Insufficiency fractures of both femoral necks in a young adult caused by osteoporosis: a case report

Abstract

Insufficiency fractures of femoral necks due to osteoporosis of unknown aetiology occurring coincidentally on both sides in young adults, have not been described in English literature so far. A 18-year-old young girl presented with a 3-month history of gradual onset of bilateral thigh pain and progressive inability to walk. At the first look, plain radiographs of both hips showed no gross abnormal findings other than some tips on reduced bone mineral density of the femoral necks. MRI was ordered upon a high suspicion of fracture and T1-weighed MRI showed a linear low signal on both femoral necks. Dual-energy X-ray absorptiometry of the lumbar spine and femoral neck showed low mineral density. She was treated surgically with in-situ internal fixation using cannulated screws. The bilateral thigh pain was resolved and walking started immediately after the treatment. Insufficiency fracture of the femoral neck due to osteoporosis should be kept in mind even in young adults complaining of atypical pain without evidence of unusual activities. We used both the terms of stress fracture and insufficiency (osteoporotic) fracture interchangeably as the mechanism of fractures resemble each other.

Valgus intertrochanteric osteotomy in neglected simultaneous, bilateral, displaced subcapital femoral neck fractures in an epileptic pregnant woman

“…26,27,32 The incidence of osteonecrosis in nondisplaced fractures is 11-19% and it increases as the fracture becomes more displaced. 27,32 Many complications such as delayed union, nonunion, refracture and osteonecrosis are associated with the displacement and delayed diagnosis, 14,15 and hence, some authors have preferred arthroplasty in displaced fractures. 30,31 Nonunion has been reported in bilateral femoral neck fractures treated with cannulated screws, 14 Knowles pins, 11 and muscle-pedicle-grafting.…”

“…These include lag screw or dynamic hip screw fixation, [6][7][8]14,15 prosthetic replacement, 4,12,13,29,30 muscle pedicle bone grafting on both sides 10 and a combination of these. 5,16,17,31 Femoral neck nonunion has been reported to occur in as many as 23-43% of patients with a displaced femoral neck fracture.…”

“…[13][14][15][16][17] Different procedures reported in the literature for treatment of bilateral femoral neck fractures have drawbacks of nonunion, delayed union, shortening, femoral head osteonecrosis, and coxa vara, which can be avoided with primary valgus intertrochanteric osteotomy. To the best of our knowledge, this is the first case report in the literature of bilateral neglected displaced subcapital femoral neck fractures in an epileptic pregnant woman successfully treated with primary valgus intertrochanteric osteotomy on both sides.…”

Neglected simultaneous bilateral femoral neck fractures secondary to narcotic drug abuse treated by bilateral one-staged hemiarthroplasty: a case report

“…These include lag screw or dynamic hip screw fixation [6-8,15,16], pedicle bone grafting [10], and a combination of these. In this case, because of the complete displacement and osteonecrosis and high risk of nonunion (23%-43%) [17-19], we decided to replace the femoral head instead of open reduction and internal fixation, and young age of the patient did not change our decision.…”

Bilateral simultaneous neck femur fracture following domestic fall in an elderly patient: a rare case report

“…Simultaneous bilateral femoral neck femur fracture is a rare entity and is often seen in patients with metabolic diseases 1 like osteomalacia, renal osteodystrophy, after epileptic attacks, electrical shock or trauma. Simultaneous traumatic bilateral neck femur fractures are even rarer and there are very few case reports published wherein fracture occurred due to low energy impact 2, 3.…”