Bilateral simultaneous proximal femoral fractures on dissimilar anatomical regions
Abstract
Simultaneous presentation of bilateral proximal femoral fractures following a traumatic event are considered very rare injuries. A literature search revealed that the fracture pattern in bilateral simultaneous proximal femoral fractures is most commonly similar to the anatomical region. We report a case of traumatic bilateral proximal femoral fractures with dissimilar pattern and anatomical location following a low energy trauma. A 90-year-old female presented with a right extracapsular - intertrochanteric neck of femur fracture and a left intracapsular - subcapital neck of femur fracture following a fall. The surgical plan was to fix the right side with a dynamic hip screw (DHS), directly followed by left cemented hip hemiarthroplasty on the left. Anesthetic concerns were raised towards the end of the first procedure hence the hemiarthroplasty was postponed. Following medical optimization, a bipolar cemented hip hemiarthroplasty was performed 4 days later. The patient was discharged after 16 days with carers support at home. Careful planning should take place in cases of simultaneous bilateral hip fracture given increased morbidity and mortality. Operation of both sides in a single stage is acceptable to reduce the risk of anesthetic complications and reduce costs. Dissimilar or asymmetrical bilateral hip fractures present a unique challenge, primarily because of the need to change the patient’s position. Communication between the surgical and the anesthetic team throughout any procedure is important, but even more so in high-risk cases. To our knowledge, dissimilar or asymmetrical bilateral proximal hip fractures in the elderly presenting simultaneously have only been described twice in literature. Their rarity necessitates careful preoperative planning. The aim should be to address both injuries in a single operation, however contingency planning is important.
##plugins.themes.bootstrap3.article.details##
bilateral proximal femur fractures, simultaneous proximal femur fractures, asymmetric proximal femur fractures, intertrochanteric fracture, subcapital hip fracture
2. Hollensteiner M, Sandriesser S, Bliven E, von Rüden C, Augat P. Biomechanics of Osteoporotic Fracture Fixation. Curr Osteoporos Rep. 2019 Dec;17(6):363-374. doi: 10.1007/s11914-019-00535-9. PMID: 31755030; PMCID: PMC6944651.
3. Cassel B, Cassel WB. Fracture in the neck of the femur in children with particular reference to aseptic necrosis. J Bone Joint Surg. 1941;23(2):225
4. Cagırmaz T, Yapici C, Orak MM, Guler O. Bilateral femoral neck fractures after an epileptic attack: A case report. Int J Surg Case Rep. 2015;6C:107-10. doi: 10.1016/j.ijscr.2014.12.003. PMID: 25528038; PMCID: PMC4334890.
5. Ovaska MT, Mäkinen TJ, Madanat R. Simultaneous bilateral subtrochanteric fractures following risedronate therapy. J Orthop Sci. 2011 Jul;16(4):467-70. doi: 10.1007/s00776-011-0058-y. Epub 2011 Mar 29. PMID: 21779886.
6. Upadhyay A, Maini L, Batra S, Mishra P, Jain P. Simultaneous bilateral fractures of femoral neck in children--mechanism of injury. Injury. 2004 Oct;35(10):1073-5. doi: 10.1016/S0020-1383(03)00190-6. PMID: 15351681.
7. Zhu Y, Hu J, Han W, Lu J, Zeng Y. Simultaneous bilateral femoral neck fractures in a dialysis-dependent patient: case report and literature review. BMC Musculoskelet Disord. 2020 Apr 15;21(1):242. doi: 10.1186/s12891-020-03281-7. PMID: 32293406; PMCID: PMC7158116.
8. Efremov K, Caterini A, De Maio F, Farsetti P. A simultaneous bilateral asymmetric hip fracture in an elderly patient: A case report and review of the literature. Int J Surg Case Rep. 2020;72:377-380. doi: 10.1016/j.ijscr.2020.06.031. PMID: 32563825; PMCID: PMC7306533.
9. National Institute for Health and Care Excellence Clinical guideline [CG124] Hip fracture: management. Updated: 22 June 2011. [Available from: https://www.nice.org.uk/guidance/cg124 at 11/2/2025]
10. National Hip Fracture Database. Best Practice Tariff (BPT) for Fragility Hip Fracture Care User Guide. Updated: V4 April 2020. [Available from: https://www.nhfd.co.uk/20/hipfracturer.nsf/0/9b0c5ea2e986ff56802577af0046b1df/$file/best%20practice%20tariff%20user%20guide.pdf at 11/2/2025]
11. McGoldrick NP, Dodds MK, Green C, Synnott K. Management of simultaneous bilateral neck of femur fractures in an elderly patient. Geriatr Orthop Surg Rehabil. 2013 Sep;4(3):71-3. doi: 10.1177/2151458513511626. PMID: 24319617; PMCID: PMC3848333
12. Takagi Y, Yamada H, Ebara H, et al. Bilateral simultaneous asymmetric hip fracture without major trauma in an elderly patient: a case report. J Med Case Rep. 2022 Jul 16;16(1):278. doi: 10.1186/s13256-022-03494-5. PMID: 35841109; PMCID: PMC9287992.
13. Robin GC. Simultaneous bilateral fractures of the neck of the femur. J Am Geriatr Soc 1963 Mar;11(3):195–8
14. Griffiths R, Babu S, Dixon P, et al. Guideline for the management of hip fractures 2020: Guideline by the Association of Anaesthetists. Anaesthesia. 2021 Feb;76(2):225-237. doi: 10.1111/anae.15291. PMID: 33289066.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Archive of Clinical Cases is protected by copyright and may be used in accordance with copyright and other applicable laws. Content available at www.clinicalcases.eu and our digital applications is intended for personal noncommercial use.
Authors who submit a manuscript for publication in Archive of Clinical Cases agree to the following terms: a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) only after the final version of the manuscript was accepted and published, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). d. It is compulsory that before submission authors ensure that their work was not published in any other medical journals or pending acceptance for publication and that "Archives of Clinical Cases" is the only beneficiary at that moment if their work/case will be accepted by us.
Guidelines for linking to www.clinicalcases.eu a. The main purpose of the site linking to the Archive of Clinical Casess site should be educational. b. Links should be made to the Archive of Clinical Casess home page (www.clinicalcases.eu) or to the articles abstract. c. It is forbidden to use the Archive of Clinical Casess cover by outside organizations unless permission has been granted in advance, notifying our Secretary. d. Material owned by the Archive of Clinical Cases (including the name, logo, cover, and text) may not be used in any manner that may induce the idea or suggest that the Archive of Clinical Cases is in some way recommending a specific company, product or service. e. You must not use or allow others to access or use, all or any part of our Site or the contents and/or applications on it for commercial purposes without our permission. To seek permission to do anything prohibited by or not contained in these TERMS, or which requires our prior consent or agreement, you can contact us.