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| CASE REPORT |
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| Year : 2022 | Volume
: 42
| Issue : 4 | Page : 191-193 |
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Bilateral fractures of the femoral neck
Tse-Pu Huang, Tsu-Te Yeh, Chia-Chun Wu, Chun-Chi Hung
Department of Orthopaedic Surgery, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China, Taiwan
| Date of Submission | 08-Aug-2021 |
| Date of Decision | 02-Feb-2022 |
| Date of Acceptance | 03-Mar-2022 |
| Date of Web Publication | 12-May-2022 |
Correspondence Address:
Dr. Chun-Chi Hung
Department of Orthopaedics, Tri-Service General Hospital, Taipei
Taiwan
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmedsci.jmedsci_278_21
Bilateral fractures of the femoral neck are rare and are usually associated with underlying bone diseases, previous metabolic diseases, high-energy trauma, electroshock, or seizure attack. Low-energy trauma, such as a fall, related bilateral fractures of the femoral neck are rare. We report a case of a 74-year-old woman with displaced bilateral femoral neck fractures following a fall. After admission, we performed bilateral cemented bipolar hemiarthroplasty and restored functional outcome postoperatively. Osteoporosis was confirmed by X-ray bone densitometry at the postoperative outpatient department follow-up.
Keywords: Femoral neck fracture, bilateral, simultaneous, low-energy trauma, elderly patient, bipolar hemiarthroplasty
How to cite this article:
Huang TP, Yeh TT, Wu CC, Hung CC. Bilateral fractures of the femoral neck. J Med Sci 2022;42:191-3 |
| Introduction | |  |
Unilateral fracture of the femoral neck is common in young adults after high-energy trauma, such as traffic accidents and in elderly patients after low-energy trauma, such as a simple fall. However, simultaneous bilateral femoral neck fractures are rare. These fractures are usually related to previous bone diseases, metabolic diseases, high-energy trauma, electroshock, and seizure attack.
Underlying bone diseases and metabolic diseases, such as osteoporosis, osteomalacia, multiple myeloma, hypocalcemia, chronic kidney injury, and malnutrition, cause changes in the bone quality and cause an increased risk of simultaneous bilateral femoral neck fractures.[1],[2],[3],[4],[5],[6] Simultaneous bilateral femoral neck fractures result from high-energy trauma, such as traffic accidents, falls from heights.[7] These fractures have a high incidence of mortality and should be managed early. Electroshock, drug-induced seizure, or seizure attack related to strong muscle contraction can also result in simultaneous bilateral femoral neck fractures.[6],[8],[9],[10] The use of muscle relaxants can reduce this kind of risk. Bilateral femoral neck fractures due to low-energy trauma, such as a simple fall are rare.[9]
| Case report | | |
A 74-year-old woman was referred to our emergency department due to painful disability of bilateral hips. According to her family, she was an active, independent woman with a history of type 2 diabetes mellitus, which was under control. She lived in a nursing home and was able to walk by herself without the assistance of walking aids.
She fell down with hip contusions at the nursing home. After falling down, she was unable to stand and walk. A physical examination revealed bilateral lower limb external rotation and painful sensations. The patient had limited capacity for movement of either hip. Radiological investigations of both hips revealed displaced bilateral subcapital fractures of the femoral neck [Garden Type IV; [Figure 1]]. | Figure 1: Preoperative anteroposterior radiograph of both the hips showing displaced bilateral subcapital fractures of the femoral neck, garden Type IV
Click here to view |
We performed a two-stage arthroplasty for this patient. Cemented bipolar hemiarthroplasty of one side was first performed within 24 h of admission. The other side cemented bipolar hemiarthroplasty was performed 2 days after the previous surgery [Figure 2]. Cemented bipolar hemiarthroplasty on both the sides was performed by the posterolateral approach. The patient was discharged under stable condition on the 7th day after the second surgery. She was regularly followed up at the outpatient department. We performed X-ray bone densitometry of the L1-L4 lumbar region that showed a T-score of-5.5 standard deviation osteoporosis was confirmed and it was related to the patient's bilateral femoral neck fractures. Restored functional outcome and full-weight bearing ability were noted at the outpatient department follow-up. | Figure 2: Postoperative anteroposterior radiograph after two-stage bilateral cemented hemiarthroplasty
Click here to view |
| Discussion | | |
Bilateral femoral neck fractures are rare as compared to unilateral femoral neck fractures. Only a few cases of bilateral femoral neck fractures have been published in the medical literature.
Some of these bilateral femoral neck fractures were related to osteoporosis, which was often associated with previous bone diseases, metabolic diseases, or drug use. Kalaci[1] described a young woman with bilateral femoral neck fractures due to osteoporosis of unknown etiology. Sahan[2] reported a 28-year-old woman with bilateral femoral neck fractures 3 days postpartum due to transient osteoporosis in pregnancy. Vitamin D deficiency and malnutrition also induce osteoporosis and subsequently cause bilateral femoral neck fractures.[3],[4],[5]
Seizure attacks related to strong uncoordinated muscle contractions can cause fractures and dislocations.[6] Alkaramani[6] reported a young patient with metabolic bone disease exhibiting atraumatic bilateral femoral neck fracture after a tonic-clonic seizure. Muscle contraction after electrical shock injury can also cause fracture. Sohal and Goyal[10] described a young patient with bilateral femoral neck fractures after an accidental electric shock with 440 V direct current.
High-energy trauma, such as traffic accidents, related bilateral femoral neck fractures are reported in the literature review. Gao[7] reported a 52-year-old man with simultaneous bilateral femoral neck fracture after a traffic accident. Low-energy trauma, such as a simple fall, related bilateral femoral neck fractures are rare.[9] Sood[9] reported a rare case of an 84-year-old man who exhibited bilateral femoral neck fractures resulting from a simple fall.
Bilateral femoral neck fractures after total knee arthroplasty have also been reported. The possible reason for these fractures may be previous deformity of the knee and changed biomechanics after total knee arthroplasty, insertion of a rotating hinge prosthesis, and increased level of activity following total knee arthroplasty.
The treatment strategies of these fractures vary. Open/close reduction and internal fixation with cannulated screws or dynamic hip screws are advised in young patients.[1],[2],[3],[4],[5],[6],[8],[9],[10] Arthroplasty is recommended in elderly patients or in cases of failed internal fixation.[9] We performed a two-stage arthroplasty for this patient. A unilateral cemented bipolar hemiarthroplasty was first performed within 24 h of admission. A cemented bipolar hemiarthroplasty was performed on the opposite side 2 days later. We measured the distance between the greater trochanter and the anterior superior iliac spine and used intraoperative fluoroscopy to maintain equal leg lengths.
| Conclusion | | |
In our patient's case, osteoporosis was confirmed with X-ray bone densitometry and was related to bilateral femoral neck fractures. Therefore, when patients at high risk of osteoporosis experience a fall, bilateral femoral neck fractures should be considered as possible outcomes. In addition, early diagnosis and adequate treatment for osteoporosis can prevent femoral neck fractures and improve the prognosis of these patients.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal his/her/their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Kalaci A, Yanat AN, Sevinç TT, Doğramaci Y. Insufficiency fractures of both femoral necks in a young adult caused by osteoporosis: A case report. Arch Orthop Trauma Surg 2008;128:865-8.  |
| 2. | Sahan I, De Deken J, Anagnostakos K. Bilateral femoral neck fracture in a postpartum woman: Beware of the risk factors. Case Rep Orthop 2019;2019:4134351. |
| 3. | Fukui K, Kaneuji A, Hirata H, Tsujioka JI, Shioya A, Yamada S. et al., Bilateral spontaneous simultaneous femoral neck occult fracture in a middle-aged man due to osteoporosis and vitamin D deficiency osteomalacia: A case report and literature review. Int J Surg Case Rep 2019;60:358-62. |
| 4. | Arisumi S, Mawatari T, Ikemura S, Matsui G, Iguchi T, Mitsuyasu H. Spontaneous bilateral femoral neck fractures in a young male adult: A case report and literature review. BMC Musculoskelet Disord 2019;20:449. |
| 5. | Tan XY, Lei T, Wu GB, Luo HE, Huang G, He CY, et al. Successful treatment for bilateral femoral neck insufficiency fractures: A rare lesion case report and an updated review of the literature. BMC Musculoskelet Disord 2020;21:102. |
| 6. | Alkaramani E, Salameh M, Adam M, George B, Alser Y, Ahmed G. Simultaneous bilateral neck of femur fracture in a young adult with underlying metabolic disturbances. Case Rep Orthop 2020;2020:8972542. |
| 7. | Gao YS, Zhu ZH, Zhang CQ. Simultaneous bilateral fractures of the femoral neck caused by high energy: A case report and literature review. Chin J Traumatol 2015;18:304-6. |
| 8. | Carlos RS, Gustavo KO, Ricardo KO, Douglas C, Pablo MW. Simultaneous bilateral femoral neck fracture. Acta Ortopedica Brasileira 2001;9:58-61. |
| 9. | Sood A, Rao C, Holloway I. Bilateral femoral neck fractures in an adult male following minimal trauma after a simple mechanical fall: A case report. Cases J 2009;2:92. |
| 10. | Sohal HS, Goyal D. Simultaneous bilateral femoral neck fractures after electrical shock injury: A case report. Chin J Traumatol 2013;16:126-8. |
[Figure 1], [Figure 2]
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