Abstract
IntroductionAtypical femoral fractures have emerged as one of the potential complications of bisphosphonates during the past decade. The American Society for Bone and Mineral Research published a Task Force report on atypical femoral fractures in 2010 and a second report in 2014. Although the current definition of atypical femoral fractures in these reports excludes periprosthetic fractures, each of three published case reports describe a bisphosphonate-associated atypical femoral fracture that occurred around the stem of a total hip arthroplasty. We report a rare case of an atypical femoral fracture that occurred at the stem tip of a total hip arthroplasty that fulfills the major criteria defined by the second American Society for Bone and Mineral Research Task Force report for an atypical femoral fracture and that was associated with prolonged use of bisphosphonate.Case presentationA 69-year-old Japanese woman with a right cementless total hip arthroplasty undertaken 44 months previously had a right femoral shaft fracture that occurred without trauma. She related that the bone fractured while she was standing, after which she fell down. Radiographs showed a noncomminuted transverse fracture located at the tip of the stem with localized periosteal thickening of the lateral cortex. The fracture was complete, extending through both cortices, and was associated with a medial spike. Her history revealed that she had been taking prednisolone to treat dermatomyositis and interstitial pneumonia for approximately 15 years. Alendronate was administered for more than 7 years. We performed open reduction and internal fixation using a locking plate with cable grip. The latest follow-up was performed 2 years after the fracture surgery. Bony union was successful. She regained the ability to walk, although her activity was limited by her comorbidities.ConclusionsAlthough the current definition of an atypical femoral fracture excludes periprosthetic fractures, there may be a periprosthetic fracture with the same or similar pathology as that of an atypical femoral fracture. We must be vigilant and aware of this type of fracture, especially in patients with prolonged bisphosphonate use.
Highlights
Atypical femoral fractures have emerged as one of the potential complications of bisphosphonates during the past decade
We report a rare case of an Atypical femoral fractures (AFFs) that occurred at the stem tip of a total hip arthroplasty (THA) that fulfills the major criteria defined by the second ASBMR Task Force report for an AFF and that was associated with prolonged use of bisphosphonate
The authors noted that the current definition of an AFF excludes periprosthetic fractures, this case suggested that these fractures do occur and should be considered in the differential diagnosis of patients on long-term bisphosphonates who present with thigh pain despite a well-fixed stem
Summary
Periprosthetic fractures are excluded by the current definition of AFFs, there may be a periprosthetic fracture that has the same or similar pathology as an AFF. We must be vigilant and aware of this type of periprosthetic fracture, especially for patients who have a history of prolonged bisphosphonate use. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests The authors declare that they have no competing interests. SYL and YS corrected the patient data. RK and MK analyzed and interpreted the patient data. All authors read and approved the final manuscript. Author details 1Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan. Author details 1Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan. 2Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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