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Atypical Femoral Fracture Despite Prophylactic Intramedullary Nailing: A Case Report
Christine E Schemitsch1, Paul Kuzyk, Michael D McKee
1Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Suite 800, 55 Queen Street East, Toronto, ON M5C 1R6, Canada. mckeem@smh.ca.
Case:
A forty-three-year-old woman on bisphosphonate therapy sustained an atypical femoral fracture that was successfully treated with an intramedullary nail. After she developed radiographic and clinical signs of an impending stress fracture of the contralateral femur, prophylactic nailing was performed. However, seven months postoperatively, she sustained a spontaneous, complete fracture of the prophylactically nailed femur at the site of the lateral cortical stress lesion.
Conclusion:
To our knowledge, progression of a bisphosphonate-associated stress lesion to a complete fracture months after initially successful prophylactic intramedullary nailing has not been previously reported. Implications regarding treatment and prognosis are discussed.
