A Missed Diagnosis of Bilateral Simultaneous Spontaneous Intracapsular Neck of Femur Fractures in a Rheumatoid Arthritis Patient

Abstract

Bilateral spontaneous simultaneous fractures of the neck of femurs are extremely rare, and only a few cases have been reported in literature. They are usually following high-energy trauma or may be due to an underlying pathological process such as frailty, osteomalacia, rickets, and chronic renal disease. They can also occur following epilepsy and electric shock. We report a 79-year-old gentleman who presented with sudden onset of bilateral hip pain with a background of rheumatoid arthritis and long-term steroid treatment. The bilateral hip fractures were missed initially and later presented with completely displaced fractures of the neck of femurs. He underwent a single-stage bilateral cemented hemiarthroplasty and made a good recovery. Bilateral simultaneous fractures of the hip in patients with rheumatoid arthritis have not been reported in literature so far, and the diagnosis can be easily overlooked. In patients with bilateral hip pain, one should have a high index of suspicion. Further appropriate cross-sectional imaging in the form of CT or MRI should also be considered.