A typical bilateral femoral fracture: A case report

Abstract

Osteoporosis is a common disease in the elderly, correlated with increased fracture risk, disability and mortality. Bisphosphonates are efficient and have been widely used in the treatment of osteoporosis. Nevertheless, long term bisphosphonate use has been linked with atypical femur fractures. These have a characteristic pattern and history. They usually occur in the proximal third of the femur, and may be complete or incomplete, manifesting either like a radiolucent line or just thickening of the lateral cortex. Their morphology is simple, transverse or short oblique. They are related to minimal, or no trauma at all, but symptoms do pre-exist long before the gross fracture actually takes place.In this paper we report the case of a 75-year-old woman who sustained an atypical right femur fracture while walking. Her past medical history of osteoporosis treated with alendronate for six years along with symptoms in the contra-lateral thigh for the past 2 years, lead to imaging of the left femur. Thus, our patient had a complete fracture on the right side and an incomplete one, represented by lateral cortex thickening on the left. Treatment consisted of discontinuation of bisphosphonates, intra-medullary nailing of the right femur and conservative treatment of the left side. Uneventful union occurred on both sides.