Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate Treatment
The current definition of atypical femoral fractures (AFFs) excludes periprosthetic fractures. However, a few cases of bisphosphonates (BPs) -associated periprosthetic atypical femoral fractures (PAFFs) have been reported in the literature. Here, we report two rare cases of PAFFs that fulfilled the...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Case Reports in Surgery |
| Online Access: | http://dx.doi.org/10.1155/2019/9845320 |
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| author | Takanori Miura Hiroaki Kijima Takayuki Tani Toshihito Ebina Naohisa Miyakoshi Yoichi Shimada |
| author_facet | Takanori Miura Hiroaki Kijima Takayuki Tani Toshihito Ebina Naohisa Miyakoshi Yoichi Shimada |
| author_sort | Takanori Miura |
| collection | DOAJ |
| description | The current definition of atypical femoral fractures (AFFs) excludes periprosthetic fractures. However, a few cases of bisphosphonates (BPs) -associated periprosthetic atypical femoral fractures (PAFFs) have been reported in the literature. Here, we report two rare cases of PAFFs that fulfilled the major criteria for AFFs in patients with prolonged use of BPs. Both cases progressed to a complete fracture with minor trauma from an incomplete fracture at the distal tip of the well-fixed femoral stem. The femoral stem effect on lateral femoral cortical bone, together with the decreased bone elastic resistance induced by BPs, was considered the cause of onset. In each case, we performed open reduction and internal fixation using a locking plate with cable grip and postoperatively prescribed teriparatide and low-intensity pulsed ultrasound (LIPUS). Both cases had a good clinical course. However, as conservative treatment was not effective in these cases, treatment such as non-weight-bearing exercises during hospitalization or prophylactic surgery may be necessary. Further studies are needed to determine the optimal treatment strategy. |
| format | Article |
| id | doaj-art-66518da4dc2e43b6ada7c89390bf4758 |
| institution | Kabale University |
| issn | 2090-6900 2090-6919 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Surgery |
| spelling | doaj-art-66518da4dc2e43b6ada7c89390bf47582025-02-03T06:00:16ZengWileyCase Reports in Surgery2090-69002090-69192019-01-01201910.1155/2019/98453209845320Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate TreatmentTakanori Miura0Hiroaki Kijima1Takayuki Tani2Toshihito Ebina3Naohisa Miyakoshi4Yoichi Shimada5Department of Orthopedic Surgery, Kakunodate General Hospital, 3-Iwase Kakunodatemachi, Senboku, Akita 014-0394, JapanDepartment of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, JapanDepartment of Orthopedic Surgery, Kakunodate General Hospital, 3-Iwase Kakunodatemachi, Senboku, Akita 014-0394, JapanDepartment of Orthopedic Surgery, Kakunodate General Hospital, 3-Iwase Kakunodatemachi, Senboku, Akita 014-0394, JapanDepartment of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, JapanDepartment of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, JapanThe current definition of atypical femoral fractures (AFFs) excludes periprosthetic fractures. However, a few cases of bisphosphonates (BPs) -associated periprosthetic atypical femoral fractures (PAFFs) have been reported in the literature. Here, we report two rare cases of PAFFs that fulfilled the major criteria for AFFs in patients with prolonged use of BPs. Both cases progressed to a complete fracture with minor trauma from an incomplete fracture at the distal tip of the well-fixed femoral stem. The femoral stem effect on lateral femoral cortical bone, together with the decreased bone elastic resistance induced by BPs, was considered the cause of onset. In each case, we performed open reduction and internal fixation using a locking plate with cable grip and postoperatively prescribed teriparatide and low-intensity pulsed ultrasound (LIPUS). Both cases had a good clinical course. However, as conservative treatment was not effective in these cases, treatment such as non-weight-bearing exercises during hospitalization or prophylactic surgery may be necessary. Further studies are needed to determine the optimal treatment strategy.http://dx.doi.org/10.1155/2019/9845320 |
| spellingShingle | Takanori Miura Hiroaki Kijima Takayuki Tani Toshihito Ebina Naohisa Miyakoshi Yoichi Shimada Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate Treatment Case Reports in Surgery |
| title | Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate Treatment |
| title_full | Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate Treatment |
| title_fullStr | Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate Treatment |
| title_full_unstemmed | Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate Treatment |
| title_short | Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate Treatment |
| title_sort | two cases of periprosthetic atypical femoral fractures in patients on long term bisphosphonate treatment |
| url | http://dx.doi.org/10.1155/2019/9845320 |
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