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

Abstract

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.

Keywords: bilateral; end-stage renal disease (esrd); femoral neck fracture; osteoporosis; renal osteodystrophy; total hip arthroplasty.

Figure 1. Radiograph of the pelvis on presentation to the emergency room two months after the injury showing bilateral femoral neck fractures.

Figure 2. Computerized tomography cuts of both hips showing decreased joint spaces with the absorption of both femoral necks.

A: Axial view. B: Coronal reconstruction.

Figure 3. After total arthroplasty of the right hip in 2017.

Figure 4. X-ray of the pelvis in 2018 after the second surgery.

Figure 5. Radiograph of the pelvis seven months after the second total hip arthroplasty with no unusual features or major complications evident.