Atypical femoral fractures (AFFs) are recently observed as a complication of long-term bone-modifying agent (BMA; bisphosphonate or denosumab) therapy for bone metastases. We describe the cases of two women diagnosed with breast cancer who developed incomplete AFF associated with BMAs prescribed for bone metastases. Radiographs of their femurs revealed thickening of the lateral subtrochanteric cortex, and tomosynthesis revealed a visible fracture line in the thickened cortex. They were initially treated with conservative management; however, the incomplete fracture resulted in a complete fracture. These cases highlight two major implications. First, symptomatic incomplete AFF associated with BMAs prescribed for bone metastases should be treated with surgical prophylaxis, given the fact that fracture healing is expected to require a longer duration and an incomplete fracture might potentially progress to a complete fracture during long-term conservative management. Second, tomosynthesis is useful in identifying radiolucent fracture lines that are reliable predictors of fracture propagation.
Coronavirus disease 2019 has spread globally and is associated with severe clinical problems, such as acute respiratory distress syndrome (ARDS) requiring intubation and mechanical ventilation (MV) in intensive care units (ICUs). 1,2) As a result of immobilization and prolonged MV, post-intensive care syndrome (PICS) can develop, leading to long-term physical, cognitive, and mental impairments in ICU patients. [3][4][5][6] Moreover, COVID-19 patients are at higher risk for PICS because rehabilitation and family visits are limited as a part of infection control measures. 7,8) Recovery from ARDS and PICS can take an extended period after discharge from the ICU, sometimes with only partial long-term recovery. 9) Recent estimates indicate that at least 40% of COVID-19 patients have prolonged significant physical dysfunction, including fatigue and weakness, after discharge from the hospital. 10) These impairments can persist for months or years after severe disease. Such impairments can have a significant impact on important outcomes for
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