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Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate Treatment

The current definition of atypical femoral fractures (AFFs) excludes periprosthetic fractures. However, a few cases of bisphosphonates (BPs) -associated periprosthetic atypical femoral fractures (PAFFs) have been reported in the literature. Here, we report two rare cases of PAFFs that fulfilled the...

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Autores principales: Miura, Takanori, Kijima, Hiroaki, Tani, Takayuki, Ebina, Toshihito, Miyakoshi, Naohisa, Shimada, Yoichi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421721/
https://www.ncbi.nlm.nih.gov/pubmed/30944750
http://dx.doi.org/10.1155/2019/9845320
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author Miura, Takanori
Kijima, Hiroaki
Tani, Takayuki
Ebina, Toshihito
Miyakoshi, Naohisa
Shimada, Yoichi
author_facet Miura, Takanori
Kijima, Hiroaki
Tani, Takayuki
Ebina, Toshihito
Miyakoshi, Naohisa
Shimada, Yoichi
author_sort Miura, Takanori
collection PubMed
description The current definition of atypical femoral fractures (AFFs) excludes periprosthetic fractures. However, a few cases of bisphosphonates (BPs) -associated periprosthetic atypical femoral fractures (PAFFs) have been reported in the literature. Here, we report two rare cases of PAFFs that fulfilled the major criteria for AFFs in patients with prolonged use of BPs. Both cases progressed to a complete fracture with minor trauma from an incomplete fracture at the distal tip of the well-fixed femoral stem. The femoral stem effect on lateral femoral cortical bone, together with the decreased bone elastic resistance induced by BPs, was considered the cause of onset. In each case, we performed open reduction and internal fixation using a locking plate with cable grip and postoperatively prescribed teriparatide and low-intensity pulsed ultrasound (LIPUS). Both cases had a good clinical course. However, as conservative treatment was not effective in these cases, treatment such as non-weight-bearing exercises during hospitalization or prophylactic surgery may be necessary. Further studies are needed to determine the optimal treatment strategy.
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spelling pubmed-64217212019-04-03 Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate Treatment Miura, Takanori Kijima, Hiroaki Tani, Takayuki Ebina, Toshihito Miyakoshi, Naohisa Shimada, Yoichi Case Rep Surg Case Report The current definition of atypical femoral fractures (AFFs) excludes periprosthetic fractures. However, a few cases of bisphosphonates (BPs) -associated periprosthetic atypical femoral fractures (PAFFs) have been reported in the literature. Here, we report two rare cases of PAFFs that fulfilled the major criteria for AFFs in patients with prolonged use of BPs. Both cases progressed to a complete fracture with minor trauma from an incomplete fracture at the distal tip of the well-fixed femoral stem. The femoral stem effect on lateral femoral cortical bone, together with the decreased bone elastic resistance induced by BPs, was considered the cause of onset. In each case, we performed open reduction and internal fixation using a locking plate with cable grip and postoperatively prescribed teriparatide and low-intensity pulsed ultrasound (LIPUS). Both cases had a good clinical course. However, as conservative treatment was not effective in these cases, treatment such as non-weight-bearing exercises during hospitalization or prophylactic surgery may be necessary. Further studies are needed to determine the optimal treatment strategy. Hindawi 2019-03-03 /pmc/articles/PMC6421721/ /pubmed/30944750 http://dx.doi.org/10.1155/2019/9845320 Text en Copyright © 2019 Takanori Miura et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Miura, Takanori
Kijima, Hiroaki
Tani, Takayuki
Ebina, Toshihito
Miyakoshi, Naohisa
Shimada, Yoichi
Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate Treatment
title Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate Treatment
title_full Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate Treatment
title_fullStr Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate Treatment
title_full_unstemmed Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate Treatment
title_short Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate Treatment
title_sort two cases of periprosthetic atypical femoral fractures in patients on long-term bisphosphonate treatment
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421721/
https://www.ncbi.nlm.nih.gov/pubmed/30944750
http://dx.doi.org/10.1155/2019/9845320
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