Bilateral Femoral Neck Fractures Research Articles

A Rare Case of Systemic Mastocytosis With Associated Clonal Hematological Non-Mast Cell Lineage Disease That Transformed to Acute Leukemia With IDH2 Mutation

An elderly 72-year-old man presented with anemia, thrombocytopenia, monocytosis, splenomegaly and lymphadenopathy. Bone marrow biopsy was consistent with mast cell neoplasm with positive CD117, CD25, CD34 myeloblasts and polymerase chain reaction (PCR) revealed mutation of D816V. He developed bilateral femoral neck fractures and biopsy confirmed that he has systemic mastocytosis (SM). He received cladribine and midostaurin with stable disease for 21 months. His SM with associated clonal hematological non-mast cell lineage disease (SM-AHNMD) transformed to acute myelogenous leukemia with isocitrate dehydrogenase 2 ( IDH2 ) mutation. A trial of enasidenib was given for 5 months but without any response. Patient decided to go with home hospice and died afterwards. J Med Cases. 2020;11(10):317-319 doi: https://doi.org/10.14740/jmc3552

Simultaneous Bilateral Femoral Neck Fracture Due to a Tonic-Clonic Seizure and High-Dose Steroid Therapy

Simultaneous bilateral femoral neck fractures (FNFs) are extremely rare and usually associated with an underlying condition affecting the bone quality and mineralization. Convulsions have also been described as a possible cause, mostly as a consequence of epilepsy, hyponatremia, and hypocalcemia. We present a 52-year-old female patient, with bilateral displaced FNFs due to a tonic-clonic seizure and high-dose steroid therapy related to a frontal lobe anaplastic oligodendroglioma brain tumor resection. Two days after admission, bilateral one-stage uncemented total hip arthroplasty (THA) under general anesthesia and through a posterolateral approach was performed using a metal-on-polyethylene bearing surface. Several risk factors can be identified in this unique case, such as the high-dose steroid therapy, the low-demand activity of the patient due to her functional sequelae, and finally, the convulsive episode. Surgeons should be aware of this uncommon injury to ensure early diagnosis and treatment in all patients with a previous history of seizures, chronic steroid use, severe hip pain, and inability to walk. For bone metabolic diseases, preventive measures should be indicated to avoid these complications. Bilateral one-stage uncemented THA represents an effective procedure with a low complication rate allowing early rehabilitation.

Total Hip Arthroplasty for the Sequelae of Femoral Neck Fractures in the Pediatric Patient.

Although rare, total hip arthroplasty (THA) may be indicated in pediatric patients with degenerative changes of the hip joint after previous trauma. To illustrate management principles in this patient population, this study describes the case of a 15-year-old female who sustained bilateral femoral neck fractures after a generalized tonic-clonic seizure, an atypical, low-energy mechanism for this injury. These fractures were not diagnosed until 14 weeks after the seizure episode, at which point they had progressed to nonunion on the left side, malunion on the right side, and degenerative hip joint changes were developing bilaterally. Bilateral THA was ultimately performed, and the patient had favorable outcomes at 1 year postoperatively. In determining the optimal management strategy for such patients, a multidisciplinary approach should be used, with input from the patient’s family, pediatrician, pediatric endocrinologist, pediatric orthopaedic surgeon, and adult reconstruction surgeon. From a surgical standpoint, this report highlights the importance of selecting the appropriate bearing surfaces, broaching technique, mode of implant fixation, and implant features when performing THA in the active pediatric patient.

Simultaneous bilateral femoral neck fractures in a dialysis-dependent patient: case report and literature review

BackgroundSimultaneous bilateral femoral neck fractures are extremely rare without obvious injury. Herein, we report the case of a patient on dialysis presenting with bilateral femoral neck fractures, which is a condition with high complication and mortality rates according to a review of the pertinent literature.Case presentationWe report the case a 47-year-old female with a history of 8 years of haemodialysis due to polycystic kidney disease who presented with bilateral hip pain during walking. The clinical history and results of physical and radiographic examinations of this patient are shown. Single-stage bilateral hemiarthroplasty was performed after a multidisciplinary team consultation. Three days after the operation, she could ambulate with a walker. The woman gradually regained her previous ability to walk over 6 months after surgery.ConclusionsA multidisciplinary team consultation for perioperative management is necessary and effective in patients on dialysis. Early diagnosis with prompt surgical treatment could lead to favourable recovery.

Outcome of Bilateral Femoral Neck Fracture in Female Child with Osteopetrosis Treated Conservatively

Outcome of Bilateral Femoral Neck Fracture in Female Child with Osteopetrosis Treated Conservatively

Chronic kidney disease presenting with bilateral spontaneous femoral neck fracture: A case report

Bone and mineral metabolism disorders are common in patients with chronic kidney disease (CKD). These patients are susceptible to fractures. Bilateral femoral neck fracture secondary to renal osteodystrophy is a rare complication. We report a case of CKD with bilateral spontaneous femoral neck fracture associated with secondary hyperparathyroidism and osteoporosis.

Low-velocity simultaneous bilateral femoral neck fracture following long-term antiepileptic therapy: A case report

Low-velocity simultaneous bilateral femoral neck fracture following long-term antiepileptic therapy: A case report

Spontaneous bilateral femoral neck fractures in a young male adult: a case report and literature review

BackgroundSimultaneous bilateral femoral neck fracture is a very rare condition, even in osteoporotic elderly individuals. We report an atypical case of a young male adult who developed simultaneous bilateral femoral neck fractures without previous trauma or overuse.Case presentationA 33-year-old man presented with discomfort in the bilateral groin, which had started 2 weeks previously. Bilateral femoral neck fractures were observed on a radiograph, and in addition, a fracture line was seen at the right subchondral region of the acetabulum using magnetic resonance imaging (MRI). Although the patient had no obvious risk factors associated with bone fragility, his bone mineral density measured using dual X-ray absorptiometry indicated severe osteoporosis (lumber spine: T score − 3.4 standard deviation [SD]; femoral neck: T score − 2.8 SD). Serum 25-hydroxyvitamin D level was deficient (19 ng/mL), which was considered to be partly due to non-sunlight exposure for 3 years owing to social withdrawal. Bilateral osteosynthesis was performed, considering his young age, although more than 2 weeks had passed since the onset of the fracture. Bone union and non-occurrence of osteonecrosis of the femoral head were confirmed via radiography and MRI 8 months after the surgery.ConclusionsOur case suggests that simultaneous non-traumatic bilateral femoral neck fractures can occur in healthy young men.

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 Uncemented Hemiarthroplasty in a Patient with Bilateral Lower limb PPRP with Right Knee Arthrodesis: Surgical Difficulties and Techniques

Introduction: Standard references such as knee and lower leg position cannot be used in patients with knee arthrodesis with a bilateral neck of femur fracture during bipolar hemiarthroplasty. We describe a simple technique that guides a surgeon in assessing the femoral stem version in such cases. Case report: We present a case of 52 years old male with bilateral lower limb Post Polio Residual Paralysis with right knee arthrodesis who sustained bilateral neck of femur fractures. The difficulties, in this case, were the inability to flex the knee and to use the ankle or the opposite limb and its bony landmarks as reference. Conclusion: We describe a simple surgical technique of inserting a Steinmann pin in the distal femur in the coronal plane parallel to the transcondylar axis for intraoperative assessment of neutral position and version of the femoral stem. Keywords: Bilateral; hemiarthroplasty; femoral stem; anteversion; knee arthrodesis.

Bilateral femoral neck fracture in pregnancy- outcome of conservative versus operative treatment: A case report

Introduction: Transient osteoporosis of pregnancy is usually benign in nature. Rarely serious complication like fragility fracture of neck of femur can occur. Usually idiopathic in nature and self-limiting. So far only 12 such cases and bilateral in only 2 patients have been reported in literature. Since, X-rays are usually avoided in pregnancy this condition is usually missed leading to late diagnosis. Case report: A 26-year-old primigravida was referred to our institute on her 7th month of gestation with bilateral hip pain and limp. She developed bilateral hip pain on her 5th month of gestation which was progressive in nature. Her radiograph showed bilateral femoral neck fracture. To avoid radiation hazard to the fetus fracture fixation was delayed till caesarean section on her 38th week of gestation. Closed reduction and internal fixation with three CC screws was done for left femur neck fracture. Fixation was planned for right side fracture simultaneously but since the patient did not consent for bilateral surgery she was asked to review after one month for right femur neck fracture fixation. The patient who lost to follow-up showed up after 6 months walking comfortably. Radiological examination showed that in the nonoperated side the fracture united in Varus with shortening of 0.5 cm. Conclusion: Musculoskeletal problems during pregnancy should not be overlooked. MRI should be used for early diagnosis whenever feasible. Fracture Neck of femur in pregnancy in-spite of delayed diagnosis and treatment has a better prognosis even with conservative treatment. Keywords: transient osteoporosis, pregnancy, femoral neck fracture, spontaneous healing.

Journey Ahead!!

Trauma International marches ahead with full determination to contribute in the field of trauma. We are thankful to the authors who are contributing to the journals work and we are sure this response will continue in the future too. We thank authors for their contribution in the May-December 2019 issue of Trauma International. This issue contains case reports on Occult Femoral Neck Fracture, Bilateral Uncemented Hemiarthroplasty, Bilateral femoral neck fracture in pregnancy and the review article on Galeazzi fracture associated with an ipsilateral fracture of ulna diaphysis and olecrane. We appreciate efforts of authors and hope for more contributions in the field of orthopaedic literature.

Undesired effect of excessive betamethasone administration during pregnancy: A rare case

Postpartum bilateral femoral neck fracture (BFNF) is a rare condition. We here report a case of BFNF due to excessive corticosteroid consumption, twin pregnancy, immobility, and vitamin D deficiency. This is a report of a 32-yr-old woman with bilateral femoral insufficiency fracture five days after emergency cesarean section due to preterm labor, twin pregnancy, and the history of a previous cesarean section at 33 wk. Antenatal repeated courses of betamethasone injections for fetal lung maturity, daily oral use of prednisolone for the history of miscarriage, immobilization, and vitamin D deficiency were the important contributing factors in her past medical history and lab investigations. The bone mineral density examination showed low bone density for the expected age. Clinicians, who deal with pregnant women, should consider the diagnosis of bilateral femoral insufficiency fracture in any pregnant women with pelvic pain. Awareness of risk factors of BFNF might help to reduce the rate of this complication.

Spontaneous bilateral femoral neck fracture in a man with end-stage renal disease and severe secondary hyperparathyroidism

Medical treatment is the primary recommended method for in the management of severe secondary hyperparathyroidism (SHPT) in pre-dialysis individuals. This paper reports a case of end-stage renal disease (ESRD) and severe SHPT with pathologic bilateral hip fractures. A 61-year-old man, as a known case of ESRD, with radial osteoporosis and persistent SHPT ( intact PTH >2000 pg/mL) and hypercalcemia with appropriate level of phosphorus and 25(OH) D who did not respond to medical treatment referred to hospital with multiple fractures. The patient referred for subtotal parathyroidectomy. One month after parathyroidectomy, parathyroid hormone (PTH) level significantly diminished from its preoperative values. Serum calcium and phosphorus returned to normal values and muscle weakness progressively improved until the patient became able to walk again. Parathyroidectomy in patients with severe secondary hyperparathyroidism (persistent serum levels of intact PTH>800 pg/mL) is suggested, particularly when is associated with severe hypercalcemia and/or hyperphosphatemia, and progressive and debilitating hyperparathyroidism bone disease, that are refractory and resistant to medical therapy.

Bilateral Fracture of Femoral Neck during Pregnancy: A Case of Spontaneous Healing

Bilateral Fracture of Femoral Neck during Pregnancy: A Case of Spontaneous Healing

Atraumatic bilateral femoral neck fractures in an octogenarian male associated with androgen deprivation therapy: A case report

Atraumatic bilateral femoral neck fractures in an octogenarian male associated with androgen deprivation therapy: A case report

Spontaneous Bilateral Femoral Neck Fracture Rare Presentation of a Metabolic Bone Disease

A 50 year old woman was observed at the emergency department after falling from her own height after sudden failure of the lower limbs, which led to bilateral femoral neck fracture. She has had multiple repeated urinary tract infections, nephrolithiasis with several admissions in urology department and extracorporeal lithotripsy episodes with shock waves. She also had history of surgical removal of kidney stones. The Laboratory tests revealed high calcemia (13.2 mg/dl) and alkaline phosphatase (445); normal phosphate and magnesium, normal Calcitonin; high parathyroid hormone(> 2500 pg / ml). Hyperparathyroidism caused by a parathyroid adenoma was diagnosed after ultrasound, biopsy and scintigraphy were performed. Radiographs revealed classic and severe bone findings in PHPT, features which were common in the past but are thought to be rare at this modern age. Parathyroidectomy was performed at the same time as a bilateral cemented total hip arthroplasty. She developed the hungry-?bone syndrome 5 days postoperatively, which resolved with administration of bisphosphonates, calcium and D vitamin.

Bilateral Simultaneous Neck of Femur Fractures Arising from a Simple Mechanical Fall—A Case Report for Guidance on Safe Surgical Management: 簡單跌倒後發生的兩側同時急性股骨頸骨折：病例報告和安全手術處理指引

Simultaneous acute femoral neck fractures are rare and infrequently reported in the literature. Of the few published cases, most result from underlying pathological bone processes or violent muscle contractions including epileptic seizures and electrocution. We present the case of a 73-year-old lady with metastatic colon cancer who presented with acute bilateral neck of femur fractures following a simple fall. Following a comprehensive discussion with anaesthetic and surgical staff, and in conjunction with the patient, a decision was made to perform simultaneous bilateral cemented stem hip hemiarthroplasties. There were no perioperative complications, and the patient made a positive recovery, being transferred to a rehabilitation institute 3 days after the surgery. Two weeks later, she was discharged home to her family. We have demonstrated that this rare injury can be safely managed during a single operative session in the presence of an experienced multidisciplinary team, despite serious patient comorbidity.

Bilateral Hemiarthroplasty in a Patient with Below-Knee and Above-Knee Amputations: A Case Report.

This case involved a sixty-two-year-old male patient with bilateral femoral neck fractures that occurred six months apart in the setting of bilateral lower-extremity amputation. Hemiarthroplasty was performed at each presentation, with the use of a standard femoral stem on the right side and a short stem on the left. At the time of follow-up, the patient had returned to his preoperative ambulatory status. This case report illustrates successful bilateral hemiarthroplasty in a patient who had previously undergone bilateral lower-extremity amputation, with use of an implant with a short stem for the limb with above-knee amputation.

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.