Neglected bilateral femoral neck fractures in a patient with end-stage renal disease before chronic dialysis

Surgical Challenge in the Management of Spontaneous, Bilateral, Nontraumatic, Neglected Femoral Neck Fractures in a Patient With End-Stage Renal Disease: A Case Report and Literature Review

Renal osteodystrophy is a spectrum of diseases that affect several organ systems including the musculoskeletal system by decreasing bone density which increases the risk of fractures. Fractures around the femoral neck are usually traumatic and unilateral and, rarely, bilateral and atraumatic. In this report, we present the case of a 37-year-old female patient with a known history of chronic kidney disease who sustained an atraumatic bilateral neck of femur fracture with late presentation. In addition, we present a review of neglected femoral neck fracture management in a young patient with renal disease and osteoporosis.

Bilateral Quadriceps Tendon Rupture and Femoral Neck Fracture After Generalized Tonic-Clonic Seizures: A Case Report

CASE

We report on a 19-year-old male renal transplant patient with multiple medical issues who sustained simultaneous bilateral quadriceps tendon ruptures and bilateral femoral neck fractures after 2 generalized tonic-clonic seizures. The quadriceps tendon ruptures were detected early surgically repaired; the femoral neck fractures were not detected and managed with bilateral total hip arthroplasty for almost 2 weeks.

CONCLUSION

Tonic-clonic seizures can be associated with unique and complex acute orthopaedic injuries that can be initially missed. Physicians should be cognizant of the need for a thorough medical history and physical examination to avoid orthopaedic postseizure missed diagnoses.

Simultaneous bilateral femoral neck fractures in a dialysis-dependent patient: case report and literature review

BACKGROUND

Simultaneous bilateral femoral neck fractures are extremely rare without obvious injury. Herein, we report the case of a patient on dialysis presenting with bilateral femoral neck fractures, which is a condition with high complication and mortality rates according to a review of the pertinent literature.

CASE PRESENTATION

We report the case a 47-year-old female with a history of 8 years of haemodialysis due to polycystic kidney disease who presented with bilateral hip pain during walking. The clinical history and results of physical and radiographic examinations of this patient are shown. Single-stage bilateral hemiarthroplasty was performed after a multidisciplinary team consultation. Three days after the operation, she could ambulate with a walker. The woman gradually regained her previous ability to walk over 6 months after surgery.

CONCLUSIONS

A multidisciplinary team consultation for perioperative management is necessary and effective in patients on dialysis. Early diagnosis with prompt surgical treatment could lead to favourable recovery.

Simultaneous, Non-traumatic, Bilateral Neck Femur Fractures in Uremic Renal Osteodystrophy: A Report of Three Cases and Literature Review

Introduction

Bilateral, simultaneous, non-traumatic, pathological femur neck fractures due to renal osteodystrophy (RO) in chronic renal failure cases are uncommon but are increasingly being reported in the literature. Seizure episodes due to uremic encephalopathy could lead to such fractures.

Case Reports

We describe three cases of patients with end-stage renal disease and RO, who presented with bilateral, non-traumatic femur neck fractures after episodes of grand mal con-vulsions. We also review the literature for all such similar cases and briefly discuss the path-ophysiology of RO and the management of these pathological fractures.

Conclusion

Spontaneous, pathological, bilateral neck femur fractures are increasingly being reported in chronic renal failure patients with high morbidity and mortality. These fractures tend to be missed as the patients are generally immobilized and bed ridden due to the renal disease. Early diagnosis with high index of suspicion in patients with hip pain followed by supervised treatment with the involvement of a nephrologist is of uttermost importance.

Bilateral impacted femoral neck fracture in a renal disease patient

Spontaneous bilateral femoral neck facture in a renal disease patient is not common. We report a case of 47-year-old female patient with chronic renal failure and on regular hemodialysis for the past 5 years who sustained bilateral impacted femoral neck fracture without history of trauma and injury and refused any surgical intervention. The patient was mobilised on wheel chair one year after the fractures. The cause of the fracture and the literature review of the bilateral femoral neck fracture in renal disease are discussed.

Simultaneous bilateral hip fractures in a level I trauma center

BACKGROUND

Hip fractures are a common occurrence among the population today, especially in the elderly. However, the incidence of simultaneous bilateral hip fractures is very rare, and there is a paucity of data in the current literature documenting patients with these hip fractures.

METHODS

A retrospective case review was performed on all patients treated for hip fractures during the past ten years at our Level I trauma center.

RESULTS

From 1993 to 2002 there were eight patients who sustained simultaneous bilateral hip fractures. The mean age of the patients was 63 years (range, 34-88 years). The overall survival rate was 63%. In the patients of age group younger than 65, the survival rate was three out of four (75%). In the patients of age group 65 and older, the survival rate was two of four (50%). The length of hospital stay was shorter on average for the younger population, 19 days (range, 17-27 days). The average hospital duration for the older population was 29 days (range, 28-30).

CONCLUSION

Bilateral hip fractures are usually the result of a high-energy trauma and are associated with other injuries. The morbidity and mortality of this injury are quite high. Patient age, associated injuries, and comorbid conditions should be examined closely because they may influence the patient's recovery.