SIMULTANEOUS BILATERAL FRACTURE NECK OF FEMUR FRACTURES: ONE FROM EPILEPSY, ANOTHER FROM ELECTRICITY

Presenting Author - VISHESH KHANNA
Introduction: Bilateral neck of femur (NOF) fractures can occur in patients with severe osteoporosis, renal diseases, after seizures and electric shocks after little or trivial trauma. Literature has scarce reports of from the last two conditions. Violent muscle contractions have been implicated in the pathomechanism of injury. Patients receiving long-term seizure prophylaxis may also develop reduced bone density, which, in turn, can result in pathological neck fractures. Fractures following electrocution are rarer and more frequently involve upper limb. It is extremely uncommon, in routine practice, to encounter NOF fractures arising from epilepsy and electrocution. There are barely any reports in the literature documenting such occurrences. We present here 2 surgically managed cases from a high-volume, tertiary care teaching centre with over 6-month follow-up. Methods and results: The first patient’s attendants gave a history of sudden onset of pain around both hips in a 17-year-old boy as he presented to our hospital, non-ambulatory with a history of recent seizures. The boy was managed by urgent closed reduction and bilateral cannulated cancellous screw (CCS) fixation. Intraoperative and postoperative courses were uneventful and the fractures united in 3 months. At 6 months postoperatively, full weight-bearing, good ROM with no residual problems was observed. Our second patient was a 42-year-old male shopkeeper who had an accidental live wire electrocution (220 V AC Mains) while standing on a stool and subsequently fell down after which he was unable to weight-bear or walk. No electrical burns were seen on any part of his body. He did not fall unconscious at any point and did not have any co-morbidities of concern. Plain radiographs of the pelvis with hips showed bilateral, comminuted, Garden type-IV sub-capital NOF fractures. CT scans revealed gross comminution and it was decided, in accordance with the patient, to opt for single-stage bilateral Total Hip Replacement (THR). Early postoperative ambulation with walker was started on day 2 and he was doing well at 1 year postoperatively. Conclusion: We’ve reported 2 rare cases of bilateral NOF fracture in 17 and 42 year-olds caused by violent muscle contractions secondary to electrocution and epileptic seizures. Both patients were successfully managed by different approaches (CCS and THR) in keeping with the fracture personality and patient’s general condition. Bilateral NOF fractures, despite their rare occurrence, should be suspected in patients with epilepsy and history suggestive of electric shock.