Bilateral impacted femoral neck fracture in a renal disease patient
A 47-year-old female was referred to the Orthopaedic Surgery and Trauma department because of pain in both groin and hip region while going for regular hemodialysis for her renal problem. She has been diagnosed as having diabetes mellitus (DM), hypertension (HTN) 10 years previously and was diagnosed as having chronic renal failure (CRF) 8 years back and has been receiving hemodialysis three times a week for the past 5 years. Consent from the relevant authority and from the patient was obtained to publish the case.\nThere was no history of injury, trauma, fall, seizure, steroid medication, fluoride treatment, smoking and alcohol abuse. On physical examination there was no active bilateral motion of the hips and very painful on passive movement. Pelvic radiograph examination did not clearly show fractures but the shortened neck of femur was seen and suggesting femoral neck fracture. The routine blood examination showed that she had moderate anaemia and serum urea was 17.6 mmol/L (normal value: 2.5-14.5), creatinine was 401.02 umol/L (normal value: 50.4-98.1), calcium total was 2.39 mmol/L (normal value: 2.10-2.55), phosphate inorganic was 1.07 mmol/L (normal value: 0.74-1.52), vitamin D was 53.48 pmol/L (normal value: 60-108) and para-thyroid hormone level was 105.37 ng/L (normal value:10-65).\nComputed tomography (CT) of pelvic [] was performed and showed the impacted bilateral fractures of neck of femurs with minimal right varus angulation. Multiple vertebral bodies’ collapses are also present with severe and diffuse reduction in mineralization. Gibbous deformity present due to the fractures of vertebral bodies of (thoracic spine) T6, T7, T8, T10 and (lumbar spine) L1. Bilateral hydro-nephrosis and thickening of the bladder wall were found on abdominal ultrasonography.\nThe patient and relatives were educated on the possible complications of the treatment of bilateral femoral neck fracture and they decided not to go for any surgical intervention. She was not able to walk and mobilised on wheel chairs only. After one year of bilateral femoral neck fracture, she is still alive and on regular dialysis with wheel chair mobilisation.