Sudden death from pelvic hemorrhage after bilateral central fracture dislocations of the hip due to an epileptic seizure

Bilateral Neck Femur Fracture during Prison Confinement: An Atypical Mechanism of Injury

Introduction:

Simultaneous bilateral neck femur fracture is a rare entity that has been associated with metabolic disorders, osteoporosis, drugs, trauma, and seizure disorders. Its occurrence following a physical assault is very rare. We present a case report of a prisoner presenting with bilateral neck femur fracture following a physical assault during prison confinement.

Case Presentation:

This article presents the case of a 64-year-old male prisoner who sustained bilateral intracapsular fracture neck femur following the physical assault. Bilateral uncemented total hip replacement was done using a posterior approach at separate sittings. The patient made an uneventful recovery with return of pain-free normal range of motion at the time of discharge. The weight-bearing mobilization was allowed immediately following bilateral hip arthroplasty. Harris hip score at the time of discharge and the last follow-up of 12 months was 83.4 and 90.3, respectively. No wound-related or other systemic complications were noted.

Conclusion:

bilateral fracture neck femur is commonly associated with metabolic conditions, rarely associated blunt trauma. This article highlights the need to suspect these fracture in all elderly cases presenting with hip pain.

Unprecedented bilateral humeral shaft fracture after cesarean section due to epileptic seizure per se

Despite the fact that spontaneous (non-traumatic) bilateral humeral fractures without trauma are seen as a rare entity, especially grand mal epileptic convulsions may result in these types of fracture in the adult. A 32-year-old early postpartum patient without osteoporosis and with a history of epilepsy is presented here. She had not used anticonvulsant drugs for nearly ten years. After a convulsive epileptic attack on the day of a cesarean section, bilateral humeral shaft fractures were diagnosed on the 5th postpartum day causing bilateral shoulder pain. An earlier chest anteroposterior X-ray including the humerus would be a help in order to perform earlier diagnosis. It should be taken into consideration that humeral bone fractures may happen without any trauma especially in early postpartum patients. A high degree of suspicion should be kept in mind while treating a patient in the post-ictal phase; as, if treated promptly, treatment leads to complete functional recovery.

Seizure induced polytrauma; not just posterior dislocation of the shoulder

A 61-year-old woman sustained multiple fractures secondary to the tonic clonic muscular contractions of a seizure. Her injuries included: bilateral proximal humerus posterior fracture dislocations, manubrium fracture, unstable sixth thoracic vertebrae crush fracture, bilateral acetabular fractures and a left femoral neck fracture. Seizures are a rare but recognised cause of fracture. Patients with osteoporosis are more susceptible to more serious fractures to long bones, spine and pelvis. The lack of history of high-energy trauma can lead to a delay in diagnosis. Rarely, the combination and magnitude of these injuries can be life-threatening.

Acetabular Central Fracture Dislocation after Generalized Seizure during Lumbar Myelography with Iohexol

Fracture is a less common complication in seizure patients, and fractures as a consequence of convulsive seizures without direct trauma occur in 0.3% of cases. Acetabular fractures after convulsions are even more rare, and only a few cases of acetabular fracture dislocations, purely caused by convulsive activity, have been reported. Therefore, we report a case of unilateral acetabular central fracture dislocation after a seizure episode, with relevant literature review. The seizure attack occurred after contrast media (Iohexol) injection for checking the myelography.

Literature review and clinical presentation of bilateral acetabular fractures secondary to seizure attacks

Central acetabular fracture dislocation is usually caused by high-energy external trauma. However, 26 cases that occurred as a result of a seizure attack appeared in the literature from 1970 to 2007, with the seizure attacks themselves caused by many different factors. In this setting, the central acetabular fracture not caused by direct trauma might initially remain unnoticed leading to a delayed diagnosis. In some cases, this may lead to death as a result of massive blood loss. We here present a case of bilateral central acetabular fracture dislocation as a result of a seizure attack.

Non-traumatic fractures following seizures: two case reports

INTRODUCTION

Seizures with or without trauma may cause fractures that occur commonly in epileptic seizures. Fracture risk is less reported in non-epileptic seizures. Some metabolic conditions leading to a decrease in bone mineral density may cause fractures secondary to non-epileptic seizure.

CASE PRESENTATION

We describe two cases of non-traumatic acetabular and vertebrae fractures following seizures without history of epilepsy. They occurred in two male patients, 18 and 48 years old suffering respectively from hypercorticism and poorly controlled diabetes mellitus. Seizures, occurring inside hospital, were secondary to hypertensive encephalopathy crisis with hypokaliemia in the first case and severe hypoglycaemia in the second one. Fracture was promoted by a decrease in mineral bone density caused respectively by hypercorticism and diabetic chronic renal failure.

CONCLUSION

These observations emphasize that fracture prevention among patients with decreased mineral bone density should include the avoidance of metabolic causes of seizure.

Simultaneous bilateral femoral neck fractures secondary to epileptic seizures: treatment by bilateral total hip arthroplasty

Simultaneous bilateral femoral neck fracture following an epileptic seizure attack are rare. Open reduction and internal fixation remains the most used therapeutic option. Arthroplasty, carrying a high risk of dislocation is less often recommended. We report the favourable evolution of a 49-year-old man who benefited from a single stage bilateral total hip arthroplasty operation for his simultaneous bilateral, femoral neck fractures secondary to a generalized seizure. This nonconsensual choice, in this case, was justified on multiple grounds: surgical care delay longer than 48 hours, substantial bone displacement, borderline bone quality, adequate antiepileptic treatment efficacy and tolerance. A ceramic-on-ceramic bearing surfaces couple, a large-diameter head and a cementless implantation design together should be able to provide an acceptable longevity in a young and active patient.

Traumatic transepiphyseal separation of the upper femoral epiphysis following seizures in a 5-month-old child: a case report

INTRODUCTION

Traumatic transepiphyseal separation of the upper femoral epiphysis is a rare lesion of the hip in children.

CASE REPORT

We report a case of conservative treatment of transepiphyseal separation of the upper femoral epiphysis following tonic/clonic seizures in a 5-month-old child. Magnetic resonance imaging confirmed the diagnosis The fracture was maintained with hip spica cast for 6 weeks. At the age of 2, complete healing of the lesion including femoral neck remodeling was noted on frontal and lateral radiographs. There was no radiological evidence of AVN or premature closure of the physis. He continues to be followed up.

DISCUSSION

Because of the remodeling potential in young children, we assume not to perform additional reduction procedures in such traumatic lesions.

Myoclonus-induced bilateral acetabular fracture dislocations

An uncommon case of myoclonus-induced bilateral central acetabular fracture-dislocation is presented. Although different fracture types due to forceful muscular contractions have been reported, this is an exceedingly uncommon injury pattern. Bilateral total hip arthroplasty, in combination with a reinforcement ring and autologous bone grafting, was performed after open reduction and internal fixation.

An autopsy case of intraoperative death due to pulmonary fat embolism—possibly caused by release of tourniquet after multiple muscle-release and tenotomy of the bilateral lower limbs

We report a case of a juvenile male with muscle rigidity caused by cerebral palsy who experienced intraoperative sudden death due to pulmonary fat embolism after multiple muscle-release and tenotomy of the bilateral lower limbs. Data were obtained through review of the surgical and anesthesia records, as well as from autopsy and histopathological examination. All surgical procedures were performed within the same operation, beginning with the right lower limb and then proceeding with the left lower limb, with application of a pneumatic tourniquet to avoid intraoperative hemorrhage. Slight changes in the hemodynamics were noticed after release of the right tourniquet. Further, sudden onset of hypotension, severe bradycardia, and a marked decrease in percutaneously monitored oxygen saturation occurred just after release of the left tourniquet when the left limb was raised for casting. The patient died despite immediate and vigorous cardiopulmonary resuscitation. At autopsy performed 20 h after death, examination of the lungs revealed a pale surface, slight edema, and obvious fat droplets in the vessels at the cut surfaces. Histopathological examination with fat staining was notable for the presence of pulmonary fat embolism. These results suggest that restoration of venous return after removal of the tourniquet combined with massive fat embolism from dead spaces was the likely cause of death.