Bilateral femoral neck fracture following a convulsion in the presence of chronic kidney disease. A case report

Introduction and importance Bilateral femoral neck fractures in young adults are a rare entity. It is usually associated with pre-existing metabolic diseases, such as osteoporosis, renal osteodystrophy, or hypocalcemic seizures. Hence, it is essential in such cases to look for other associated injuries following a traumatic event. Missing associated injuries may lead to significant morbidities and poor functional outcomes. Case presentation A 37 years old male, who had chronic renal failure secondary to hypertension, and presented to the emergency room following a seizure episode, in which he developed a generalized tonic-clonic convulsion secondary to electrolyte imbalances with metabolic acidosis. As a result, he developed bilateral neck of femur fracture. Intervention and outcome The medical team optimized electrolytes imbalance and then the patient underwent surgical stabilization of both femur neck fracture, 1 year following the surgical fixation the patient had full range of motion of both hips with radiological evidence of complete healing of the fracture. Conclusion In cases of fractures secondary to metabolic conditions, bilateral femoral neck fractures should be suspected and investigated; especially in young patients who develop a generalized tonic-clonic seizure. The etiology is multifactorial, and the treating surgeon should be aware of predisposing factors which may affect bone quality, thereby raising the risk of fractures even with low-energy atraumatic events. Hip preservation should always be the primary target when treating these patients.
Highlights • Non-traumatic Bilateral femoral neck fractures in young adults following a generalized tonic-clonic is a rare entity. • Pre-disposing metabolic disease such as hypocalcemia seizure are usually associated with this injury pattern • Other associated fractures involving upper and lower extremities may co-exist. • Ideal control of seizure disorder in pre-existing metabolic bone disorder may reduce risk of such injuries. • Hip preservation should always be the primary target when treating these young patients.