Archives of Orthopaedic and Trauma Surgery

, Volume 127, Issue 7, pp 597–601 | Cite as

Bilateral femoral insuffiency fractures treated with inflatable intramedullary nails: a case report

  • Bahtiyar Demiralp
  • Seyfettin Ilgan
  • A. Ozgur Karacalioglu
  • Engin Ilker Cicek
  • Duzgun Yildrim
  • Kaan Erler
Osteoporotic Fracture Management


Stress fractures could be classified as fatigue fractures and insufficiency fractures (IF). Fatigue fractures occur when abnormal mechanical stress is applied to a normal bone, on the other hand insufficiency fractures occur when normal to moderate pressure is applied to a bone that has decreased resistance (Daffner and Pavlov in Am J Radiol 159:242–245, 1992). IF have been observed mainly in patients with postmenopausal osteoporosis, and are becoming more common with the increase of elderly population (Daffner and Pavlov in Am J Radiol 159:242–245, 1992). Other systemic and metabolic conditions that can result in osteopenia and IF include osteomalacia, hyperparathyroidism, hyperthyroidism, rheumatoid arthritis, fluoride treatment, diabetes mellitus, fibrous dysplasia, Paget’s disease, irradiation and mechanical factors (Daffner and Pavlov in Am J Radiol 159:242–245, 1992; Soubrier et al. in Joint Bone Spine 70:209–218, 2003; Epps et al. in Am J Orthop 33:457–460, 2004; Austin and Chrissos in Orthopedics 28:795–797, 2005). In this case report, the authors present an osteoporotic woman who developed bilateral insufficiency fracture of the femoral shaft after longstanding steroid, thyroxine replacement and alendronate therapy due to partial empty sella syndrome and osteoporosis, resulting in the treatment of the fracture by inflatable intramedullary nailing.


Fatique fractures insufficiency fracture  Intramedullary nailing Osteoporosis Stress fracture 


  1. 1.
    Daffner RH, Pavlov H (1992) Stress fractures: current concepts. Am J Radiol 159:242–245Google Scholar
  2. 2.
    Soubrier M, Dubost JJ, Boisgard S, Sauvezie B, et al (2003) Insufficiency fracture: a survey of 60 cases and review of the literature. Joint Bone Spine 70:209–218PubMedCrossRefGoogle Scholar
  3. 3.
    Epps HR, Brinker MR, O’Connor DP (2004) Bilateral femoral neck fractures after pelvic irradiation. Am J Orthop 33:457–460PubMedGoogle Scholar
  4. 4.
    Austin JC, Chrissos M (2005) Displaced bilateral femoral neck fractures in a woman with a history of oral steroid use. Orthopedics 28:795–797PubMedGoogle Scholar
  5. 5.
    Goh SK, Yang KY, Koh JS, Wong MK, Chua SY, Chua DT, Howe TS (2007) Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution. J Bone Joint Surg Br 89(3):349–353PubMedCrossRefGoogle Scholar
  6. 6.
    Bjerre P. The empty sella (1990) A reappraisal of etiology and pathogenesis. Acta Neurol Scand (Suppl) 130:1–25Google Scholar
  7. 7.
    Jeffcoate W (1999) Assessment of corticosteroid replacement therapy in adults with adrenal insufficiency. Ann Clin Biochem 36:151–157PubMedGoogle Scholar
  8. 8.
    Ito K, Hori K, Terashima Y, Sekine M, Kura H (2004) Insufficiency fracture of the body of the calcaneus in elderly patients with osteoporosis. Clin Orthop Relat Res 422:190–194PubMedCrossRefGoogle Scholar
  9. 9.
    Rizzo PF, Gould ES, Lyden JP, Asnis SE (1993) Diagnosis of occult fractures about the hip: magnetic resonance imaging compared with bone scanning. J Bone Joint Surg Am 75:395–401PubMedGoogle Scholar
  10. 10.
    Yamamoto T, Schneider R, Bullough PG (2000) Insufficiency subchondral fracture of the femoral head. Am J Surg Pathol 3:464–468CrossRefGoogle Scholar
  11. 11.
    Lepore L, Lepore S, Maffulli N (2003) Intramedullary nailing of the femur with an inflatable self-locking nail: comporison with locked nailing. J Orthop Sci 8:796–801PubMedCrossRefGoogle Scholar
  12. 12.
    Franck WM, Olivieri M, Jannasch O, et al (2002) An expandable nailing system for the management of pathological humerus fractures. Arch Orthop Trauma Surg 122:400–405PubMedGoogle Scholar
  13. 13.
    Grundnes O, Reikeras O (1993) Acute effects of intramedullary reamering on bone blood flow in rats. Acta Orthop Scand 64:203–206PubMedCrossRefGoogle Scholar
  14. 14.
    Heim D, Regazzoni P, Tsakiris DA, et al (1995) Intramedullary nailing and pulmonary embolism: does undreamed nailing prevent embolization? An in vitro study in rabbits. J Trauma 38:899–906PubMedCrossRefGoogle Scholar
  15. 15.
    Levin PE, Schoen RW, Browner BD (1987) Radiation exposure to the surgeon during closed interlocking intramedullary nailing. J Bone Joint Surg Am 69:761–766PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Bahtiyar Demiralp
    • 1
    • 4
  • Seyfettin Ilgan
    • 2
  • A. Ozgur Karacalioglu
    • 2
  • Engin Ilker Cicek
    • 1
  • Duzgun Yildrim
    • 3
  • Kaan Erler
    • 1
  1. 1.Department of Orthopedics and TraumatologyGulhane Military Medical Academy and Medical FacultyAnkaraTurkey
  2. 2.Department of Nuclear MedicineGulhane Military Medical Academy and Medical FacultyAnkaraTurkey
  3. 3.Department of RadiologyGulhane Military Medical Academy and Medical FacultyAnkaraTurkey
  4. 4.GATA Ortopedi ve Travmatoloji ADEtlik, AnkaraTurkey

Personalised recommendations