Simultaneous, Bilateral Pathological Displaced Intracapsular Hip Fractures Occurring Spontaneously Secondary to Osteomalacia of Hypomagnesemic Origin: A Case Report and Review of the Literature

Abstract

Spontaneous fractures involving both of the femoral necks simultaneously are exceedingly rare events. We report a case of an elderly female who presented after breaking both femoral necks following a trivial fall, initially diagnosed as age-related osteoporosis. Both the hips were treated by hemiarthroplasty. The diagnosis was revised to vitamin D-resistant osteomalacia secondary to hypomagnesemia after histopathological confirmation and further investigations. We examine the different etiological factors and mechanisms operating in the causation of this rare injury and explore the possible role of magnesium in the pathogenesis of osteomalacia. Fractures may remain occult until late, leading to increased morbidity and mortality. The value of an early MRI is recapitulated, with emphasis placed on prevention and early fixation.

Bilateral spontaneous simultaneous femoral neck occult fracture in a middle-aged man due to osteoporosis and vitamin D deficiency osteomalacia: A case report and literature review

“…Such subclinical deficiency will commonly progress silently, without obvious clinical manifestations, until it is suddenly revealed when a spontaneous fracture occurs. The literature suggests that patients usually complain of bilateral groin or thigh pain that persists over a period of a few weeks to several months [[23], [24], [25], [26], [27], [28], [29]], so that these fractures develop gradually and diagnosis is typically delayed. In cases such as this, even if the initial radiographs are negative, the possibility of bilateral hip fracture should be considered, particularly if the pain worsens suddenly or the patient exhibits signs of bone insufficiency [26].…”

“…The literature suggests that patients usually complain of bilateral groin or thigh pain that persists over a period of a few weeks to several months [[23], [24], [25], [26], [27], [28], [29]], so that these fractures develop gradually and diagnosis is typically delayed. In cases such as this, even if the initial radiographs are negative, the possibility of bilateral hip fracture should be considered, particularly if the pain worsens suddenly or the patient exhibits signs of bone insufficiency [26]. Although a previous study on radiographic features of femoroacetabular impingement in femoral neck stress fracture showed a relatively high incidence of pincer type morphology [30], our arthroscopic observation indicated cleavage at the labro-cartilage junction due to cam-type impingement (Fig.…”

"Simultaneous Bilateral Femoral Neck Fractures Due to Vitamin D Deficiency and Chronic Ankle Instability in a Young Adult -- A Case Report and Literature Review"

“…traffic accident [6][7][8], The recruit training [9,10], high or sudden fall [11,12], weight lifting [13], etc. There are also secondary to pathological condition, The etiology due to hyperparathyroidism or osteomalacia caused by vitamin D deficiency [14][15][16][17][18][19][20][21][22], epileptic seizure [16][17][18][19][20][21][22][23][24][25], chronic renal insufficiency [25,26], secondary metabolic disorder of malnutrition [26][27][28][29][30], postoperative joint replacement [31], drugs of Allen phosphonic acid or sugar cortical hormone [32], narcotic drug abuse [33], abnormal bone metabolism and bone resorption on account of metastatic tumor [34], etc. The etiology of this kind of fracture is complex and the condition of a patient is occult.…”