Advertisement

Osteoporosis International

, Volume 24, Issue 11, pp 2893–2895 | Cite as

Pseudoarthrosis in atypical femoral fracture: case report

  • S. Giannotti
  • V. Bottai
  • G. Dell’Osso
  • G. De Paola
  • M. Ghilardi
  • G. Guido
Case Report

Abstract

Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment; they have a high frequency of delayed healing. The authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy. Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment even if, in the literature, there is no clarity on the exact pathogenetic mechanism. The Task Force of the American Society for Bone and Mineral Research described the major and minor features to define atypical fractures and recommends that all the five major features must be present while minor features are not necessary. Another controversial aspect regarding the atypical femoral fractures is the higher frequency of the delayed healing that can be probably related to a suppressed bone turnover caused by a prolonged period of bisphosphonates treatment. This concept could be corroborated by the Spet Tc exam. In the case of a pseudoarthrosis, there is not a standardization of the treatment. In this report, the authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy; the patient was studied with clinical, bioumoral end SPECT-Tc exam of both femurs. Many studies show the relationship between bisphosphonates and the presence of atypical fractures. These fractures should be monitored more closely due to the risk of nonunion and they require considering an initial treatment with pharmacological augmentation to reduce the complications for the patient and the health care costs.

Keywords

Atypical femoral fracture Biphosphonates Pseudoarthrosis 

Notes

Conflicts of interest

None.

References

  1. 1.
    Grady MK et al (2012) Treatment of femoral fracture nonunion after long-term biphosphonate use. Orthopedics 35(6):e 991–e 995CrossRefGoogle Scholar
  2. 2.
    Shkolnikova J et al (2012) Burden of biphosphonate-associated femoral fractures. ANZ J Surg 83(3):178–181Google Scholar
  3. 3.
    Shane E et al (2010) Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 25(11):2267–2294PubMedCrossRefGoogle Scholar
  4. 4.
    Annanuntana A et al (2013) Atypical femoral fractures: what do we know about them. J Bone Joint Surg Am 95(1–13):e8Google Scholar
  5. 5.
    Carvahlo NN et al (2011) Atypical femoral fractures during prolonged use of bisphosphonates: short-term responses to strontium ranelate and teriparatide. J Clin Endocrinol Metab 96(9):2675–2680CrossRefGoogle Scholar
  6. 6.
    Negri AL et al (2012) Healing of subtrochanteric atypical fractures after strontium ranelate treatment. Clin Case Miner Bone Metabol 9(3):166–169Google Scholar
  7. 7.
    Giannotti S, Bottai V, Pini E, Dell’Osso G, De Paola G, Guido G (2013) Clinical and surgical approach of severe bone fragility fracture: clinical case of 4 fragility fracture in patient with heavy osteoporosis . Clin Cases Miner Bone Metab 10(1):52–55Google Scholar
  8. 8.
    Lin TL et al (2013) Discontinuation of alendronate and administration of bone-forming agents after surgical nailing may promote union of atypical femoral fractures in patients on long term alendronate therapy. BMC Res Notes 6(1):11PubMedCrossRefGoogle Scholar
  9. 9.
    Mohan OC et al (2012) Radiographic features of multifocal endosteal thickening of the femur in patients on long-term bisphosphonate therapy. Eur Radol 23(1):222–227CrossRefGoogle Scholar
  10. 10.
    Zafeiris CP (2012) Simultaneous bilateral atypical femoral fractures after alendronate therapy. J Musculoskelet Neuronal Interact 12(4):262–264PubMedGoogle Scholar
  11. 11.
    Vergano LB et al (2012) Spontaneous femoral shaft fractures: is there an association with bisphosphonates therapy? Review of the literature and 2 cases report. GIOT febbraio 38:35–40Google Scholar
  12. 12.
    Innocenti M et al (2009) Proximal femural fractures: epidemiology. Clin Case Miner Bone Metab 6(2):117–119Google Scholar
  13. 13.
    Giannotti S, et al. (2012) Atrophic femoral nonunion successfully treated with teriparatide. Eur J Orthop Surg Traumatol. doi: 10.1007/s00590-012-1143-4
  14. 14.
    Giannotti S et al (2013) Treatment of pseudoarthrosis of the upper limb using expanded mesenchymal stem cells: a pilot study. Eur Rev Med Pharmacol Sci 17(2):224–227PubMedGoogle Scholar
  15. 15.
    Pietrogrande L, Raimondo E (2013) Teriparatide in the treatment of non-unions: scientific and clinical evidences. Injury Suppl 1:S54–S57CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • S. Giannotti
    • 1
  • V. Bottai
    • 1
  • G. Dell’Osso
    • 1
  • G. De Paola
    • 1
  • M. Ghilardi
    • 1
  • G. Guido
    • 1
  1. 1.Clinica Ortopedica e Traumatologica IIUniversita’ Di PisaPisaItaly

Personalised recommendations