Simultaneous bilateral femoral neck fractures. Etiology and outcome in a consecutive case series

A case series of seven patients with simultaneous bilateral femorae neck fractures is presented. Six patients were females and one patient was male with an age range from 18-68 years. The mechanism of injury was high-energy trauma in one patient. In the remaining six patients, the trauma was a minor trauma with the presence of a predisposing disease. These included epilepsy in two patients [fractures followed convulsions in one patient], and osteomalacia, primary hyperparathyroidism, chronic renal failure, bone metastasis [one patient each]. The surgical procedures included internal fixation by cancellous lag screws in one patient, intertrochanteric valgus repositioning osteotomy and plating in one patient, and hemiarthroplasty [unipolar or bipolar] in five patients. At the final follow-up, five patients were available for evaluation of the index operation [one patient died and another was lost to follow-up]. Follow-up averaged 50 months [range 18-77 months]. For the fixation group patients [n=2], all fractures healed and the functional score was excellent in one patient and good in one patient. For the replacement group [n=3], two patients had a good result and the third patient was considered a failure of the index surgery. Despite being rare, exploring reported cases with bilateral femoral neck fractures can help in establishing a high index of suspicion for identifying patients who are at risk aiming at early diagnosis and better management

Neonatal langerhan's cell histiocytosis; early presentation with delayed diagnosis

Neonatal Langerhan's cell histiocytosis [LCH] is a rare disease which presents in the first four weeks of life with skin manifestations; although the diagnosis may be delayed till other organ involvement becomes apparent. We describe a four-month-old male infant who presented with skin lesions in the neonatal period and was diagnosed later, when involvement of lymph nodes, liver, spleen and bone became apparent. Due to the possibility of clinically unapparent involvement of other organ systems in neonatal LCH, thorough clinical, laboratory and imaging studies are mandatory for a comprehensive evaluation of all cases on presentation