r e v b r a s o r t o p . 2017;52(3):363–365
SOCIEDADE BRASILEIRA DE ORTOPEDIA E TRAUMATOLOGIA
w w w . r b o . o r g . b r
Case
Report
Bilateral
simultaneous
neck
femur
fracture
following
domestic
fall
in
an
elderly
patient:
a
rare
case
report
夽
Mayank
Vijayvargiya,
Vivek
Shetty
∗,
Kiran
Makwana,
Nitesh
Agarwal
HindujaNationalHospital,DepartmentofOrthopaedics,Mumbai,India
a
r
t
i
c
l
e
i
n
f
o
Articlehistory: Received15April2016 Accepted13June2016
Availableonline14September2016
Keywords:
Femoralneckfractures Arthroplasty
Replacement Hip
Aged
a
b
s
t
r
a
c
t
Simultaneousbilateralneckfemurfractureisarareentitythathasbeenassociatedwith underlyingbonedisease,variousmetabolicdiseases,high-energytrauma,andseizure dis-orders.Itsoccurrencefollowingminimaltraumaisveryrare.Thisarticlepresentsthecase ofa66-year-oldfemalewhosustainedbilateralintracapsularfractureneckfemur follow-ingaslipandfallathome.Single-stagebilateralcementedtotalhipreplacementwasdone usingadirectlateralapproachwithalternaterightandleftlateralpositions.Theauthors reportasatisfactoryoutcome,withHarrishipscoreof98atoneyear,whichpersisteduntil herlastfollow-upat30months.
©2016SociedadeBrasileiradeOrtopediaeTraumatologia.PublishedbyElsevierEditora Ltda.ThisisanopenaccessarticleundertheCCBY-NC-NDlicense(http:// creativecommons.org/licenses/by-nc-nd/4.0/).
Fratura
simultânea
bilateral
do
colo
do
fêmur
após
queda
doméstica
em
uma
paciente
idosa:
relato
de
um
caso
raro
Palavras-chave:
Fraturasdocolodofêmur Artroplastia
Substituic¸ão Quadril Idoso
r
e
s
u
m
o
Afraturasimultâneabilateraldocolodofêmuréumaentidaderaraquetemsidoassociada adoenc¸asósseas,diversasdoenc¸asmetabólicas,traumasdealtaenergiaedistúrbios con-vulsivos.Suaocorrênciaapóstraumamínimoémuitorara.Esteartigoapresentaocasode umamulherde66anosdeidadequesofreufraturaintracapsularbilateraldocolodofêmur apósumdeslizeequedaemcasa.Umaartroplastiatotaldoquadril,bilateralecimentadafoi feitaemumúnicomomento,usandoumaabordagemlateraldireta,alternandoasposic¸ões lateraisdireitaeesquerda.Osautoresrelatamumresultadosatisfatório,comHarrisHip Scorede98apósumano,quepersistiuatéoúltimoseguimento,aos30meses.
©2016SociedadeBrasileiradeOrtopediaeTraumatologia.PublicadoporElsevierEditora Ltda.Este ´eumartigoOpenAccesssobumalicenc¸aCCBY-NC-ND(http:// creativecommons.org/licenses/by-nc-nd/4.0/).
夽
WorkperformedwithintheDepartmentofOrthopaedics,HindujaNationalHospital,Mumbai,India. ∗ Correspondingauthor.
E-mail:vivshetty7777@gmail.com(V.Shetty). http://dx.doi.org/10.1016/j.rboe.2016.09.002
364
rev bras ortop.2017;52(3):363–365Introduction
Simultaneous bilateral femoral neck femur fracture is a rare entity and is often seen in patients with metabolic diseases1 like osteomalacia, renal osteodystrophy, after
epileptic attacks, electrical shock or trauma. Simultaneous traumaticbilateral neckfemurfracturesare evenrarerand thereare veryfew casereportspublishedwherein fracture occurredduetolowenergyimpact.2,3Unilateralfractureneck
femurarecommonlyseeninyoungadultsafterhighenergy injuryandinelderlypatientsafterlowenergyinjury. Bilater-allysimultaneousoccurrenceoffractureneckfemurfollowing roadtrafficaccidentsandhighenergytraumasuchasfallfrom aheighthasbeenreportedinliteraturebutitsassociationwith lowenergyinjurieslikeafallathomeisveryrare.2,3
Wereporthereacaseofa66-year-old femalewho sus-tainedbilateral intracapsularfractureneckfemurfollowing anaccidentalslipandfallathome(domesticfall)(Fig.1).
Case
presentation
A66 yearoldfedtotheemergencydepartmentfollowinga historyofsimplefallwhiletreadingaslipperyfloorathome. Afterthefall,shewasunabletostandonherownandwas thus brought tothe hospital.She had noprior complaints ofhip pain and was mobilizing well without any aid. She wasanactive,independent womanwithnoassociated co-morbidities.Clinicalexaminationrevealedexternallyrotated limbsandpainonlimbmovements.Radiographsweretaken which revealed bilateral intracapsular fracture neck femur PauwelltypeIII(Fig.1).Soabilateralcementedtotalhip arthro-plastywasplannedfollowinghermedicalfitness.
Singlestagebilateralcementedtotalhiparthroplastywas done using CPTfemoral stem (Zimmer,Warsaw, USA)and ZCAacetabularcup (Zimmer,Warsaw,USA)two daysafter injury(Figs.2and3).Directlateralapproachwithalternateleft andright lateralpositionwas employed.Followingsurgery, patientwasmobilizedfullweightbearingwithwalkeronfirst
Fig.1–Preoperativeradiographshowingbilateral
intracapsularneckfemurfracture.
Fig.2–Postoperativeanteroposteriorradiographafter
bilateralcementedarthroplasty.
post-operativedayanddischargedon5thpostoperativeday. Shehadanuneventfulwoundhealingandwasambulating independently without any aid by 6th week post surgery. Shewassymptomfreeatherprotocolizedfollow-up of3rd month,6thmonthandat1year.Harrishipscoreat1year follow-up was 98 which shecontinued tomaintain ather lastfollow-upof30monthspostsurgery.Radiographsofthe pelvisat30monthsfollow-upareshowninFig.4.
Discussion
Bilateral fracture neckfemur isarare entity and onlyfew cases havebeen reported inthe literature.These fractures occur mainly due to high impact injury4,5 or fall from a
height.6Non-traumaticcausesincludechronicrenalfailure,
pelvicirradiation,osteomalacia,pregnancy,renal osteodystro-phy,chronicsteroid,andantiepilepticuse.Otheruncommon causesarefollowingepilepticattack,electricalshock,orpost electroconvulsivetherapy.
Uncomplicatedtraumaisararecauseofbilateralfracture neckfemur.7Dhar8describedacaseofbilateralfractureneck
femurin a9year oldfollowinga roadtrafficaccident and Carrelletal.6ina8yearoldfollowingfallfromaheight.
Atkin-sonet al.9alsohasreportedfourcasesofbilateral fracture
neckfemurfollowingviolenttrauma,oneaftervehicular acci-dent,twoafterfallofheavyobjectandoneduetofallfrom height.Therehavebeenfewreportsofbilateralfractureneck femurinelderlypatientsfollowingminimaltrauma.10Also,
it isimportanttohaveradiographsofpelviswithbothhip ininitialassessmentforeverypatient,especiallyforelderly patientsandpatientswithco-morbidconditionstoruleout thisrareentity.
Various modalities of treatment have been advised for treating suchfractures.Inyoungerpatients, osteosynthesis withclosed/openreductionandcannulatedscrewfixationis beingadvocatedandinelderlypatients,arthroplastyis rec-ommendedtobethetreatmentofchoice.
Sood et al.2 advised singlestage cemented arthroplasty
rev bras ortop.2017;52(3):363–365
365
Fig.3–Postoperativelateralradiographafterbilateralcementedarthroplasty.
Fig.4–Anteroposteriorradiographofpelvisat30months
follow-up.
fractureneckfemurfractureinelderlypatients.McGoldrick et al.5 also advised for single stage total hip arthroplasty
butwithalternatelateralposition.Althoughlateralposition increasesoperativetime and requires repeatdraping, both authorsagreethatnotechniqueissuperior.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
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1.KalaciA,YannatAN,SevineTT,DogramaciY.Insufficiency fracturesofbothfemoralnecksinayoungadultcausedby osteoporosis:ararecasereport.ArchOrthopTraumaSurg. 2008;128(8):865–8.
2.SoodA,RaoC,HollowayI.Bilateralfemoralneckfracturesin anadultmalefollowingminimaltraumaafterasimple mechanicalfall:acasereport.CasesJ.2009;2(1):92.
3.McGoldrickNP,DoddsMK,GreenC,SynnottK.Management ofsimultaneousbilateralneckoffemurfracturesinan elderlypatient.GeriatrOrthopSurgRehabil.2013;4(3): 71–3.
4.GunalI,GursoyY,AracS.Traumaticbilateralfracturesofthe femoralneck(ararecasereport).HacettepeJOrthopSurg. 1991;1:4.
5.KonfortiB,ChokanovK.Simultaneousbilateralnailingbytwo teamsofsurgeonsinfracturesofthefemoralneck.Khirurgiia (Sofiia).1956;9(1):75–8.
6.CarrellB,CarrellWB.Fracturesintheneckofthefemurin childrenwithparticularreferencetoasepticnecrosis.JBone JointSurgAm.1941;23:225–39.
7.PowellHD.Simultaneousbilateralfracturesoftheneckofthe femur.JBoneJointSurgBr.1960;42-B:236–52.
8.DharD.Bilateraltraumaticfractureofneckoffemurina child:acasereport.MalaysOrthopJ.2013;7(2):34–6. 9.AtkinsonRE,KinnettJG,ArnoldWD.Simultaneousfractures
ofbothfemoralnecks:reviewoftheliteratureandreportof twocases.ClinOrthopRelatRes.1980;(152):284–7.
