous bilateral fractures of the femoral neck are an extremely rare occurrence. It is even more uncommon for a young healthy male to suffer significant fractures from a low voltage injury.

Case presentation

A 25-year-old male attempted suicide by filling a bathtub with water and getting into it prior to dropping a blender into the water. He experienced full body convulsions but remained awake throughout the entire event. In the trauma bay his primary complaints were bilateral hip pain and back pain, without neurologic deficit. Radiological studies confirmed bilateral sub-capital femur fractures and thoracic vertebral fractures (compression fractures of T3, T4, T5, T6, T7, T9, and T11). The patient underwent bilateral open reduction and internal fixation (ORIF) of the femurs, while the spine fractures were treated with a thoracic-lumbar-sacral orthosis TLSO brace.

Clinical discussion

Low voltage electrical injury is more likely to lead to fractures in patients with chronic renal failure and metabolic conditions such as hypocalcemia, osetomalacia, and osteoporosis. Fractures after low voltage electrical injury are extremely uncommon and a high suspicion for these injuries should be maintained because if missed there is a high risk of morbidity and mortality.

Conclusion

We present a rare case of low voltage electrical injury by 120 V from a domestic US power supply, amplified by water conduction resulting in bilateral femoral neck fractures and vertebral body fractures.

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Fractures resulting from low voltage electrical injury are usually related to chronic renal failure, and metabolic conditions such as hypocalcemia, osetomalacia, and osteoporosis.

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Electrical injuries require a thorough assessment including voltage, duration of injury, environment (wet skin or humid environment), and any existing comorbidities.

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Bilateral femure and vertebral fractures are rare injuries following low-voltage electrical injury.

Management of lower extremity orthopaedic injuries in epileptic patients: A systematic review

Lower-extremity injuries may occur during seizures. There is a lack of standardized guidelines when diagnosing and planning perioperative care. Databases were systematically screened using predefined search terms. Of the 13 patients included, seven (53.8%) involved bilateral femoral neck fractures. Associated fractures were observed in all cases with surgical intervention performed in eight (61.5%) patients. Eleven patients reported functional outcomes, with over a quarter (three of 11, [27.3%]) endorsing mild range of motion deficits or issues with ambulation. Post-seizure patients may require standardized diagnostic protocols to ensure prompt management with a specialized treatment approach that accommodates the nuances of their condition.

Rare Complications of Seizures in End-Stage Renal Disease: A Case Report

Patients with chronic kidney disease (CKD) that progresses to end-stage renal disease (ESRD) typically present with uremic symptoms. CKD causes renal osteodystrophy, which leads to disturbances in mineral and bone metabolism. Pathological bone fractures after seizures activity has been reported in literature.

In this study, we present what we consider the first case of combined bilateral femoral neck fractures, bilateral temporomandibular joint dislocations, and right shoulder anterior fracture dislocation in a patient who had a seizure activity due to electrolyte imbalance resulting from ESRD. The patient is a 36-year-old man with CKD that progressed to ESRD.

Joint dislocations and bone fractures are rare complications of seizures activity. Diagnosis is usually delayed due to the low prevalence of these complications after seizures. Clinicians should always bear in mind that ESRD places patients at high risk of these rare complications.

A simultaneous bilateral asymmetric hip fracture in an elderly patient: A case report and review of the literature

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Simultaneous bilateral hip fractures in the elderly are rare and usually have a symmetric pattern.

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Intracapsular fractures on one side and trochanteric on the other are even rarer.

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They are caused by a spontaneous fracture which causes a fall on the contralateral side.

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The trochanteric fracture should be operated first to avoid possible complications.

Introduction

Simultaneous bilateral hip fractures are usually associated with high energy trauma, seizures, metabolic diseases and bisphosphonates use. They are observed rarely in the elderly population after simple trauma and usually have the same fracture pattern (symmetric). We report a rare case of asymmetric fracture and discuss mechanism of injury and treatment, analyzing the literature.

Presentation of case

We report a case of an 86-year old woman with a simultaneous bilateral asymmetric hip fracture (trochanteric on the right side and subcapital on the left), occurred after a fall at home. The patient was surgically treated by open reduction and internal fixation with an intramedullary nail on the right and by hemiarthroplasty on the left performed during the same surgical session, with good results.

Discussion

Simultaneous bilateral hip fractures in the elderly are rare and usually are symmetric. In the majority of the cases these fractures are intracapsular and are treated by hemiarthroplasties. On the contrary, simultaneous bilateral hip fractures with a different pattern, as the described case, are extremely rare. The possible mechanism of injury is a spontaneous fracture on one side, which causes a fall the contralateral side. The surgical treatment may be performed bilaterally, treating first the trochanteric fracture.

Conclusion

Simultaneous bilateral asymmetric hip fracture are extremely rare and may occur in elderly patient with a specific mechanism of injury. We believe that the trochanteric fracture should be operated first to avoid possible complications.

Simultaneous Bilateral Neck of Femur Fracture in a Young Adult with Underlying Metabolic Disturbances

Introduction. Simultaneous bilateral fractures of the femoral neck are considered very rare injuries. Few cases were reported in the literature. Most cases were reported in elderly patients with underlying bone pathology. Case Report. We report a case of a 31-year-old male patient who presented to the emergency department with bilateral hip pain and inability to bear weight after a sudden loss of consciousness and fall while running on a treadmill. The patient had a recent history of anabolic steroids, growth hormone, and other supplements used for bodybuilding. Radiological studies confirmed bilateral neck of femur fracture. Laboratory investigations revealed pan-pituitary axis insufficiency and mild vitamin D deficiency, and his EEG suggested a seizure attack. The patient was treated with three 6.5 mm cannulated cancellous screws on one side and a sliding hip screw on the other side and was followed with strict physical therapy and rehabilitation plan. 6 months from the injury, a radiographic bilateral union achieved with the patient back to his normal daily activity and noncontact sports.

Simultaneous bilateral neck of femur fractures in an adolescent secondary to hypocalcaemic seizure

We present a rare case of a previously healthy 16-year-old boy who sustained simultaneous bilateral femoral neck fractures after a single first-time seizure episode. He was diagnosed to have severe vitamin D deficiency and secondary hyperparathyroidism. Symptomatic hypocalcemia was the cause of seizures. Both fractures were treated surgically and united at 3 months. Bilateral femoral neck fractures after seizures are very rare, especially in children. Severe vitamin D deficiency may cause seizures and also weakening of bone, predisposing to fractures without significant trauma. We recommend that paediatric cases of femoral neck fractures after seizures should be investigated for underlying metabolic disease.

Bilateral Femoral Neck Fracture in a Postpartum Woman: Beware of the Risk Factors

Bilateral femoral neck fractures pose a rare injury. Literature data describe this entity in association with epileptic seizures, renal osteodystrophy, electric shock, pregnancy-associated transient osteoporosis, and hypocalcemic seizure. In the present work, we report on a rare case of a 28-year-old woman who suffered from such an injury 3 days postpartum. The patient had two predisposing factors (epilepsy history, transient osteoporosis) that were neglected as possible risk factors by the treating physicians. Awareness of the factors might have prevented the emergence of this injury.

Seizures Causing Simultaneous Bilateral Neck of Femur Fractures

Neck of femur fractures are a ubiquitous injury seen by orthopaedic surgeons. In the elderly, these fractures usually occur after a low energy fall, and are invariably unilateral injuries. Bilateral neck of femur fractures have been reported in patients with metabolic bone disease, after electroconvulsive therapy, and in association with stress fractures. The otherwise healthy index patient in this case report presented most unusually, with simultaneous, bilateral neck of femur fractures that were sustained during a seizure.

Side-Effects of Convulsive Seizures and Anti-Seizure Therapy on Bone in a Rat Model of Epilepsy

The severe sole effects of seizures on the cortical part of bone were reported in our previous study. However, the side effects of anti-epileptic drug therapy on bones has not been differentiated from the effects of the convulsive seizures, yet. This study provides the first report on differentiation of the effects of seizures and carbamazepine (a widely used antiepileptic drug) therapy on bones; 50 mg/kg/day drug was given to genetically induced absence epileptic rats for five weeks. Distinct bone regions including cortical, trabecular, and growth plate in each of tibia, femur, and spine tissues were studied using Fourier transform infrared (FT-IR) imaging and Vickers microhardness test. Blood levels of vitamin D and bone turnover biomarkers were also measured. According to the FT-IR imaging results, both seizure and carbamazepine-treated groups, more dominantly the drug-treated group, had lower mineral content with altered collagen crosslinks and higher crystallinity, implying reduced bone strength. Lower microhardness values also supported lower mechanical strength in bones. The most affected bone tissue and region from seizures and treatment was found as the spine and cortical, respectively. While there was a reduction in vitamin D and calcium levels in both seizure and carbamazepin-treated groups, significantly elevated PTH and bone turnover biomarkers were only seen in the drug-treated group.

Bilateral avascular necrosis of the femoral head following asynchronous postictal femoral neck fractures: a case report and review of the literature

Bilateral avascular necrosis (AVN) following postictal bilateral fracture neck of the femur is a rare occurrence. Here, we report a case of bilateral AVN of the femoral head following an asynchronous bilateral postictal fracture neck of the femur. A 16-year-old autistic boy presented with left hip pain following an episode of seizures and radiographs showed Delbet type II fracture neck of the left femur. This was treated by closed reduction and cancellous screw fixation and skeletal traction for 6 weeks. At 3 months, follow-up radiograph showed union of the fracture, but he had developed segmental AVN with collapse of the head. At 8 months, the patient presented with pain in the right hip following another episode of seizures and radiograph of the pelvis showed a fresh Delbet type II fracture neck of the right femur with established AVN of the left femoral head. He underwent closed reduction and cancellous screw fixation of the right hip and implant exit of the left hip. At the 6-month follow-up after this surgery, his radiograph of the pelvis showed AVN with collapse and extrusion of the femoral head on the right side as well. Literature review shows an increased risk of fracture neck of the femur among epileptics. The incidence of AVN is maximum in Delbet type I, followed by Delbet type II and type III in that order. Although there are no clear guidelines on the management of post-traumatic AVN of the femoral head, the majority have reported that most of them will eventually develop arthritis and will require total hip replacement at a later date. Upon extensive literature search, no case report of bilateral fracture neck of the femur with bilateral AVN was found and hence this case was reported.

Bilateral spontaneous anterior shoulder dislocation: A missed orthopedic injury mistaken as proximal neuropathy

A number of orthopedic injuries can occur during epileptic seizures. Anterior shoulder dislocation is one such orthopedic injury that is quite rare. The shoulder dislocation may injure the brachial plexus. Besides seizures, the nerves can also be damaged by anticonvulsive therapy. Muscle wasting following a seizure can misguide a clinician to investigate only neural or muscular pathologies. We report here an individual with epilepsy who was referred to us for electrodiagnostic evaluation of proximal muscle wasting related to a suspected proximal neuropathy. He was found to have a normal electrodiagnostic evaluation and later on discovered to have had bilateral shoulder dislocation on X-rays. This report advocates a thorough clinical appraisal, radiographs, and electrodiagnostic evaluation in a case with muscle wasting following a seizure.

Bilateral Neck of Femur Fractures in a Bilateral Below-Knee Amputee: A Unique Case

According to the National Hip Fracture Database, over 64,000 patients were admitted with a hip fracture across England, Wales, and Northern Ireland in 2013, but very few are bilateral, and there are no current cases in the literature of bilateral neck of femur fractures in a patient with bilateral below-knee amputations. We present a case of a 69-year-old bilateral below-knee amputee male admitted to the emergency department with bilateral hip pain and radiological evidence of bilateral displaced neck of femur fractures. The patient subsequently underwent synchronous bilateral total hip replacements under general anaesthetic and an epidural and then went on to make a full recovery. He was discharged 27 days after arrival in hospital. Outpatient follow-up at 3 months has shown that the patient has returned to a similar level of preinjury function and is still able to carry out his daily activities with walking aids and bilateral leg prostheses.