Sequential bilateral hip fractures after conservative treatment of femoral neck fracture: a case report

Conservative treatment for valgus-impacted fractures can yield a high union rate; however, determining the ideal indications for this approach remains challenging. Older adults may sustain bilateral hip fractures from low-impact falls, typically presenting a symmetric fracture pattern. Nonetheless, asymmetric bilateral hip fractures, though extremely rare, have been documented. This report describes a case of a 78-year-old woman who presented after a low-impact fall at home. Her medical history included a previous fall 3 months earlier, resulting in a Garden I right femoral neck fracture treated conservatively in another department of our institution. Radiological examination revealed a left peritrochanteric fracture and a displaced (Garden IV) subcapital fracture of the right hip. Both fractures were treated surgically on the same day, with cephalomedullary nailing of the left femur followed by cemented bipolar hemiarthroplasty of the right femur. The postoperative course was uneventful, and the 1-year follow-up was satisfactory. The surgical sequence was chosen to facilitate intraoperative positioning, minimize the risk of prosthetic dislocation, and allow accurate restoration of leg length using the fixation as a reference point for hemiarthroplasty. This case highlights the importance of individualized treatment planning and careful consideration of surgical fixation for older adults with valgus-impacted femoral neck fractures who are at high risk of subsequent falls and hip fractures.