Bilateral femoral neck fractures resulting from a grand mal seizure in an elderly man with Down syndrome

Abstract

Simultaneous bilateral hip fractures are exceedingly rare and usually occur following a seizure. To our knowledge, only 22 cases of such injuries have been reported in the literature during the past forty years and the majority of fractures are treated with open reduction and internal fixation. We present a case of a 66-year old man with Down syndrome and severe dementia who was diagnosed with bilateral displaced femoral neck fractures following an epileptic seizure. He was treated with single staged bilateral uncemented monopolar hemi-arthroplasties through lateral Hardinge approaches. The treatment choice was governed by fracture displacement, the lack of pre-existing osteoarthritis, length of time to diagnosis, the patient's age, ambulatory status and mental impairment, with the intention to minimize post-operative complications such as avascular necrosis, non-union and hip dislocation.

Simultaneous bilateral femoral neck fracture and end-stage renal disease in a 76-year-old woman: a case report

“…The fact that the average volume of admissions at San Gerardo University Hospital is approximately 32,000 patients per year confirms the rarity of bilateral femur fractures. The few cases of bilateral femoral neck fractures that have been reported in the elderly were associated with convulsive seizures [6][7][8][9][10], vitamin D deficiencies [11], fluoride treatment for osteoporosis [12], steroid treatment [13], celiac disease [14], mechanical stress [15,16], minimal traumas after a simple fall [17], and spontaneous fractures [18]. Several case reports were depicted among young patients, in which the bilateral femur fractures were associated with seizures [19][20][21][22], pharmaco-convulsive treatments [23], high-energy traumas [24], bone-related disorders [12,25,26], and electrical shock injuries [27][28][29].…”

Bilateral hip fracture in a patient with Down syndrome

“…Aunque esta indicación es aplicable a la mayoría de los casos, en función de las características del paciente deben considerarse otras opciones, como prótesis. Las tasas de necrosis avascular o reintervención después de una fractura de cuello cervical desplazada son aproximadamente del 20 al 26% y hacen de las prótesis de cadera una buena opción para las personas mayores 15 . Según nuestra experiencia, la esperanza de vida, el estado de actividad previa, la discapacidad mental y el tiempo entre la fractura y el tratamiento deben tenerse en cuenta antes de tomar la decisión quirúrgica.…”

“…El 28% de estos pacientes desarrollan artrosis de cadera [3][4][5][6] , en la mayoría de los casos secundaria a displasia de cadera 3,4,6,7 o luxación o subluxación recurrente 4,6,[8][9][10] . Aunque en la literatura existen varios artículos acerca de la realización de artroplastia de cadera en estos pacientes 5,11,12 , las fracturas de cadera bilaterales son muy raras, incluso en la población general [13][14][15][16] . Por ello, dichas lesiones plantean muchas preguntas acerca del mejor tratamiento, las posibles complicaciones y el pronóstico del paciente.…”

Simultaneous bilateral fractures of the femoral neck

“…2 Simultaneous bilateral fractures of the femoral neck were first reported in psychiatric patients having drug-induced or electroshock-induced seizures. 5,6 In the past 40 yr, only 25 simultaneous bilateral fractures of the femoral neck have been reported in the literature, and most have occurred in association with tonic-clonic seizures. 5,6 In the past 40 yr, only 25 simultaneous bilateral fractures of the femoral neck have been reported in the literature, and most have occurred in association with tonic-clonic seizures.…”