Treatment and Prognosis of Femoral Insufficiency Fracture Associated with Prolonged Bisphosphonate Use

Abstract

Purpose: This study was conducted to investigate and identify an appropriate fracture treatment method by analyzing patients in whom a femoral incompetence fracture occurred after receiving a long-term bisphosphonate administration. Materials and Methods:The subjects of this study were 13 cases out of ten patients among those who had a history of receiving bisphosphonate for more than five years and had a fracture or an imminent fracture with a characteristic radiological finding in the femoral subtrochanteric region and the interfemoral region. The period of the drug administration, bone density, the existence of a prodromal symptom, and bilateral fracture were investigated. Results: In seven out of the 13 cases, the patients complained of painat the femoral and pelvic parts as a prodrome (53.8%), and three of them showed a bilateral fracture (30%). An imminent fracture with a prodrome was observed in six cases (46.2%); for three of these cases, a prophylactic fixture pexis was performed by inserting a metal nail into the medullary cavity, and in two out of these three, a complete fracture was found within 11 months on average (3 to 19 months). In the three prophylactic fixture pexis performed cases, no postoperative complications were found, and a radiological finding of concrescence was seen within one year after the operation. Among the nine operation performed cases after the fracture, non-union was found in two. Conclusion: In the patients who have received bisphosphonate for a long periodof time, a prodome may be a useful indicator of a fracture in the femoral subtrochanteric region and the interfemoral region; therefore, a careful observation is necessary. A prophylactic internal fixation is recommended for patients with imminent fracture with a prodome since they have a high risk of a complete fracture is high in them.

Subtrochanteric Fracture Reduction during Intramedullary Nailing: Technical Note

“…1,2) 특히 비전형 골 절이 자주 발생하는 부위로서 비전형 골절은 불유합의 빈도 가 일반적인 골절보다 높기 때문에 가급적 골절부의 해부학 적인 정복을 획득하는 것이 권장된다. 3,4) 5. When the marrow canal is wide, the distal fragment is displaced posteriorly.…”