Pathological Fractures of Bilateral Neck of Femur in Geriatric Population: Our Experience and Review of Literature.

Introduction:Bilateral neck of femur stress fractures is rare clinical presentation in elderly population. Diagnosis of such fractures when presented can be difficult with inconclusive radiographs and hence their early diagnosis by high index of suspicion and their management can avoid further complications in this age group. In this case series, we report three elderly patients with different predisposing factors for their fractures and treatment options chosen with detailed discussion about the management. Case Report:These case series of three elderly patients with bilateral neck of femur fracture were associated with different predisposing factors. Grave's disease or primary thyrotoxicosis, steroid induced osteoporosis, and renal osteodystrophy were the identified risk factors in these patients. Biochemical evaluation for osteoporosis in these patients revealed significant derangement in levels of vitamin D, Alkaline phosphatase, and serum calcium. One of these patients was operated with hemiarthroplasty and osteosynthesis with percutaneous screw fixation on the other side. Management of osteoporosis, dietary modifications, and lifestyle changes in these patients also had significant impact on their prognosis. Conclusion:Stress fractures occurring in elderly individuals with simultaneous bilateral presentation are rare and can be prevented if taken care on their risk factors. As radiographs remain inconclusive few times in these kinds of fracture, a high degree of suspicion is to be kept in mind. With advanced diagnostic tools and surgeries, they carry good prognosis if timely intervention is provided.