Rare non-traumatic periprosthetic femoral fracture with features of an atypical femoral fracture: a case report

Journal of Medical Case Reports

Masahiro Kurosaka¹  Ryosuke Kuroda¹  Yoshitada Sakai²  Sang Yang Lee¹  Takahiro Niikura¹ 

[1] Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Kobe 650-0017, Chuo-ku, Japan;Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Kobe 650-0017, Chuo-ku, Japan

关键词: Periprosthetic fracture;    Glucocorticoid;    Dermatomyositis;    Bisphosphonate;    Atypical femoral fracture;   

Others  :  1204614
DOI  :  10.1186/s13256-015-0590-z

 received in 2015-02-02, accepted in 2015-04-08,  发布年份 2015

【 摘 要 】

Introduction

Atypical femoral fractures have emerged as one of the potential complications of bisphosphonates during the past decade. The American Society for Bone and Mineral Research published a Task Force report on atypical femoral fractures in 2010 and a second report in 2014. Although the current definition of atypical femoral fractures in these reports excludes periprosthetic fractures, each of three published case reports describe a bisphosphonate-associated atypical femoral fracture that occurred around the stem of a total hip arthroplasty. We report a rare case of an atypical femoral fracture that occurred at the stem tip of a total hip arthroplasty that fulfills the major criteria defined by the second American Society for Bone and Mineral Research Task Force report for an atypical femoral fracture and that was associated with prolonged use of bisphosphonate.

Case presentation

A 69-year-old Japanese woman with a right cementless total hip arthroplasty undertaken 44 months previously had a right femoral shaft fracture that occurred without trauma. She related that the bone fractured while she was standing, after which she fell down. Radiographs showed a noncomminuted transverse fracture located at the tip of the stem with localized periosteal thickening of the lateral cortex. The fracture was complete, extending through both cortices, and was associated with a medial spike. Her history revealed that she had been taking prednisolone to treat dermatomyositis and interstitial pneumonia for approximately 15 years. Alendronate was administered for more than 7 years. We performed open reduction and internal fixation using a locking plate with cable grip. The latest follow-up was performed 2 years after the fracture surgery. Bony union was successful. She regained the ability to walk, although her activity was limited by her comorbidities.

Conclusions

Although the current definition of an atypical femoral fracture excludes periprosthetic fractures, there may be a periprosthetic fracture with the same or similar pathology as that of an atypical femoral fracture. We must be vigilant and aware of this type of fracture, especially in patients with prolonged bisphosphonate use.

【 授权许可】

   
2015 Niikura et al.; licensee BioMed Central.

【 图 表 】

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【 参考文献 】

• [1]Shane E, Burr D, Ebeling PR, Abrahamsen B, Adler RA, Brown TD et al.. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2010; 25:2267-94.
• [2]Shane E, Burr D, Abrahamsen B, Adler RA, Brown TD, Cheung AM et al.. Atypical subtrochanteric and diaphyseal femoral fractures: Second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2014; 29:1-23.
• [3]Sayed-Noor AS, Sjödén GO. Case reports: two femoral insufficiency fractures after long-term alendronate therapy. Clin Orthop Relat Res. 2009; 467:1921-6.
• [4]Curtin BM, Fehring TK. Bisphosphonate fractures as a cause of painful total hip arthroplasty. Orthopedics. 2011; 34:e939-44.
• [5]Cross MB, Nam D, van der Meulen MC, Bostrom MP. A rare case of a bisphosphonate-induced peri-prosthetic femoral fracture. J Bone Joint Surg Br. 2012; 94:994-7.
• [6]Gill TJ, Sledge JB, Orler R, Ganz R. Lateral insufficiency fractures of the femur caused by osteopenia and varus angulation: a complication of total hip arthroplasty. J Arthroplasty. 1999; 14:982-7.
• [7]Schilcher J, Aspenberg P. Incidence of stress fractures of the femoral shaft in women treated with bisphosphonate. Acta Orthop. 2009; 80:413-5.
• [8]Donnelly E, Meredith DS, Nguyen JT, Gladnick BP, Rebolledo BJ, Shaffer AD et al.. Reduced cortical bone compositional heterogeneity with bisphosphonate treatment in postmenopausal women with intertrochanteric and subtrochanteric fractures. J Bone Miner Res. 2012; 27:672-8.
• [9]Koh JS, Goh SK, Png MA, Ng AC, Howe TS. Distribution of atypical fractures and cortical stress lesions in the femur: implications on pathophysiology. Singapore Med J. 2011; 52:77-80.
• [10]Unnanuntana A, Saleh A, Mensah KA, Kleimeyer JP, Lane JM. Atypical femoral fractures: what do we know about them? AAOS Exhibit Selection. J Bone Joint Surg Am. 2013; 95:e8.
• [11]Allen MR, Burr DB. Three years of alendronate treatment results in similar levels of vertebral microdamage as after one year of treatment. J Bone Miner Res. 2007; 22:1759-65.
• [12]Brennan O, Kennedy OD, Lee TC, Rackard SM, O’Brien FJ. Effects of estrogen deficiency and bisphosphonate therapy on osteocyte viability and microdamage accumulation in an ovine model of osteoporosis. J Orthop Res. 2011; 29:419-24.
• [13]Kidd LJ, Cowling NR, Wu AC, Kelly WL, Forwood MR. Bisphosphonate treatment delays stress fracture remodeling in the rat ulna. J Orthop Res. 2011; 29:1827-33.
• [14]Sloan AV, Martin JR, Li S, Li J. Parathyroid hormone and bisphosphonate have opposite effects on stress fracture repair. Bone. 2010; 47:235-40.
• [15]Chiang CY, Zebaze RM, Ghasem-Zadeh A, Iuliano-Burns S, Hardidge A, Seeman E. Teriparatide improves bone quality and healing of atypical femoral fractures associated with bisphosphonate therapy. Bone. 2013; 52:360-5.