Simultaneous Bilateral Fractures Research Articles

Simultaneous Bilateral Acetabular Fractures: A Case Report

Simultaneous bilateral acetabular fractures are extremely rare. The authors report a rare case of simultaneous bilateral acetabular fracture in an adult due to a road accident. Clinical diagnosis can be misleading in many patients seen in the context of polytrauma. Managing these fractures is a complex task that requires careful planning and surgical intervention, and the foremost goal of surgical intervention is to achieve an anatomically precise reduction of the fracture, as this factor greatly influences the future function of the hip joint.

Simultaneous bilateral traumatic clavicle fractures: incidence, characteristics, and surgical outcomes

BackgroundAlthough clavicle fractures are common injuries in adults, simultaneous bilateral clavicle fractures are rarely reported. The present report describes 13 patients with simultaneous bilateral traumatic clavicle fractures who were treated with surgical management and followed for more than 12 months postoperatively.MethodsThis retrospective chart review involved skeletally mature patients with traumatic clavicle injuries. Patients with bilateral clavicle fractures who were followed up for at least 12 months after surgery were included. Data regarding the patients’ demographics, injury characteristics, fracture classification, comorbidities, concomitant injuries, and treatment strategies were collected. Each displaced fracture was managed with open reduction and internal fixation. Postoperative follow-up included radiographs for assessment of bone union; calculation of the Constant–Murley score for shoulder function; administration of the Disability of the Arm, Shoulder, and Hand questionnaire for upper limb function; determination of the visual analogue scale score for pain; and assessment of complications.ResultsFrom October 2013 to November 2021, 15 patients (10 men, 5 women) were diagnosed with bilateral clavicle fractures among 1542 patients with clavicle injuries (overall incidence of 1.0%). Of these 15 patients, this study included 13 patients (8 men, 5 women; mean age, 38.3 ± 15.3 years) who were followed up for more than 12 months postoperatively. Among the 13 patients, 10 (77.0%) had associated concomitant injuries, and 25 sides were fixed with internal plate fixation. After a follow-up period of 29.9 ± 28.5 months, all fractures achieved bone healing. Eleven patients attained excellent shoulder function on both sides and returned to their pre-injury daily activities, and the remaining two patients had unilateral shoulder dysfunction. No complications occurred.ConclusionsBilateral clavicle fractures are extremely rare and associated with polytrauma. Open reduction and internal fixation is recommended for such patients, especially those with severe chest injuries, because osteosynthesis of the clavicle can improve respiratory function and reduce the duration of functional disability.

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

BackgroundSimultaneous 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 presentationWe 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.ConclusionsWe 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.

Simultaneous Bilateral Hip Fractures in an Elderly Patient in the Absence of Bone Disease: A Case Report

Case: Eighty-three years old female patient who sustained a simultaneous bilateral hip fractures after a mechanical fall. The bilateral nature of the problem was not appreciated by the emergency team and was found after the orthopedic consultation. The patient underwent a single stage bilateral cemented bipolar hemiarthroplasty without perioperative complications. Conclusion: Simultaneous bilateral hip fractures in elderly are not commonly encountered after a low energy mechanism but early recognition of this diagnosis is important to optimize perioperative management. Having bilateral cemented stems did not lead to any significant cardiopulmonary complications as can often be concerned with so called cement syndrome.

Simultaneous bilateral olecranon fracture: a case report and review of the literature.

Background and aim of the work:A bilateral fracture of the olecranon is a rare injury, with only few cases reported in the literature.Methods:A single case of bilateral Mayo type II A olecranon fracture in a 88 years old woman is described. A research of all articles regarding simultaneous bilateral olecranon fracture was performed in the PubMed database.Result:The reported case demonstrated good clinical and radiographic results at 5 months follow-up with surgical treatment. The literature search produced other 6 cases in 5 case reports. Except for one case of fatigue fracture that had been treated conservatively, the others received surgical treatment with satisfactory results.Conclusion:Simultaneous bilateral olecranon fracture is very uncommon. Bilateral internal fixation yields good clinical and radiographic results in most cases. (www.actabiomedica.it)

Simultaneous bilateral versus unilateral tibial tubercle fractures

PurposeTibial tubercle/tuberosity fractures are rare injuries in young patients accounting for less than one percent of physeal fractures. Bilateral simultaneous fractures are even rarer, with only a few case reports in literature. The purpose of our study was to describe the largest case series of bilateral simultaneous tibial tuberosity avulsion fractures and compare it with unilateral fractures. We also wanted to compare our bilateral fractures case series with all the cases reported in the last 65 years. MethodsIRB approved retrospective study involving patients under age 18 years with tibial tuberosity avulsion fractures. Bilateral simultaneous fractures were compared to a unilateral group including demographic data, mechanism of injury, clinical exam findings, complication rates, and outcomes including return to function. Statistical analysis was performed using Mann-Whitney and Fisher Exact tests to compare the different groups. Results138 patients (131 males, 7 females) from a tertiary children’s hospital between 2012 and 2019 with tibial tuberosity avulsion fractures were included. 11 bilateral simultaneous fractures (BL Group) were identified and compared to age matched cohort from the 127 unilateral fracture patients (UL group). There was no significant difference found in BMI, height, weight, age, sex, mechanism of injury, return to functional range of motion, and return to sports between the groups. 7/11 (63%) of the patients in the BL group who sustained simultaneous fractures had to be home bound and could not attend school for an average of 8.3 weeks. There was a higher rate of complications in the BL group (63.3%) compared to the UL group (21.1%), which was statistically significant. The most common complications in the bilateral group were hardware removal and wound dehiscence. ConclusionThis first case series comparing unilateral versus bilateral simultaneous tibial tuberosity avulsion fractures suggests that the final outcomes of the two groups are similar, however it shows a significantly higher complication rate and hardware removal rate in the BL group. This study is also the first to highlight the significant initial morbidity in the BL fracture group with issues with regards to early mobility and loss of school-days. Keeping in mind the profound initial impact the bilateral injury poses to the patient; surgeons can possibly plan for rigid fixation for early mobilization to better prepare bilateral fracture patients for the early post-operative recovery process.

Bilateral Simultaneous Proximal Tibial Insufficiency Fractures in a Patient Suffering From Psoriatic Arthritis

Bilateral synchronous proximal tibia insufficiency fractures are rarely reported. We present a case of simultaneous proximal tibia bilateral insufficiency fractures in a 51-year-old female patient with underlying psoriatic arthritis, who was on chronic steroid medication. She reported sudden onset of bilateral knee pain after intense workout one week ago. Initial clinical and X-ray evaluation did not reveal significant pathology. Four weeks later, due to persistent pain in the absence of significant radiographic findings during follow-up, the patient was referred for MRI, which revealed fractures of both proximal tibias. A "mixed" treatment protocol was applied. In particular, this protocol included combination of rest and intermittent removable knee ranger braces immobilization with weight-bearing when applied. The patient went on to make a full recovery. Chronic inflammatory disorders accompanied by suspicious clinical manifestations should be thoroughly inspected. Diagnostic and treatment protocols should be further discussed and implemented.

Bilateral Distal Humeral Fracture in a patient with Osteogenesis imperfecta During the Covid Pandemic– A Rare Case Report

Introduction: Osteogenesis imperfecta (OI) is a genetic disorder which is characterised by bone deformity, low bone mass, connective tissue manifestations and brittle bones with history of multiple fractures. Although recurrent fractures are known in patient with OI, the occurrence of bilateral simultaneous fracture of humerus is quite rare. Presenting complaint and investigations: The patient had a fall in the outdoors during a storm during the height of covid pandemic and sustained injury to both arms. Radiographs revealed comminuted fracture of left distal humerus and transverse extraarticular supracondylar fracture of right humerus. Diagnoses, therapeutics interventions, and outcomes: Although, conservative measures were advised as per the guidelines for orthopaedic surgery during the covid pandemic for most of the fractures, the decision to operate was made considering the morbid obesity and hampered mobility due to bilateral above elbow plaster.The patient underwent staged open reduction and internal fixation of both distal humerus with anatomical locking plates in a span of 2 weeks. She recovered uneventfully with a good functional range of movements and resumed her routine activities. Conclusion: The treatment for complex and unusual fractures should be individualised and should take into consideration of patient’s general condition and safety.

A Missed Diagnosis of Bilateral Simultaneous Spontaneous Intracapsular Neck of Femur Fractures in a Rheumatoid Arthritis Patient

Bilateral spontaneous simultaneous fractures of the neck of femurs are extremely rare, and only a few cases have been reported in literature. They are usually following high-energy trauma or may be due to an underlying pathological process such as frailty, osteomalacia, rickets, and chronic renal disease. They can also occur following epilepsy and electric shock. We report a 79-year-old gentleman who presented with sudden onset of bilateral hip pain with a background of rheumatoid arthritis and long-term steroid treatment. The bilateral hip fractures were missed initially and later presented with completely displaced fractures of the neck of femurs. He underwent a single-stage bilateral cemented hemiarthroplasty and made a good recovery. Bilateral simultaneous fractures of the hip in patients with rheumatoid arthritis have not been reported in literature so far, and the diagnosis can be easily overlooked. In patients with bilateral hip pain, one should have a high index of suspicion. Further appropriate cross-sectional imaging in the form of CT or MRI should also be considered.

Conservative and operative treatment in the setting of simultaneous bilateral humeral fractures

Conservative and operative treatment in the setting of simultaneous bilateral humeral fractures

Fractura bilateral de cadera no simultánea. Estudio de cohorte retrospectiva

Background and aimAfter a first hip fracture, the contralateral hip can also get fractured. The characteristics of this second hip fracture are determined and its differences with the first one are evaluated. Materials and methodsRetrospective cohort study was conducted that included patients older than 50 years old with a hip fracture. Patients were excluded if they had pathological fractures, high-energy fractures, peri-prosthetic fractures, bilateral simultaneous fracture, a history of ipsilateral hip fracture, and ipsilateral simultaneous femur fracture. A total of 610 patients with a fracture over a 10-year period (2005-2014) were eligible at the institution. They were divided in two groups: first and second hip fracture. The incidence of non-simultaneous bilateral hip fracture was calculated and for each group, the demographic variables, complications, comorbidities, and mortality were recorded. ResultsThe incidence of non-simultaneous bilateral hip fracture was 8.0% (n=49). The mean time between the first and second fracture was 2.3 years. Patients were, on average, 85 years-old when they fractured the second time, and 6 years older than for the first fracture. Of the 49 patients included, 77.6% were women (n=38), with a ratio of 3.5 to 1 in relation to men. There were more medical complications for the second fracture, as well as a higher prevalence of dementia and diabetes. The 3 months mortality rate was higher for the second fracture: 10.2% vs 6.9%, with a RR=1.46 (95% CI: 0.6-3.6) (p=.39). DiscussionThe second fracture occurs several years after the first one, is more frequent in women, and could be associated with more complications and higher mortality. Level of evidenceII.

Management of Simultaneous Bilateral Femur Fractures in a Tertiary Care Hospital: A Retrospective Review

Management of Simultaneous Bilateral Femur Fractures in a Tertiary Care Hospital: A Retrospective Review

Simultaneous bilateral femoral neck stress fractures in a young female runner: A case report and review of literature

Fatigue fractures generally appear in normal bone following increased repetitive activity or strenuous exercise, when imbalance occurs between applied force and elastic resistance. Femoral neck fatigue fractures are most common in athletes and young military recruits. They are not as common as stress fractures of the metatarsals or tibia and other bones. This paper reports bilateral stress fractures of the femoral neck in a 14-year-old girl presenting with pain in the anterior aspect of the right thigh of 3 months duration and without evidence of previous injury with low Vitamin D and elevated parathyroid hormone levels. Correction of Vitamin D levels, bed rest, and relief of weight-bearing were indicated as fractures were undisplaced.

Outcome of Bilateral Simultaneous Fracture Neck of Femur in Patients with Low Socioeconomic Status

Fracture neck of femur (NoF) is a rare injury but represents a serious condition in low-income countries. It results from major or minor-repetitive trauma(s) or from different pathological conditions such as parathyroid or renal dysfunction, antiepileptic medication, seizure and tumors. Similarly to other hip fractures, the diagnosis of this condition can be missed where management becomes more complicated. The present study was conducted in a country with low socioeconomic status to assess the prognosis of such injury.

Simultaneous, Isolated Traumatic Bilateral Patella Fractures

IntroductionIsolated traumatic fractures of both Patellae, occurring at the same time, in an otherwise healthy person, are very rare. The Patella, as a subcutaneous and a cancellous bone, is vulnerable to injury. However, simultaneous injury to both Patellae without the involvement of any other bony injuries occurs infrequently, and only a few cases have been reported in the literature.Case PresentationWe report a rare case of isolated, traumatic bilateral Patella fracture with unusual fracture patterns and briefly review the literature.ConclusionsIn simultaneous bilateral Patella fractures, good functional outcome can be expected following a stable surgical fixation and a structured rehabilitation regime. However, personality of the fracture determines salvage versus sacrifice of the Patella.

Simultaneous bilateral trochanteric fractures—a report of four cases

Simultaneous bilateral intertrochanteric fractures are very rare. There is a paucity of data in current literature documenting patients with such kind of hip fractures. It is severe and potentially life-threatening, associated with a high morbidity. The major determinants of successful outcome are high vigilance, early single stage stabilization and mobilization as well as management of associated comorbid conditions that may influence the long term rehabilitation of patients. Here we reported 4 cases of concurrent bilateral trochanteric fractures along with review of the literature. Our study aimed to discover its frequency, identify the injury mechanisms as well as factors present in the pathogenesis of these fractures, and outline the available treatment modalities.

Simultaneous Bilateral Scaphoid Fractures in A Soldier Managed Conservatively by Scaphoid Casts

Simultaneous Bilateral Scaphoid Fractures in A Soldier Managed Conservatively by Scaphoid Casts

A MISSED DIAGNOSIS OF ASYMPTOMATIC SIMULTANEOUS BILATERAL FRACTURE NECK FEMUR DUE TO VITAMIN D DEFICIENCY TREATED AS SEVERE BILATERAL OSTEOARTHRITIS KNEE: HOW TO PREVENT IT?

Simultaneous bilateral neck of femur fracture is a rare injury and poses a diagnostic challenge. This uncommon pattern of injury has been associated with high-energy trauma and seizure disorders. Proper clinical examination of both hip and knee joint should be performed in patients presenting with bilateral knee pain. Clinical suspicion and detailed radiologic evaluation of both hip and knee joint is essential for diagnosis of uncommon injury around hip joint. A battery of metabolic tests to assess vitamin D deficiency and histology study of the specimen should be performed. Patients with simultaneous bilateral fracture neck femur can be treated well and perform activities of daily living with good outcomes with prompt surgical intervention and medical treatment. We report the case of asymptomatic simultaneous bilateral neck of femur fracture following vitamin D deficiency which was missed and was misdiagnosed and treated for severe bilateral osteoarthritis knee.

Bilateral Simultaneous Avulsion Fractures of the Proximal Tibia in a 14-Year-Old Athlete with Vitamin-D Deficiency.

Fractures involving the proximal tibial epiphysis are rare and form 0.5% of all epiphyseal injuries. The specific anatomical and developmental features of the proximal tibial epiphysis make it vulnerable to unique patterns of fractures. Vitamin-D plays a vital role in bone homeostasis and its deficiency has an impact on fracture risk and healing. We present the first ever reported case of simultaneous bilateral proximal tibial physeal fractures in an athlete with vitamin-D deficiency. Treatment consisted of plaster immobilisation, and the patient made a full recovery and returned to preinjury level of activities. We report this case for its uniqueness and as an educational review of the importance of the developmental anatomy of the proximal tibia. We review the literature and discuss how the stages of the growing physis determine the type of fracture sustained.

Simultaneous Bilateral Femoral Neck Stress Fracture in a Young Stone Mason.

Unilateral stress fractures of the femoral neck are very uncommon and bilateral involvement is even rarer. They commonly occur in athletes, military recruits, older persons, or individuals with underlying metabolic disorders and very seldom in normal individuals. We present a rare case of simultaneous bilateral fracture neck of femur in a 25-year-old man who came with complaints of pain in bilateral groin for 1 month. There was no history of trauma or history suggestive of excessive activity prior to the onset of pain, but there was history of lifting heavy weights daily. On evaluation with MRI scan bilateral fracture of the femur neck was diagnosed and patient was operated on bilaterally with internal fixation done using dynamic hip screw. Patient then regained his routine activity over a period of 6 months and on follow-up at 1 year no avascular necrosis changes were seen in the femur head. We presented this case because of its unusual presentation and the diagnostic challenge it poses.