Schenkelhalsfraktur durch eklamptischen Anfall bei HELLP-Syndrom – ein Fallbericht

Abstract

While preeclampsia and HELLP syndrome occur in 5-7 % of all pregnancies and are therefore quite a frequent event, eclamptic seizures are rare (0.05 % of all deliveries in Europe). Some case reports on fractures in different localizations after eclampsia can be found in the literature. A change in bone structure may play an important role in their pathogenesis. This report describes a femoral neck fracture after an eclamptic seizure in a woman with pregnancy-induced osteoporosis without additional trauma. A 43-year-old patient was admitted to our hospital because of preeclampsia in the 40th week of gestation. After inducing labour she had a vaginal delivery without complications. Post partum, she developed HELLP syndrome. In spite of intravenous prophylaxis against convulsion she suffered an eclamptic seizure. Thereafter, she complained of pain in the right inguinal region. A right-sided femoral neck fracture was diagnosed. The X-ray showed increased bone transparency reflecting a pre-existing pregnancy-induced osteoporosis. Total right-sided hip replacement was necessary. The cause of this femoral neck fracture was presumably multifactorial. On the basis of the radiologically diagnosed pregnancy-induced osteoporosis leading to increased bone fragility, the eclamptic seizure resulted in a fracture due to strong traction by the muscles. Various causes can lead to osteoporosis in pregnancy. In patients with osteoporosis, a fracture even without a gross traumatic event is possible. In cases of unexplained hip or leg pain, especially after eclampsia, in addition to thrombosis and infections it is also necessary to exclude possible fractures.