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

Atraumatic Bilateral Transcervical Femoral Neck Fractures in an Elderly Epileptic Patient: A Case Report

Introduction

The occurrence of non-traumatic bilateral femoral neck fractures is exceedingly rare, and their manifestation subsequent to an epileptic attack is an uncommon entity with very few cases reported globally.

Case Report

We present the positive outcome of a 68-year-old man who underwent staged bilateral constrained total hip arthroplasty following a fracture resulting from a generalized seizure. This unconventional decision was justified based on several factors, including fracture pattern, bone quality, seizure history, and advanced tribology.

Conclusion

Epileptic patients pose a potential high risk for hip dislocation or fracture neck of femur. In such cases, we advocate for primary constrained arthroplasties as a viable and durable option, considering the specific circumstances and challenges associated with these patients.

Hemiarthroplasty for Hip Fracture in Down Syndrome: A Retrospective Series of Five Cases

Purpose

There is limited evidence regarding the outcomes of hip hemiarthroplasty (HA) following trauma in individuals living with Down syndrome (DS). This study aims to summarize the outcomes of hip HA in a series of individuals living with DS following femoral neck fractures.

Materials and Methods

This retrospective study includes five cases of hip HA in four individuals with DS and displaced femoral neck fractures. Subjects (four males) had a mean age of 49.3 years (range, 26.1-59.7 years) at the time of surgery. All subjects presented with hip pain, loss of weight-bearing ability, and decreased activity level as reported by the subject caregivers. In all cases, the precise time of injury was not known.

Results

After a mean follow-up of 15.2 months, all subjects had returned to the pre-injury activity level without any recorded complications. One individual died 32 months after surgery for unrelated causes; the remaining subjects are alive and ambulating without pain at a mean of 24.2 months since the surgery.

Conclusion

When treating femoral neck fractures in those living with DS, careful history taking should be performed as regards the timing of trauma and the individual's functional status. Hip HA seems a viable treatment option for those living with DS if a proper surgical procedure is utilized.

Changes in bone mineral density in Down syndrome individuals: a systematic review and meta-analysis

Data evaluating changes in bone mineral density (BMD) in Down syndrome (DS) individuals remains controversial. Therefore, we conducted a systematic review and meta-analysis to better understand associations between BMD and DS. A systematic literature search of PubMed, EMBASE, Web of Science, and the Cochrane Library up until 1st January 2021 was conducted. We used the keywords "bone mineral density" and "Down Syndrome." Fifteen studies were included. Overall, our results showed a significant decrease in BMD of total body (TB BMD) [MD =  - 0.18; 95% CI (- 0.23 and - 0.12), P < 0.00001, I2 = 89%], total hip (TH BMD) [MD =  - 0.12; 95% CI (- 0.15 and - 0.10), P < 0.00001, I2 = 0%], lumbar spine (LS BMD) [MD =  - 0.12; 95% CI (- 0.14 and - 0.09), P < 0.00001, I2 = 18%], and femoral neck (FN BMD) [MD =  - 0.08; 95% CI (- 0.10 and - 0.06), P < 0.00001, I2 = 0%] in DS individuals when compared with controls. Moreover, the volumetric BMD of lumbar spine (LS vBMD) [MD =  - 0.01; 95% CI (- 0.02 and - 0.01), P = 0.0004, I2 = 19%] also showed a decreasing tendency while the volumetric BMD of the femoral neck (FN vBMD) [MD = 0.01; 95% CI (0.00 and 0.02), P = 0.02, I2 = 0%] was elevated in DS individuals versus controls. These findings demonstrated that individuals with DS had a decreased total and regional (TH, LS, and FN) BMD when compared with the general population. Additionally, when BMD was adjusted for skeletal volume, LS vBMD was also lower, while FN vBMD was elevated in DS individuals versus controls.

Total Hip Arthroplasty for the Sequelae of Femoral Neck Fractures in the Pediatric Patient

Although rare, total hip arthroplasty (THA) may be indicated in pediatric patients with degenerative changes of the hip joint after previous trauma. To illustrate management principles in this patient population, this study describes the case of a 15-year-old female who sustained bilateral femoral neck fractures after a generalized tonic-clonic seizure, an atypical, low-energy mechanism for this injury. These fractures were not diagnosed until 14 weeks after the seizure episode, at which point they had progressed to nonunion on the left side, malunion on the right side, and degenerative hip joint changes were developing bilaterally. Bilateral THA was ultimately performed, and the patient had favorable outcomes at 1 year postoperatively. In determining the optimal management strategy for such patients, a multidisciplinary approach should be used, with input from the patient’s family, pediatrician, pediatric endocrinologist, pediatric orthopaedic surgeon, and adult reconstruction surgeon. From a surgical standpoint, this report highlights the importance of selecting the appropriate bearing surfaces, broaching technique, mode of implant fixation, and implant features when performing THA in the active pediatric patient.

Low-velocity simultaneous bilateral femoral neck fracture following long-term antiepileptic therapy: A case report

BACKGROUND

Simultaneous bilateral femoral neck fractures are relatively rare injuries. They are usually associated with underlying metabolic bone disorders or systemic diseases. Long-term use of narcotics and bisphosphonates can also result in similar fracture patterns; however, association of this fracture type with long-term use of antiepileptic drugs is not very common. Only one such case has been reported in the literature. This article describes the second.

CASE REPORT

We report a case of simultaneous displaced bilateral femoral neck fractures in a 50-year-old epileptic patient, who had taken phenytoin for the past 3 years. The fractures were a result of low-velocity injury following a fall from the bed. The fractures were managed with a bilateral hemi-replacement arthroplasty. Oral bisphosphonates were given to improve the bone quality in the post-operative period. The patient had a good post-operative outcome, that was sustained throughout the entire follow-up period of 1 year.

CONCLUSION

Antiepileptic drugs should be supplemented with bisphosphonates and vitamin D to improve bone quality and prevent fractures in epileptic patients.

Bone health in Down syndrome

Patients with Down syndrome have a number of risk factors that theoretically could predispose them to osteoporosis, such as early aging, development disorders, reduced physical activity, limited sun exposure, frequent comorbidities and use of drug therapies which could affect bone metabolism. In addition, the bone mass of these people may be affected by their anthropometric and body composition peculiarities. In general terms, studies in adults with Down syndrome reported that these people have lower areal bone mineral density (g/cm²) than the general population. However, most of them have not taken the smaller bone size of people with Down syndrome into account. In fact, when body mineral density is adjusted by bone size and we obtain volumetric body mineral density (g/cm³), the difference between both populations disappears. On the other hand, although people with Down syndrome have risk factor of hypovitaminosis D, the results of studies regarding 25(OH)D in this population are not clear. Likewise, the studies about biochemical bone markers or the prevalence of fractures are not conclusive.

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

Hip fracture is a common occurrence in the elderly. Due to the growing demand for the specific care of these patients, we established the Orthogeriatric Unit (OGU) at San Gerardo University Hospital (Italy) in 2007. However, simultaneous bilateral femoral neck fractures among the geriatric population (those aged ≥65 years) are rarely reported in the literature. Reporting the rare case of a frail 76-year-old woman admitted with bilateral hip fracture and end-stage renal disease, we explain the important role played by the OGU and its flexible multidisciplinary approach for providing comprehensive care to patients with multimorbidity and clinical complexity. The team of geriatricians, orthopedic surgeons, anesthesiologists, and, in this case, a nephrologist, helped in the careful planning and timing of the single-step surgical repair, decided the appropriate type of anesthesia, and optimized outcomes. After a prompt evaluation of the patient, the OGU approach can achieve clinical stabilization prior to intervention. Along with a strict follow-up in the postoperative phase, this could result in a significant reduction of complications and mortality rates and an early start to a tailored rehabilitation process. We strongly suggest employing facilities with multidisciplinary teams for cases involving complex patients at short-term high risk for poor clinical outcomes. Indeed, the usual single-specialist model of care is gradually being abandoned worldwide.

Bilateral neck femur fracture following a generalized seizure- a rare case report

Hip fractures are one of the most common injuries which present to an orthopaedic surgeon. Most of these cases are unilateral .Bilateral simultaneous femur neck fracture is a rare occurrence. We report a case of a bilateral neck femur fracture in a 30 year male following a generalized tonic clonic seizure in view of its rarity and also to increase the awareness of such rare injuries. The patient was operated within 3 hours. At 5 months, the patient had good radiological and functional outcome. During a convulsion, there is a powerful and forceful contraction of muscles which may lead to fracture or dislocation. The incidence of fractures following a convulsion is 1.1%. A delay in diagnosis can lead to complications like avascular necrosis, osteoarthritis, non union, functional disability and legal consequences. All orthopaedic surgeons and emergency physicians should be aware of such uncommon injuries to ensure early diagnosis and treatment.

Multiple lumbar vertebral fractures following a single idiopathic seizure in an otherwise healthy patient; a case report

It has been reported that fractures are more common in epileptic patients relative to the general population.Seizures by repeated muscular contractions can increase fracture risk throughout the skeleton, but the reportedpapers about non traumatic vertebral fractures following a single episode of seizure are rare and mostly locatedin thoracic spine with only one or two vertebral fracture. The case we reported here was a 42 year old otherwisehealthy man who had three vertebral fractures due to a single idiopathic seizure affected the lumbar region withno previous history of underlying disease, trauma, or drug use.