Atypical incomplete femoral neck fracture in patients taking long-term bisphosphonate: Case report, a report of 2 cases.

Abstract

RATIONALE:

We present 2 cases of lateral incomplete impending fracture of the femoral neck without trauma in elderly patients taking long-term bisphosphonate (BP) treatment, and we defined it as atypical femoral neck fracture (AFNF). To the best of our knowledge, this is the first report on the follow-up results of AFNF.

PATIENT CONCERNS:

Patients in both cases had been taking BP drugs for a long time with osteoporosis. The duration of BP treatment was 6 years, and there was no history of repeated stresses.

DIAGNOSES:

All fractures were linear at the lateral aspect of the mid portion of the femoral neck, and the BMD of the femoral neck was -0.9, and -1.8, respectively.

INTERVENTIONS:

Internal fixation was performed in both cases (73 years, 68 years) using cannulated screws.

OUTCOMES:

In both patients who underwent screw fixation, the fracture line started to extend distally at 4 weeks and 2 weeks following surgery. In the 3-month follow-up image, the length of the fracture increased by 20.1 mm and 9.9 mm, respectively. There was a problem with active rehabilitation, and the possibility of revision was also found to be a burden in terms of mortality and cost in older patients.

LESSONS:

In the case of AFNF, guidelines for treatment should be set in consideration of the decreased bone healing, even when the fracture pattern is simple. Arthroplasty based on a wider indication may be worth considering.

• Authors: You-Sung Suh, Byung-Woong Jang, Jae-Hwi Nho, Sung-Hun Won, Won-Seok Lee
• Journal: Medicine (Medicine (Baltimore)) Vol. 98 Issue 9 Pg. e14701 (Mar 2019) ISSN: 1536-5964 [Electronic] United States
• PMID: 30817607 (Publication Type: Case Reports, Journal Article)

Chemical References

• Diphosphonates

Topics

• Aged
• Diphosphonates (adverse effects, therapeutic use)
• Female
• Femoral Neck Fractures (chemically induced, surgery)
• Fracture Fixation, Internal
• Fracture Healing (physiology)
• Humans
• Osteoporosis (drug therapy)