Construct Failure in an Atypical Femoral Fracture treated with Intramedullary Nailing: A Case Report.

L Bonifacio,P Syson

doi:10.5704/moj.1403.008

Abstract

The aim of this paper is to document a rare case of construct failure in a 68-year old Filipina who sustained an atypical femoral fracture (AFF) in her left subtrochanteric area. The patient previously had a 40-month history of alendronate 70mg + vitamin D 5600u therapy for osteoporosis and underwent closed intramedullary nailing for the AFF. Six months postoperatively, she began to experience progressive pain in her operated thigh. Radiographs revealed a broken nail at the proximal screw hole and non-union of the AFF. The patient was treated with exposure of the fracture site, removal of the broken device, exchange intramedullary nailing, and iliac bone grafting. She had radiographic and clinical union and was full weight bearing after three months.

Highlights

Atypical femoral fractures (AFFs) have been reported after prolonged intake of bisphosphonates (BPs)
The aim of this paper is to document a rare case of construct failure in a 68-year old Filipina who sustained an AFF in her left subtrochanteric area
The contralateral femur must be assessed for impending AFF, and the patient should be started on medical therapy, which always includes calcium and vitamin D

Summary

Introduction

Atypical femoral fractures (AFFs) have been reported after prolonged intake of bisphosphonates (BPs). The updated case definition of an AFF is a fracture located along the femoral diaphysis from just distal to the lesser trochanter to just proximal to the supracondylar flare, with at least four of five major features present. These features are: (1) minimal or no trauma, (2) fracture line originates at the lateral cortex and is substantially transverse, (3) complete fractures may be associated with a medial spike while incomplete fractures involve only the lateral cortex, (4) noncomminuted or minimally comminuted, and (5) localized periosteal or endosteal thickening of the lateral cortex (“beaking” or “flaring”) 1.

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Discussion

Conclusion