Simultaneous Bilateral Neck of Femur Fracture in a Young Adult with Underlying Metabolic Disturbances

Abstract

Introduction. Simultaneous bilateral fractures of the femoral neck are considered very rare injuries. Few cases were reported in the literature. Most cases were reported in elderly patients with underlying bone pathology. Case Report. We report a case of a 31-year-old male patient who presented to the emergency department with bilateral hip pain and inability to bear weight after a sudden loss of consciousness and fall while running on a treadmill. The patient had a recent history of anabolic steroids, growth hormone, and other supplements used for bodybuilding. Radiological studies confirmed bilateral neck of femur fracture. Laboratory investigations revealed pan-pituitary axis insufficiency and mild vitamin D deficiency, and his EEG suggested a seizure attack. The patient was treated with three 6.5 mm cannulated cancellous screws on one side and a sliding hip screw on the other side and was followed with strict physical therapy and rehabilitation plan. 6 months from the injury, a radiographic bilateral union achieved with the patient back to his normal daily activity and noncontact sports. Conclusion. We report this rare case of bilateral neck of femur fracture in a young adult after a generalized seizure attack with underlying metabolic disturbances. Ruling out other biological underlying etiologies, early diagnosis and early fracture anatomic reduction and fixation are crucial to decrease potential complications such as avascular necrosis and fracture nonunion.

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.…”

“…[ 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 ].…”

Post seizure bilateral simultaneous neck of femur fractures in a young adult

“…BNOF fractures in young patients induced by muscular spasm following either a seizure episode or electric injury are rare and reported in the literature. [5][6][7][8][9][10][11][12][13][14][15] They typically occur as a result of high-energy trauma in a young, healthy population. [2] The underlying renal disease can affect bone mineral density, quality, tensile stiffness, and remolding potential.…”

“…[21] Alkaramani et al reported a 31-year-old male with a history of anabolic steroid and growth hormone abuse for bodybuilding who sustained BNOF fracture following an episode of a tonic-clonic seizure as a result of hormonal imbalance. [7] They chose to treat him with a sliding hip screw on the left side due to comminution and cannulated screws on the right side. Sathyanarayana et al reported a 23-year-old male with an end-stage renal disease on dialysis who was diagnosed on the 3 rd day with BNOF fractures following a seizure episode.…”

“…[4] Bilateral simultaneous hip fractures in young patients without a history of underlying diseases affecting bone mineralization are relatively rare and reported in the literature. [5][6][7] They can be sustained, as well as posterior shoulder dislocations or proximal humerus fractures, due to seizure episodes or following electrical shock injuries and can be initially missed causing a delay in treatment. [8,9] In general, the neck of femur fractures can be treated with internal fixation; cannulated screws, sliding hip screws, or cephalomedullary nail fixation with or without the need for open reduction.…”