Simultaneous bilateral femoral neck fractures secondary to epileptic seizures: Treatment by bilateral total hip arthroplasty

Abstract

Simultaneous bilateral femoral neck fracture following an epileptic seizure attack are rare. Open reduction and internal fixation remains the most used therapeutic option. Arthroplasty, carrying a high risk of dislocation is less often recommended. We report the favourable evolution of a 49-year-old man who benefited from a single stage bilateral total hip arthroplasty operation for his simultaneous bilateral, femoral neck fractures secondary to a generalized seizure. This nonconsensual choice, in this case, was justified on multiple grounds: surgical care delay longer than 48 hours, substantial bone displacement, borderline bone quality, adequate antiepileptic treatment efficacy and tolerance. A ceramic-on-ceramic bearing surfaces couple, a large-diameter head and a cementless implantation design together should be able to provide an acceptable longevity in a young and active patient.

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

“…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]. Some of these cases were secondary to hypocalcaemic convulsions related to chronic renal failure [30,31].…”

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

“…1 However, many factors play a role in operative decision making. The rates of avascular necrosis and non-union of displaced femoral neck fractures treated with open reduction and internal fixation are 9.7% and 18.5%, respectively.…”

“…Although many surgeons will manage several femoral neck fractures in one day, it is exceedingly rare to have a patient present with bilateral hip fractures. To our knowledge, 22 cases of bilateral femoral neck fractures have been presented in the literature over the past forty years, all of which were the result of seizures, 1 and only one of these cases involved a patient with Down syndrome. 2 Such injuries raise many questions ranging from the optimal type of operative fixation to rates of post-operative complications and overall patient prognosis.…”

Cemented Constrained Total Hip Arthroplasty in a Patient With Osteogenesis Imperfecta and Recurrent Grand Mal Seizure Activity

“…Seizure activity increases the danger of proximal femoral and acetabular fractures, as well as prosthetic hip instability and dislocation [5][6][7].…”