Long-term results of a post-partum bilateral Garden 4 femoral neck fracture in a young woman with transient osteoporosis treated with closed reduction and internal fixation

Bilateral femoral neck fractures are very rare conditions. In our knowledge, only five cases were reported of bilateral acute femoral neck fracture secondary to transient osteoporosis. The present case is the first with a long-term follow up after treatment with closed reduction and internal fixation. A 32-year-old women was admitted to the emergency orthopedic clinic due to severe pain in both hips and an inability to walk one-day post-partum. Clinical examination revealed bilateral externally rotated legs and X-ray showed bilateral Garden 4 displaced subcapital fracture of the neck of the femur. The patient was operated on urgently by closed reduction and internal fixation.  Osteoporosis was found in the measurements of bone mineral density and bisphosphonate with vitamin D medication was started. 6 years after surgery the patient can carry out her daily activities without limitation. His Harris hip score was 97 points/right and 95 points/left; and the X-ray was normal regarding osteoarthritis and avascular necrosis. Internal fixation should be the primary choice for the treatment of a bilateral femoral neck fractures with a high degree of displacement in young adults even with reversible poor bone quality condition such transient osteoporosis.

Bilateral Distal Clavicle Nonunion: A Case Report

Bilateral clavicle nonunion is extremely rare (4 published cases), and no case of bilateral distal clavicle nonunion has been reported in the literature. We present the case of a 75-year-old patient followed up for chronic obstructive pulmonary disease, presenting a bilateral fracture of the distal clavicle type “Neer 1” following a road traffic accident and orthopedically treated. After 1 year, the patient complained of mild pain at both shoulders occasionally in cold weather and during an unusual effort without neurovascular symptom associated. The shoulder radiographs showed bilateral distal clavicle nonunion. We chose a conservative treatment because of the mild symptomatology, advanced age, and limited functional demands. The functional outcome was satisfactory. The therapeutic decision in the treatment of the bilateral distal clavicle nonunion is difficult, whereas the therapeutic indications are based on symptomatology, functional impairment, age, comorbidities, and functional demands