Is It a Simple Stress Fracture or Bisphosphonate-related Atypical Fracture?.
10.11005/jbm.2012.19.2.129
- Author:
Soo Yong KANG
1
;
Ji Hoon BAEK
;
Bun Jung KANG
;
Min Kyu KIM
;
Han Jun LEE
Author Information
1. Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea.
- Publication Type:Case Report
- Keywords:
Bisphosphonate;
Early diagnosis;
Femoral fractures;
Fractures stress;
Osteoporosis
- MeSH:
Alendronate;
Early Diagnosis;
Female;
Femoral Fractures;
Femoral Neck Fractures;
Femur;
Femur Neck;
Fractures, Closed;
Fractures, Stress;
Hip;
Humans;
Osteoporosis;
Reoperation;
Vitamins
- From:Journal of Bone Metabolism
2012;19(2):129-132
- CountryRepublic of Korea
- Language:English
-
Abstract:
A number of reports regarding atypical fractures of the femur have raised questions concerning the possible correlation between long-term bisphosphonate treatment and the occurrence of insufficiency fractures in the proximal femur. However, clinically, it is often confused whether is it a fatigue fracture because of implant induced stress concentration or a bisphosphonate-related atypical fracture, especially in a patient with a subtrochanteric fracture who receive bisphosphonate therapy after open reduction and internal fixation, such as dynamic hip screw (DHS) fixation for previous ipsilateral femoral neck or intertrochanteric fracture. The authors experienced a case of a progressive femoral insufficiency fracture in a woman who had been on Fosamax (Alendronic acid with Vitamin D; Merck & Co. Inc, NJ, USA) therapy for four years after ipsilateral femoral neck fracture treated with a two hole DHS system. Despite a high suspicion of an insufficiency femoral subtrochanteric fracture by bone scan, the occult fracture progressed to a displaced femoral subtrochanteric fracture one year after. The fracture site was fixed with a 6 hole DHS plate, and six months after reoperation the patient had no symptoms and the fracture site had united without any complication.
