Simultaneous Bilateral Femoral Neck Stress Fracture in a Young Stone Mason

Bilateral Non-traumatic Neglected Femoral Neck Fracture in a Healthy Adolescent: A Case Report and Review of Literature

Introduction

Bilateral femoral neck fracture in children is uncommon and is extremely rare in the absence of significant injury or any underlying systemic and local bone disease. Diagnosis in these healthy children is usually delayed due to the presence of mild symptoms and lack of suspicion for a fracture.

Case Report

We report a case of 13-year-old girl with a bilateral neck of femur fracture without any history of trauma or any underlying systemic or local disease. The child presented to us 6 months after the onset of symptoms and was managed by osteosynthesis and valgus intertrochanteric osteotomy. The fractures on both sides healed satisfactorily without any evidence of avascular necrosis of the femoral head. However, nonunion of the intertrochanteric osteotomy was observed on the left side. It was subsequently managed by open reduction and bone grafting and healed satisfactorily thereafter. The relevant literature about this rare case has been discussed.

Conclusion

Management of late presenting fractured neck femur is more complex and often needs more invasive procedures. Besides, it is known to increase the risk of complications and compromise the treatment outcome. Hence, it is important to realize the possibility of a fracture neck femur in an otherwise normal child and such children should be evaluated and treated at the earliest for a better outcome.

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.

Failed Internal Fixation in Bilateral Femoral Neck Stress Fracture Salvaged with Total Hip Arthroplasty: A Report of Two Cases with Literature Review

Bilateral Femoral neck stress fractures (FNSFs) are rare without any underlying metabolic disease or repeated strenuous activities like athletes or military recruits. It constitutes about 5-8% of all stress fractures. Treatment options are still controversial. We report two young women with bilateral simultaneous FNSFs without any metabolic cause, presented to us following failed internal fixation with cancellous screws and neck resorption salvaged with total hip arthroplasty. Compression type stress fracture healed in the final follow-up on the other side.

Bilateral Femoral Neck Stress Fracture Presented with Unilateral Symptoms in a Shipman Laborer: A Case Report

Femoral neck stress fracture occured commonly in athlete and military recruit populations, some of them are bilateral. Bilateral femoral neck stress fracture that associated with other occupation is very uncommon. We report a bilateral femoral neck stress fracture case that presented with unilateral symptoms in a male shipman laborer. The patient was successfully treated conservatively. Stress fracture sometimes occur associated with an unexpected specific occupation. Consideration of bilateral involvement is highly important in managing stress fracture.

Bilateral stress fracture of femoral neck in non-athlete - case report

Bilateral stress fracture of femoral neck in healthy young patients is an extremely rare entity, whose diagnostic and treatment represent a major challenge. Patients with history of hip pain, even non-athletes or military recruits, should be analyzed to achieve an early diagnosis and prevent possible complications from the surgical treatment. This report describes a 43-year-old male patient, non-athlete, without previous diseases, who developed bilateral stress fracture of femoral neck without displacement. He had a late diagnosis; bilateral osteosynthesis was made using cannulated screws. Although the diagnosis was delayed in this case, the study highlights the importance of the diagnosis of stress fracture, regardless of the activity level of the patients, for the success of the treatment.

Trochanteric Stress Fracture in a Female Window Cleaner

Stress fractures may occur at various sites in the femur including the head, neck, shaft, supracondylar and condylar regions. To the best of our knowledge, stress fracture occurring in the trochanteric region has not been previously reported. We report here a case of trochanteric stress fracture in a 53-year-old female window cleaner treated with hip nailing without adverse consequences. Careful consideration of this entity is needed when evaluating patients who have repetitive jumping up and down.

Compliance with established guidelines for the radiological reporting of atypical femoral fractures

OBJECTIVE

Atypical femoral fractures (AFFs) are important to diagnose early to avoid progression to complete fracture. We set out to determine the reporting accuracy of AFFs.

METHODS

We conducted a retrospective analysis of imaging performed between November 2010 and June 2013 to analyse the X-ray reporting of AFFs and to describe the key clinical considerations. Radiological reports were reviewed from the 3805 separate femoral images for search terms thought likely to identify AFFs. This identified 1558 patients. The identified radiographs were reviewed by radiologists with reference to the 2010 American Society of Bone and Mineral Research (ASBMR) criteria.

RESULTS

Within these 1558 patients, 16 patients met the radiological criteria for AFF according to the 2010 ASBMR task force statement of which, although all were identified as fractures, 15 were not reported as "atypical" by the original reporting author and none was formally classified as AFF by the original reporting author. Within the 1558 patients, there were an additional 17 patients labelled as having "atypical" fracture features originally, although only 1 patient met the 2010 ASBMR task force criteria for AFF. Only 13 of 16 patients had imaging of the contralateral femur, and there was a significant delay for those who were imaged (111 ± 44 days). Furthermore, two of the patients with an AFF had previous radiographs demonstrating cortical changes indicative of AFFs prior to formal diagnosis.

CONCLUSION

Whilst AFFs are rare diagnoses, the compliance with published guidelines for their radiological classification is low.

ADVANCES IN KNOWLEDGE

We have raised awareness of the importance of recognizing AFFs to guide management.