1/4 Volume 1 - Issue - 2 RWPM Geerts 1 , L Verlaan 1 , JJ Arts 2 , PBJ Tilman 1 and EJP Jansen 1 1 Department of Orthopaedic Surgery, The Netherlands 2 Department of Orthopaedic Surgery, The Netherlands *Corresponding author: EJP Jansen, Department of Orthopaedic Surgery, Orbis Medisch Centrum, Dr. H van der Hoffplein1, 6162 BG, Sittard-Geleen, The Netherlands Submission: October 01, 2017; Published: October 31, 2017 Abdominal Pain Caused by Bilateral Acetabular Fractures Secondary to an Epileptic Seizure Case Report and Review of the Literature Copyright © All rights are reserved by EJP Jansen Abstract Background: Epileptic patients have increased risk of fractures. This is related to the traumatic event itself and to concomitant factors. Clear fracture related complaints are not always present at primary survey of these patients. This indicates a thorough primary evaluation of the complete individual post-seizure. We present a unique case of abdominal pain due to bilateral fractures fracture after an epileptic seizure. Case Report: A 66-year old patient, who chose to live solitary and was in suboptimal hygienic condition, was admitted to the neurological department after two epileptic seizures. Three days after admission, an abdominal radiograph revealed bilateral acetabular and pubic fractures as chance findings. Treatment was challenging due to patient and fracture specific conditions. Conservative treatment options were limited and eventually failed. Eventually, bilateral total hip prosthesis with bone impaction grafting were performed. At one-year follow up, no restriction in active daily living was noted. Conclusion: Seizure induced bilaterally acetabular fractures are very rare. Thorough physical examination after an epileptic seizure is imperative to identify fractures. Abdominal pain can be the only symptom of a fractured acetabulum. Treatment options are dependent of patient’s morbidity, bone quality and surgeon’s preference. Primary total hip arthroplasty might be indicated and can offer good results even in case of bilateral acetabular fractures. Keywords: Seizure; Bilateral; Acetabulum; Fracture; Abdominal; Treatment; Conservative; Surgical; Prosthesis; Osteoporosis; Case; Literature; Review Introduction Patients with epilepsy have increased fracture risks [1-3]. These fractures can be related to the seizure itself but 40% are associated with osteopenia [4,5]. Osteopenia may occur as a result of physical impairment, a postmenopausal state, or can be induced by anti- epileptic drugs [6]. Thorough secondary survey for fractures after seizures is therefore essential especially when osteoporosis is present. To the best of our knowledge, this is the first report of a patient in whom abdominal pain was the only complaint due to bilateral acetabular fractures caused by epileptic seizures. Besides, the literature is reviewed and treatment options are suggested. Case Report A 66-year old female was admitted to the neurological ward after two epileptic seizures. Her medical history consisted of hypothyroidism, chronic hyponatraemia, anaemia, and a lumbar vertebral fracture (L1) after an epileptic seizure 5 years earlier. She suffered from poor mobility due to chronic back pain and lived in social isolation. Traumatic injuries were not diagnosed during primary evaluation at the emergency department. She was admitted for neurological observation. Morbus Hashimoto and a Hashimoto-encephalopathy (steroid-responsive encephalopathy associated with auto-immune thyroiditis) were diagnosed during the first days. Her laboratory results showed a small drop in serum hemoglobin one day after admission (8.9mmol/L and 8.4mmol/L on day 0 and day 1, respectively). During mobilization she complained of persevering abdominal pain. Three days after admission, an abdominal radiograph revealed bilateral acetabular and pubic fractures as chance findings. Further radiographic (Figure 1) and computed tomographic (CT, Figure 2) pelvic analysis revealed multi-fragmented acetabular fractures with protrusion of both femoral heads through the Case Report Orthopedic Research Online Journal C CRIMSON PUBLISHERS Wings to the Research ISSN: 2576-8875