Bilateral acetabular fractures induced by an epileptic seizure in a paediatric patient: a unique case and its management

Abstract

Bilateral acetabular fractures following epileptic seizures are a rare but known occurrence in adults, with an 18.5% mortality rate. These fractures occurring post epileptic seizures have not been previously documented in children. We report a case of a 13-year-old boy who presented to hospital via ambulance following two violent generalised tonic–clonic seizures in a postictal state, metabolically acidotic and a low haemoglobin. Acute abdomen was suspected and the patient underwent a CT scan which showed bilateral acetabular fractures with central dislocations of both femoral heads and free fluid in the abdomen. The patient underwent initial damage control intervention with insertion of bilateral distal femur skeletal traction. Definitive fixation of the acetabular fractures occurred 1 week later with an open reduction internal fixation with novel supra-pectineal plates using a Pfannenstiel incision. We use this report to increase awareness of significant pelvic injuries in paediatric patients post epileptic seizures.

Management and Outcomes of Bilateral Acetabular Fractures: A Critical Review of the Literature

“…Those were reported in 89% of the cases (42/47 cases) [ 5 – 14 , 16 , 17 , 19 – 24 , 26 – 34 , 36 – 41 ]. The most common associated injuries were upper limb injuries (26%) [ 8 , 10 , 13 , 17 , 19 , 31 , 32 , 34 , 37 , 39 ], pelvic fractures (23%) [ 7 , 11 , 12 , 34 , 36 , 38 , 39 , 41 ], femoral fractures (19%) [ 10 , 16 , 31 , 32 , 34 , 38 ], spine injuries (14%) [ 10 , 27 , 30 , 31 , 34 ], acetabular fracture associated with hip dislocation (23%) [ 10 , 14 , 20 , 22 , 23 , 26 , 33 , 38 , 40 ], chest injuries (12%) [ 13 , 29 , 34 , 36 ], lower leg fractures (7%) [ 30 , 34 , 36 ], and head injury (2%) [ 26 ].…”

“…Operative treatment versus non-operative treatment was undertaken in 70% [ 5 – 8 , 10 , 12 – 18 , 20 , 21 , 23 , 27 , 28 , 31 , 33 , 34 , 36 – 40 ] and 30% [ 9 , 11 , 18 , 19 , 22 , 25 , 26 , 29 , 30 , 32 , 35 , 41 ] of cases, respectively.…”

“…Overall, single-stage fixation was reported in 52% of cases [ 7 , 8 , 13 , 16 , 17 , 20 , 23 , 27 , 34 , 36 , 37 , 39 ], a 2-stage in 45% of cases [ 5 , 10 , 12 – 15 , 21 , 26 , 28 – 30 , 33 , 34 , 38 , 40 ], whereas in 1 case (3%) a 4-staged operative management [ 6 ] was reported (Table 4 ). The mean time elapsed between stages ranged from 1 day to 3 months [ 5 , 10 , 12 – 15 , 21 , 26 , 28 – 30 , 33 , 34 , 38 , 40 ].…”

“…Overall, there were 58% excellent/good outcomes with complete functional recovery and independent mobilization [5, 7, 9, 10, 13, 15-18, 22, 25, 26, 28, 31, 33-35, 38-40], 22% fair with limited range of motion of both hips and moderate pain [6,8,23,30,32,34,36,37], and 20% poor outcomes with limited activity and walking ability (Table 7) [11,12,14,20,21,24,34]. According to injury group, excellent/good outcomes were reported in 60% of the high-energy patients [13,15,18,25,26,33,34,38,39], 47% of the seizures patients [9,10,16,17,22,31,35,40], and in 100% of the insufficiency fracture group [5,7,28].…”

高齢者のけいれん発作に合併した非外傷性寛骨臼骨折の1例(Nontraumatic acetabular fracture associated with convulsive seizure in an older patient: a case report)

“…けいれん発作は年齢の上昇に伴い発生頻度が増加し，新規発症の2人に1人が高齢者である 20)。二次的外傷などの外的エネルギーを伴わないけいれん発作により，0.25～2.4%の患者に骨折を合併することが知られている 4)が，寛骨臼骨折の報告は少ない 5), 6)。…”