Fracture Cascade in Patients with End-Stage Renal Disease: Complications and Outcome

Abstract

We report a 68-year-old end-stage renal disease female patient on dialysis for 15 years. She sustained consecutive fractures starting with left-sided femoral neck fracture, followed 16 months later by a right-sided one. On her recovery from her right hip injury she sustained a stress type subtrochanteric fracture at the entry site of the fixation implants and an ipsilateral humeral shaft fracture. Cementless total hip replacement was done for the left femoral neck, and osteosynthesis was done for her undisplaced right femoral neck fracture. Revision fixation was done for her right subtrochanteric fracture with a long Gamma nail that was statically locked. The humeral fracture was fixed with an interlocking nail in a closed manner. This case highlights the fact that sequential hip fractures is an ominous event which is likely to be followed by a quick cascade of bone injuries with trivial trauma and a high rate of unexpected complications. Our treatment approach is explained here, stressing the unexpected complications and challenges met.