Bilateral simultaneous proximal femoral fractures on dissimilar anatomical regions

Simultaneous presentation of bilateral proximal femoral fractures following a traumatic event are considered very rare injuries. A literature search revealed that the fracture pattern in bilateral simultaneous proximal femoral fractures is most commonly similar to the anatomical region. We report a case of traumatic bilateral proximal femoral fractures with dissimilar pattern and anatomical location following a low energy trauma. A 90-year-old female presented with a right extracapsular - intertrochanteric neck of femur fracture and a left intracapsular - subcapital neck of femur fracture following a fall. The surgical plan was to fix the right side with a dynamic hip screw (DHS), directly followed by left cemented hip hemiarthroplasty on the left. Anesthetic concerns were raised towards the end of the first procedure hence the hemiarthroplasty was postponed. Following medical optimization, a bipolar cemented hip hemiarthroplasty was performed 4 days later. The patient was discharged after 16 days with carers support at home. Careful planning should take place in cases of simultaneous bilateral hip fracture given increased morbidity and mortality. Operation of both sides in a single stage is acceptable to reduce the risk of anesthetic complications and reduce costs. Dissimilar or asymmetrical bilateral hip fractures present a unique challenge, primarily because of the need to change the patient's position. Communication between the surgical and the anesthetic team throughout any procedure is important, but even more so in high-risk cases. To our knowledge, dissimilar or asymmetrical bilateral proximal hip fractures in the elderly presenting simultaneously have only been described twice in literature. Their rarity necessitates careful preoperative planning. The aim should be to address both injuries in a single operation, however contingency planning is important.