A bilateral simultaneous fracture of the neck of the femur is an extremely rare injury. 50% of reported cases are due to electric shock. We report a rare case of a simultaneous bilateral femoral neck fracture caused by electric shock as part of spiritual therapy. The patient underwent bilateral open reduction and internal fixation with cannulated screws. Unfortunately, the fixation failed, and the patient underwent bilateral hip arthroplasty. The patient was satisfied with the result at the final follow-up.
Femoral neck fractures usually require high mechanical injuries such as road traffic accidents or falls from a height in healthy young patients; On the other hand, femur neck fractures in the elderly usually result from low mechanical injuries such as falling from a standing height . A concurrent bilateral neck fracture of the femur is a rare injury, especially in non-pathological bones. This fracture occurs during violent tension of the muscles in the tension stage . Several cases have been reported in the literature, with electric shock and seizures being the common etiology [3-10].
A 36-year-old male, smoker (20 years pack), who was known to have incontinence secondary to neurogenic bladder; The patient was in good health. The patient presented to the emergency department with pain in his thighs and an inability to bear weight after being shocked with an electric current as part of a spiritual therapy session. Prior to being presented to the hospital, the patient had been bed-bound for a week and had not sought any medical care. On presentation, patient was fully awake, with tender hips; There was no open wound or burn. The legs were bilaterally shortened and externally rotated with an intact distal neurovascular condition. X-ray showed a bilateral neck fracture of the femur (Fig 1).
Routine rolls were obtained, and cardiologists were involved to relieve the patient from surgery as he had elevated cardiac enzymes (Table 1). The patient was taken for surgery one day after it was presented.
Under general anesthesia, the patient is placed on a traction table. The Leadbetter method has been attempted, but an appropriate reduction cannot be achieved. Starting from the left side, preparation and coiling were performed in the usual sterile manner, a 2 cm lateral thigh incision was used to drive three cannulated screws with washers, inserted under the guidance of the C arm, and the wound was irrigated with closure layer by layer. The same technique was used for the right side. The patient tolerated the surgery well and was transferred to the recovery room in a stable condition. Postoperative X-rays showed poor fixation bilaterally (Fig 2).
Eleven days after the first procedure, the patient underwent bilateral hip arthroplasty. The patient tolerated the surgeries well. Instructed and taught to initiate full weight bearing with rear hip precautions. Later, he was discharged from the hospital on the third day of surgery. He was followed up and seen regularly in our clinic, and then at his last follow-up (three years after surgery) he was satisfied with the result including full range of motion and no pain. The patient developed heterogeneous ossification on plain radiographs but without clinical limitations. The X-ray after surgery is shown in Fig 3 and shape 4and X-rays in the final follow-up are shown in Fig 5.
Delays in the management of femoral neck fractures can adversely affect the quality of the reduction and the final outcome. Late presentation, failure to investigate, distraction of injuries, and difficulty in clarifying a clear history of a patient who was recently electrocuted are all possible justifications for delay; This delay can range from days to weeks [11,12].
Electric shock can cause musculoskeletal injuries in various locations of the body as reported in the literature, for example, posterior shoulder dislocation, proximal humerus fracture, distal radius fracture, and L4 burst fracture [12- 14]. Therefore, careful head-to-toe examination and proper imaging are critical and should be performed so that these injuries are not missed. Our patient presented a week after infection with no apparent reason for delay; After further questioning, the patient admitted that he had been subjected to an electric shock as part of an exorcism treatment.
Neck femur fractures tend not to fuse and must be surgically reduced well to increase the chance of union. To check non-union rates, banks followed a number of displaced fracture patients who were treated with closed reduction and various types of internal fixation. . The incidence of non-conjunction was 18% in 100 of the adequately reduced fractures and 70% in 23 of the inadequately reduced fractures. In our case, the patient initially underwent open reduction and internal fixation which reduced the defect that led to non-union. Later, he requested a hip replacement to override the neck of the femur and treat it bilaterally.
Total hip arthroplasty is superior to knee arthroplasty in the treatment of femur neck fractures in terms of ambulation, pain, and recurrent surgeries, as results from two large analyzes. [16,17].
We report a rare case of a simultaneous bilateral fracture of the neck of the femur resulting from electric shock. The fracture was reduced and the patient underwent bilateral hip arthroplasty on each side simultaneously. The patient was satisfied with the final outcome at the final three-year follow-up. The patient had multiple risk factors for heterogeneous ossification (HO), including male sex, smoking, and femoral neck fracture. ; He developed HO but fortunately, was asymptomatic with nearly a full range of motion.
In rare cases, the electric shock may fracture the neck of the femur. Our case presented a simultaneous bilateral fracture of the neck of the femur due to electric shock as part of spiritual therapy. Open reduction and internal fixation initially failed and the patient underwent bilateral hip arthroplasty. The patient was satisfied with the end result at the final follow-up. Failure of fixation is attributable to late presentation and hence early diagnosis and early anatomical fracture reduction and fixation are crucial to reduce potential complications such as avascular necrosis and fracture nonunion.