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

Abstract

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

Bilateral Neck of Femur Fracture in a Child With Underlying Vitamin D Deficiency: A Case Report on Management and 10-Year Follow-Up

“…These types of fractures are also reported in patients suffering from renal osteodystrophy, primary hyperparathyroidism, celiac disease, and malignancy. Corticosteroid, anti-epileptic, antacid drugs, and pelvic irradiation are other rare causes [ 3 , 4 ]. A bilateral replacement has been considered as a treatment of choice in the adult patient by most of the authors [ 5 ].…”

Energy, Waves, and Forces in Bilateral Fracture of the Femoral Necks: Two Case Presentations and Updated Critical Review

“…Though some authors tend to claim that older females have a predisposition to bilateral femoral neck fractures, recent case reports show that children with a vitamin D deficiency [ 1 , 2 , 3 ], were subject to this kind of fracture, as well as a young male who had been deprived of sunlight for several years [ 42 ]. Atraumatic bilateral fracture of the femoral neck in young male patients with suspected osteomalacia [ 4 ] and low-velocity simultaneous bilateral femoral neck fracture following long-term antiepileptic therapy [ 5 , 6 ] have also been reported recently, but are very rare indeed.…”

“…Another underlying cause of bone fragility causing bilateral femoral neck fracture is osteoporosis, encountered both in young, pregnant female patients, [ 5 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 38 ], young adult females with amenorrhea [ 24 ], or postpartum [ 41 ], and also in aged patients, both women and men [ 16 , 17 , 43 , 44 , 45 ]. Supposedly, metastatic conditions, as in prostate carcinoma described in ref.…”

“…The strongest sources for such an enhanced frailty of the bone are presumably her metabolic diseases (see also refs. [ 5 , 10 , 11 , 12 , 13 , 14 , 20 , 21 , 22 , 23 ]).…”

“…It is also difficult to precisely determine whether men or women are more prone to this condition, or if patients of a certain age can be found more frequently in the studies available to date, because data present both sexes and a range of ages, including children. [ 1 , 2 , 3 , 4 , 5 ]. Osteoporosis in older females is claimed as a criterion, but it is not self-consistent [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”