Published online Oct 18, 2019. doi: 10.5312/wjo.v10.i10.371
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
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.
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.
Antiepileptic drugs should be supplemented with bisphosphonates and vitamin D to improve bone quality and prevent fractures in epileptic patients.
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.