A Case report of Simultaneously Bilateral Femoral Neck Fractures in a Patient with Chronic Kidney Disease

Background: Chronic kidney disease (CKD) increases bone fragility, leading to renal osteodystrophy and pathological fractures. Simultaneous bilateral hip fractures are rare and present management challenges. Case presentation: A 45-year-old woman with CKD on hemodialysis presented with a left femoral neck fracture after a low-energy fall. She underwent total left hip arthroplasty (THA). On postoperative day 1, the patient experienced sudden right hip pain during assisted mobilization. Subsequent examination revealed a right femoral neck fracture, and she underwent right THA on postoperative day 2. Perioperative management included dialysis optimization, anemia correction, antibiotic prophylaxis, and thrombo-prophylaxis adjusted according to renal function. Pathology was consistent with renal osteodystrophy/osteomalacia, and malignancy was ruled out. At the 3-month follow-up, the patient was ambulating with a cane, reported reduced pain, and radiographs showed stable prostheses. Conclusion: CKD-related bone disease increases the risk of bilateral femoral neck fractures. Multidisciplinary optimization, cautious mobilization, and close follow-up are thus recommended.