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. 2021 Dec:89:106545.
doi: 10.1016/j.ijscr.2021.106545. Epub 2021 Nov 2.

Bilateral femoral neck fracture following a convulsion in the presence of chronic kidney disease. A case report

Isam Sami Moghamis  1 , Aiman Mudawi  2 , Elhadi Babikir  2 , Mohamed Hafez Elsheikh Elamin  2 , Maamoun Abou Samhadaneh  2 , Shamsi Abdul Hameed  2
Affiliations

Bilateral femoral neck fracture following a convulsion in the presence of chronic kidney disease. A case report

Isam Sami Moghamis et al. Int J Surg Case Rep. 2021 Dec.

Abstract

Introduction and importance: Bilateral femoral neck fractures in young adults are a rare entity. It is usually associated with pre-existing metabolic diseases, such as osteoporosis, renal osteodystrophy, or hypocalcemic seizures. Hence, it is essential in such cases to look for other associated injuries following a traumatic event. Missing associated injuries may lead to significant morbidities and poor functional outcomes.

Case presentation: A 37 years old male, who had chronic renal failure secondary to hypertension, and presented to the emergency room following a seizure episode, in which he developed a generalized tonic-clonic convulsion secondary to electrolyte imbalances with metabolic acidosis. As a result, he developed bilateral neck of femur fracture.

Intervention and outcome: The medical team optimized electrolytes imbalance and then the patient underwent surgical stabilization of both femur neck fracture, 1 year following the surgical fixation the patient had full range of motion of both hips with radiological evidence of complete healing of the fracture.

Conclusion: In cases of fractures secondary to metabolic conditions, bilateral femoral neck fractures should be suspected and investigated; especially in young patients who develop a generalized tonic-clonic seizure. The etiology is multifactorial, and the treating surgeon should be aware of predisposing factors which may affect bone quality, thereby raising the risk of fractures even with low-energy atraumatic events. Hip preservation should always be the primary target when treating these patients.

Keywords: Bilateral femoral neck fracture; Chronic kidney disease; Convulsions; End stage renal disease; Seizure.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
Initial radiograph showing an AP view of the pelvis with bilateral Garden type 4 transcervical femoral neck fractures.
Fig. 2
Fig. 2
Intraoperative fluoroscopic AP and frog lateral views of both femur necks showing in-situ fixation with cannulates screws.
Fig. 3
Fig. 3
One-year post-operative x-ray of both hips AP and frog lateral views showing in-situ fixation with complete healing of the fractures.
See this image and copyright information in PMC

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