Intramedullary Nailing: Definitive as well as Prophylactic Fixation Method in a Case of Bilateral Atypical Femoral Fractures – A Case Report

INTRODUCTION: Atypical femoral fractures(AFF) are rare. To get more knowledge, these cases are being reported at an increasing rate in recent literature. Surgical treatment in these fractures is controversial. CASE REPORT: A 73-year-old lady, known rheumatoid and osteoporotic with a history of long-term bisphosphonate intake, presented with sudden onset right thigh pain after trivial trauma. We diagnosed a complete atypical femoral fracture, treated with closed intramedullary nailing. 4 months later, she presented with dull aching left thigh pain for 2 weeks. Radiographic features suggested an incomplete atypical femoral fracture, treated with prophylactic insitu intramedullary nailing. At 1 year follow-up, lady was walking well with stick support. CONCLUSION: Our case highlights two important points. Intramedullary nailing is a minimally invasive treatment option for incomplete and complete AFF. We should have a high index of suspicion in diagnosing and recognizing warning signs of incomplete fractures such as prodromal thigh pain and isolated focal lateral cortical thickening, thereby preventing further progression and treatment with prophylactic nailing at an early stage.