Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2019; 10(10): 371-377
Published online Oct 18, 2019. doi: 10.5312/wjo.v10.i10.371
Low-velocity simultaneous bilateral femoral neck fracture following long-term antiepileptic therapy: A case report
Mohammed Sadiq, Vikrant Kulkarni, Syed Azher Hussain, Mohammed Ismail, Mayur Nayak
Mohammed Sadiq, Vikrant Kulkarni, Syed Azher Hussain, Mohammed Ismail, Mayur Nayak, Department of Orthopaedics, ESIC Medical College, Gulbarga, Karnataka 585106, India
Author contributions: Sadiq M, Kulkarni V and Hussain SA were part of the orthopaedics team that operated on the patient; Ismail M assisted in the radiological investigations; Nayak M and Sadiq M performed the literature review and analysed the results.
Informed consent statement: The patient provided informed consent for publication of this case and any related images.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest related to this report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mohammed Sadiq, MD, DNB, Assistant Professor, Department of Orthopaedics, ESIC Medical College, Sedam Road, Gulbarga, Karnataka 585106, India. mdsadiqaiims@gmail.com
Telephone: +91-99-68835869
Received: March 1, 2019
Peer-review started: March 4, 2019
First decision: June 12, 2019
Revised: July 21, 2019
Accepted: September 15, 2019
Article in press: September 15, 2019
Published online: October 18, 2019
Processing time: 236 Days and 21.1 Hours
Abstract
BACKGROUND

Simultaneous bilateral femoral neck fractures are relatively rare injuries. They are usually associated with underlying metabolic bone disorders or systemic diseases. Long-term use of narcotics and bisphosphonates can also result in similar fracture patterns; however, association of this fracture type with long-term use of antiepileptic drugs is not very common. Only one such case has been reported in the literature. This article describes the second.

CASE REPORT

We report a case of simultaneous displaced bilateral femoral neck fractures in a 50-year-old epileptic patient, who had taken phenytoin for the past 3 years. The fractures were a result of low-velocity injury following a fall from the bed. The fractures were managed with a bilateral hemi-replacement arthroplasty. Oral bisphosphonates were given to improve the bone quality in the post-operative period. The patient had a good post-operative outcome, that was sustained throughout the entire follow-up period of 1 year.

CONCLUSION

Antiepileptic drugs should be supplemented with bisphosphonates and vitamin D to improve bone quality and prevent fractures in epileptic patients.

Keywords: Case report; Bilateral femoral neck fracture; Antiepileptic drug therapy; Drug-induced osteopenia; Bisphosphonates; Vitamin D

Core tip: Drug-induced bilateral femoral neck fractures are extremely rare. The injury has been reported to be associated with long-term intake of bisphosphonates, narcotics, anti-retroviral therapy, and antiepileptic drugs. Only one case of simultaneous bilateral femoral neck fracture associated with long-term antiepileptic drug intake has been reported. Our case report of this type of injury further substantiates the association between long-term antiepileptic drug intake and reduced bone mineral density. Through our experience with this case, we recommend that supplementation of calcium, vitamin D and bisphosphonates along with antiepileptic drugs is essential to maintain bone quality and prevent fractures.