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Disturbance of Osteonal Remodeling in Atypical Femoral Fracture: A Short Review of Pathogenesis and a Case Report: Histomorphometric Analysis of Fracture Site

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Osteoporotic Fracture and Systemic Skeletal Disorders

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Abstract

A short review of the pathogenesis of an atypical femoral fracture (AFF) and a case report were made on radiological and histological findings.

An 83-year-old Japanese woman complained of left lateral thigh pain following a low-energy fall 4 months prior to admission. She had been treated for osteoporosis with Risedronate for the previous 5 years. She was diagnosed with an AFF. Radiographs revealed cortical thickening and a transverse radiolucent fracture line in the lateral cortex of the shaft. The patient had normal levels of bone biomarkers except for low 25(OH) Vitamin D. Due to significant bowing, a corrective osteotomy, intramedullary nailing and plate fixation were performed after double fluorochrome labeling. The resected bone wedge was histomorphometrically analyzed. Three ground sections of the lateral cortex, stained with Villanueva bone stain at the fracture site showed many and large pores, occupying 16–59% of the lateral cortex. Increased pore sizes with widespread variation suggested prolonged osteoclastic activity in the reversal/resorptive phase, and incomplete coupling from resorption to formation in osteonal remodeling. Endocortical lamellar bone formation had started about 2.7 years prior to osteotomy, probably as an adaptation for weakness due to many intracortical pores. With the gradual accumulation of large pores and their coalescence, in combination with high tensile stresses on the lateral femoral cortex, an AFF eventually occurred.

The present invited review was completed and submitted to the publisher on 13-Sep-20. 

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Authors and Affiliations

  1. Niigata Bone Science Institute, Niigata Rehabilitation Hospital, Niigata-shi, Niigata-ken, Japan

    Hideaki E. Takahashi, Taketoshi Shimakura & Noriaki Yamamoto

  2. Department of Orthopaedic Surgery, Moji Medical Center, Kitakyushu-shi, Fukuoka-ken, Japan

    Fumitaka Hirano & Hideo Ohnishi

  3. Department of Orthopaedic Surgery, University of Occupational and Environmental Health, School of Medicine, Kitakyushu-shi, Fukuoka-ken, Japan

    Fumitaka Hirano, Kayoko Furukawa Okuma, Yukichi Zenke, Kunitaka Menuki & Akinori Sakai

  4. Department of Orthopaedic Surgery, Kitakyushu General Hospital, Kitakyushu-shi, Fukuoka-ken, Japan

    Fumio Fukuda

  5. Niigata Bone Science Institute, Niigata Rehabilitation Hospital, Niigata-shi, Niigata-ken, Japan

    Hiroshige Sano

  6. Department of Orthopaedic Surgery, Uonuma Kikan Hospital, Minami Uonuma-shi, Niigata-ken, Japan

    Hiroshige Sano

  7. Niigata University of Health and Welfare, Graduate School, Kita-ku, Niigata-shi, Niigata-ken, Japan

    Yuta Tokunaga

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  1. Hideaki E. Takahashi
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Correspondence to Hideaki E. Takahashi .

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Editors and Affiliations

  1. Niigata Bone Science Institute, Niigata Rehabilitation Hospital, Niigata, Japan

    Hideaki E. Takahashi

  2. Department of Anatomy, Cell Biology and Physiology, Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA

    David B. Burr

  3. Niigata Bone Science Institute, Niigata Rehabilitation Hospital, Niigata, Japan

    Noriaki Yamamoto

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Takahashi, H.E. et al. (2022). Disturbance of Osteonal Remodeling in Atypical Femoral Fracture: A Short Review of Pathogenesis and a Case Report: Histomorphometric Analysis of Fracture Site. In: Takahashi, H.E., Burr, D.B., Yamamoto, N. (eds) Osteoporotic Fracture and Systemic Skeletal Disorders. Springer, Singapore. https://doi.org/10.1007/978-981-16-5613-2_16

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  • DOI: https://doi.org/10.1007/978-981-16-5613-2_16

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