0022-5282/00/4804-0777
The Journal of Trauma: Injury, Infection, and Critical Care
Copyright © 2000 by Lippincott Williams & Wilkins, Inc.

Vol. 48, No. 4
Printed in the U.S.A.

Unilateral Transverse Acetabular Fracture with Medial
Displacement of the Femoral Head after an Epileptic Seizure
Cornelis J. J. M. Sikkink, MD, and Anno van der Tol, MD

A

lthough the occurrence of fractures is a well-known
complication of convulsive activity, acetabular fractures after convulsions are very rare. Only a few cases
of acetabular fracture dislocations, purely caused by convulsive activity, have been described in the literature.1– 8 Acetabular fractures are usually caused by extreme external
forces, such as seen in car crashes. Therefore, it is quite
remarkable that the muscle contractions during a seizure are
sometimes of sufficient force to induce such a fracture. A
case is reported of a unilateral transverse acetabular fracture
with medial displacement of the femoral head after an epileptic seizure, in a patient with a history of a cerebrovascular
accident.
CASE REPORT

FIG 1. Radiograph showing acetabular fracture on the left side with medial displacement of the femoral head.

A 77-year-old man presented to the emergency department of
the Martini Hospital after a grand mal seizure. He had a
history of a cerebrovascular accident in the left hemisphere a
year earlier, which had resulted in an expressive speech
impediment and a right-sided hemiparesis. The patient never
suffered an epileptic seizure before. During the attack, the
patient was seated in a chair and he sustained no external
injury, except for the convulsive activity. The neurologist
who examined the patient, found a tenderness in the left
lower region of the abdomen and consulted a surgeon. Physical examination revealed a painful inguinal region rather
than a tender abdomen. Furthermore, the left lower extremity
was externally rotated and shortened. Left hip range of motion was restricted in all planes secondary to pain. Radiographs showed an acetabular fracture with medial displacement of the femoral head on the left side (Fig. 1), which was
further visualized by computed tomographic scan (Fig. 2).
The fracture was classified as a transverse fracture. Moreover, the radiographs reveal osteopenia. The computed tomographic scan of the cerebrum showed cerebral damage caused
by the cerebrovascular accident a year earlier, but no new
abnormalities. It must be noted that, despite the paresis, the

FIG 2. Computed tomographic scan showing acetabular fracture on the left side
with medial displacement of the femoral head.

patient was ambulatory before having the seizure. During the
first days of hospitalization, treatment consisted of skin traction. Multiple factors were considered in the surgical decision-making process. Looking at the patient’s medical condition and the comminution of the fracture, the decision was
made to perform a total hip arthroplasty. In our minds, this
procedure would allow early mobilization of the patient. No
problems were encountered during surgery. Postoperative
radiographs revealed a well-positioned total hip prosthesis
(Fig. 3). The patient’s right hemiparesis continued to deteriorate, which made it impossible to mobilize the patient.

Submitted for publication April 13, 1999.
Accepted for publication January 4, 2000.
From the Department of Surgery (C.J.J.M.S.), University Hospital Nijmegen, and Department of Surgery (A.v.d.T.), Martini Hospital Groningen,
the Netherlands.
Address for reprints: Anno van der Tol, MD, Department of Surgery,
Martini Hospital Groningen, Postbus 30033, 9700 RM Groningen, the Netherlands.

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The Journal of Trauma: Injury, Infection, and Critical Care

April 2000

FIG 3. Radiograph showing total hip prosthesis on the left side.

leptic seizure, which resulted in an acetabular fracture. The
occurrence of the epileptic seizure could be explained by the
cerebral damage caused by a cerebrovascular accident a year
earlier. The patient showed radiographic signs of osteopenia,
which predisposed his bone to fracture. Despite a successful
operative procedure, the outcome of this treatment was poor.
This outcome was explained by a decline of the patient’s
hemiparesis. There were no obvious perioperative events that
could have accounted for this deterioration.
It is striking that convulsive activity can result in an acetabular fracture, which is usually caused by violent external
forces. Therefore, the forces of the muscle contractions generated during a seizure are not to be underestimated. While
examining a postictal patient, one should always consider the
possible presence of fractures.

DISCUSSION

REFERENCES

Acetabular fracture dislocations are usually caused by extreme external forces to the lateral aspect of the greater
trochanter, as can be seen in, e.g., car crashes. There are only
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Karladani6 reported acetabular fractures after epileptic seizures. The patient described by Berman et al.3 had chronic
renal disease. In that patient, the combination of a grand mal
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fracture dislocation. Duus4 reported a patient with several
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Granhed and Karladani6 (two cases) do not report of osteoporosis in their patient(s); perhaps the occurrence of an acetabular fracture after convulsive activity is even possible in
patients with healthy bone. Other very rare causes of acetabular fractures are eclamptic convulsions as described by
Varma et al.7 and hyponatremic convulsions as described by
Remec and Evarts.8
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