Venkatadass K, Avinash M, Rajasekaran S
Ganga Hospital, Coimbatore, Tamilnadu, India.
J Pediatr Orthop B. 2018 May;27(3):274-278. doi: 10.1097/BPB.0000000000000460.
Bilateral avascular necrosis (AVN) following postictal bilateral fracture neck of the femur is a rare occurrence. Here, we report a case of bilateral AVN of the femoral head following an asynchronous bilateral postictal fracture neck of the femur. A 16-year-old autistic boy presented with left hip pain following an episode of seizures and radiographs showed Delbet type II fracture neck of the left femur. This was treated by closed reduction and cancellous screw fixation and skeletal traction for 6 weeks. At 3 months, follow-up radiograph showed union of the fracture, but he had developed segmental AVN with collapse of the head. At 8 months, the patient presented with pain in the right hip following another episode of seizures and radiograph of the pelvis showed a fresh Delbet type II fracture neck of the right femur with established AVN of the left femoral head. He underwent closed reduction and cancellous screw fixation of the right hip and implant exit of the left hip. At the 6-month follow-up after this surgery, his radiograph of the pelvis showed AVN with collapse and extrusion of the femoral head on the right side as well. Literature review shows an increased risk of fracture neck of the femur among epileptics. The incidence of AVN is maximum in Delbet type I, followed by Delbet type II and type III in that order. Although there are no clear guidelines on the management of post-traumatic AVN of the femoral head, the majority have reported that most of them will eventually develop arthritis and will require total hip replacement at a later date. Upon extensive literature search, no case report of bilateral fracture neck of the femur with bilateral AVN was found and hence this case was reported.
癫痫发作后双侧股骨颈骨折导致双侧缺血性坏死（AVN）的情况较为罕见。在此，我们报告一例非同步双侧癫痫发作后股骨颈骨折导致双侧股骨头缺血性坏死的病例。一名16岁的自闭症男孩在一次癫痫发作后出现左髋疼痛，X线片显示左侧股骨为Delbet II型股骨颈骨折。该骨折通过闭合复位、松质骨螺钉固定及骨牵引治疗6周。3个月时，随访X线片显示骨折愈合，但他已出现节段性缺血性坏死并伴有股骨头塌陷。8个月时，该患者在另一次癫痫发作后出现右髋疼痛，骨盆X线片显示右侧股骨为新鲜的Delbet II型股骨颈骨折，左侧股骨头已有缺血性坏死。他接受了右侧髋关节的闭合复位和松质骨螺钉固定以及左侧髋关节的植入物取出术。此次手术后6个月的随访中，他的骨盆X线片显示右侧股骨头也出现了缺血性坏死并伴有塌陷和股骨头挤出。文献综述表明癫痫患者股骨颈骨折的风险增加。缺血性坏死的发生率在Delbet I型中最高，其次依次为Delbet II型和III型。尽管目前对于创伤后股骨头缺血性坏死的治疗尚无明确指南，但大多数报道称，其中大多数最终会发展为关节炎，后期需要进行全髋关节置换。经广泛文献检索，未发现双侧股骨颈骨折伴双侧缺血性坏死的病例报告，因此报告了本病例。
