J Korean Fract Soc.  2013 Jul;26(3):217-220. 10.12671/jkfs.2013.26.3.217.

Insufficiency Fracture of Proximal Femur Shaft without Bisphosphonate Therapy: Report of Three Cases

• Choo SK
• Jo DY
• Oh HK

• KMID: 1431667
• DOI: http://doi.org/10.12671/jkfs.2013.26.3.217

Abstract

There is a growing interest in the factors related to insufficiency fractures. We are going to report three insufficiency fracture cases which are considered to be caused by osteoporosis, rheumatoid arthritis, steroid use and femoral shaft bowing among the patients not taking bisphosphonate. All cases are caused by low energy trauma and among these cases, one patient is being presented with a prodromal symptom and another patient complains of both prodromal symptoms and bilateral lesions.

Keyword

Proximal femur; Bisphosphonate; Insufficiency fracture

MeSH Terms

Arthritis, Rheumatoid
Femur
Fractures, Stress
Humans
Osteoporosis
Prodromal Symptoms

Figure

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  Fig. 1 (A) The radiograph shows typical patterns; lateral cortical hypertrophy, transverse fracture line and medial spike. (B) After left side operation, whole body radionuclide scan shows a focal uptake of right femur shaft.

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  Fig. 2 Femur shaft shows severe lateral bowing, so internal fixation was done using locking compression plate.

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  Fig. 3 (A) An anteroposterior radiograph obtained 5 months after the first operation demonstrates metal breakage and displaced fragment. (B) Using long proximal femur nail antirotation and auto bone graft, the revisional operation was done.

Reference

1. Bone HG, Hosking D, Devogelaer JP, et al. Ten years' experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med. 2004; 350:1189–1199.

2. Hodgson SF. Corticosteroid-induced osteoporosis. Endocrinol Metab Clin North Am. 1990; 19:95–111.

3. Huusko TM, Korpela M, Karppi P, Avikainen V, Kautiainen H, Sulkava R. Threefold increased risk of hip fractures with rheumatoid arthritis in Central Finland. Ann Rheum Dis. 2001; 60:521–522.

4. Kim JW, Kim JJ, Lee HS, Choo SK, Oh HK, Chang JS. Low energy femur shaft and subtrochanteric fracture with bisphosphonate therapy. Korean J Bone Metab. 2010; 17:19–23.

5. Kiuru MJ, Pihlajamaki HK, Ahovuo JA. Fatigue stress injuries of the pelvic bones and proximal femur: evaluation with MR imaging. Eur Radiol. 2003; 13:605–611.

6. Kwek EB, Goh SK, Koh JS, Png MA, Howe TS. An emerging pattern of subtrochanteric stress fractures: a long-term complication of alendronate therapy? Injury. 2008; 39:224–231.

7. Nawata H, Soen S, Takayanagi R, et al. Subcommittee to Study Diagnostic Criteria for Glucocorticoid-Induced Osteoporosis: Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research (2004). J Bone Miner Metab. 2005; 23:105–109.

8. Yang KH, Sim DS. Clinical consideration on insufficiency fracture of femur. Korean J Bone Metab. 2009; 16:37–41.