Journal of Musculoskeletal Trauma

Insufficiency Fracture of Simultaneously Bilateral Femur Neck in Patient Treated with Long-Term Bisphosphonate Treatment - A Case Report -: Seong Kee Shin, Hyung Gon Ryu, Dae Won Shin, Beom Su Han; J Korean Fract Soc 2022;35(3):109-113. Published online July 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.3.109

Abstract PDF: Bisphosphonate is used widely for osteoporosis management. On the other hand, some studies have reported that prolonged use of bisphosphonate without a proper resting period can cause insufficiency fracture and, in rare cases, fractures on the femur neck. This paper reports a case of an elderly patient who suffered bilateral femur neck insufficiency fractures induced by non-stopped long-term bisphosphonate therapy. The patient complained of pain in her buttocks at the first visit. During the admission period, inguinal area pain newly developed. Both a femur neck insufficiency fracture was observed on the hip radiographic image. Hip pinning and postoperative parathyroid hormone treatment were performed. The patient was discharged without specific complications and reported improvement in symptoms on the last follow-up. Several authors have reported one-sided femoral neck insufficiency fractures due to bisphosphonate use, but the present case is uncommon in that it occurred simultaneously in both femur necks. In addition, in the case of bilateral femur fractures, the walking ability after surgery is lower than that of one-sided fracture cases, so active rehabilitation is necessary.

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Clinical Outcomes and Radiologic Characteristics of Insufficiency Femoral Neck Fracture in Elderly Patients: Hee-Uk Ye, Kyung-Jae Lee, Byung-Woo Min, Kyung-Hwan Lim, Beom-Soo Kim, Young-Hoon Kim; J Korean Fract Soc 2021;34(1):1-7. Published online January 31, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.1.1

Abstract PDF: Purpose
In elderly patients, femoral neck insufficiency fractures that occur without a history of trauma are difficult to diagnose and treat, so it is emphasized that early suspicion of fractures and additional diagnostic tests are conducted. Materials and Methods: Between December 2010 to December 2019, 12 femoral neck insufficiency fractures (group 1) were evaluated by comparing them with 50 traumatic femoral neck fractures of a similar age. Along with demographic data, neck cortical thickness, shaft cortical thickness, head diameter, neck width, trochanter width, shaft width, neck-shaft angle, hip axis length, femoral neck index on the simple radiographic image were compared. Results: Seven of the 12 cases were non-displaced fractures, and it took an average of 19.2 days to diagnose the fracture after the symptoms occurred. The height was smaller than the control group at 149.1 cm in group 1 and 157.2 cm in group 2 (p<0.001). The cortical thickness of the medial femoral neck showed significant differences between the two groups: 3.16 mm in group 1 and 4.11 mm in group 2 (p=0.004). There was no statistical difference in the other measurements. Conclusion: Femoral neck insufficiency fracture often has a delayed diagnosis because of the characteristics of the fracture. The cortical thickness of the medial femoral neck in simple radiographic images can help suspect femoral insufficiency fractures in elderly patients when considered with detailed medical history taking and a physical examination.

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Failure of Intramedullary Nailing for Subtrochanteric Atypical Femoral Fractures Caused by Endosteal Cortical Thickening: Young Ho Roh, Kimoon Kang, Hee Joong Kim, Kwang Woo Nam; J Korean Fract Soc 2019;32(4):211-221. Published online October 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.4.211; Correction in: J Musculoskelet Trauma 2020;33(1):63

PURPOSE
Recent literature has noted incidences of subtrochanteric atypical femoral fractures (AFFs) in patients who have taken long-term bisphosphonates (BPs). Most cases of subtrochanteric AFFs have been treated with intramedullary nailing and cases of delayed union have been reported. On the other hand, there is no data available on the complications associated with endosteal thickening or cortical thickening. This study evaluated the results of surgical treatment according to the endosteal thickening of the lateral cortex in subtrochanteric AFFs.
MATERIALS AND METHODS
Investigation was performed at the Department of Orthopaedic Surgery, Jeju National University Hospital. The study consisted of patients with subtrochanteric AFFs, defined by the American Society for Bone and Mineral Research (ASBMR) major criteria, who underwent intramedullary nailing from March 2012 to October 2014. The cases were categorized into two groups based on the presence of endosteal thickening. The evaluation included the demographic data, radiographic data of initial reduction state, and duration of BPs.
RESULTS
The demographic data and duration of BPs were similar in the two groups. On the other hand, varus reduction (Group I: 12.5% vs. Group II: 78.9%; p=0.001), delayed union (Group I: 0% vs. Group II: 70.0%; p=0.003), nonunion (Group I: 0% vs. Group II: 47.4%; p=0.017), and union time (Group I: 5.5 months vs. Group II: 8.3 months; p<0.001) were significantly different in the two groups.
CONCLUSION
Endosteal thickening of the lateral cortex in subtrochanteric AFFs was identified as an independent factor that decides the reduction of the fracture and nonunion. The endosteal thickening should be removed to obtain anatomical alignment for successful surgical results.

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Controlled bending of proximal femoral nails used in fractures of bowed femurs: biomechanical study with clinical application
Hong Moon Sohn, Suenghwan Jo
Medical Biological Science and Engineering.2022; 5(2): 63. CrossRef

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Clinical Features and Outcomes of Pelvic Insufficiency Fractures: Yong Min Seo, Young Chang Kim, Ji Wan Kim; J Korean Fract Soc 2017;30(4):186-191. Published online October 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.4.186

Abstract PDF: PURPOSE
The purpose of this study was to investigate the radiological and epidemiological characteristics, as well as the clinical course of pelvic insufficiency fractures in the elderly population.
MATERIALS AND METHODS
At a Haeundae Paik Hospital, we retrospectively reviewed patients with pelvic insufficiency fractures between March 2010 and May 2017. The demographic data of patients were analyzed, and bone mineral density and bone turnover markers were evaluated to estimate the metabolic status of the bone. The radiological characteristics were evaluated by comparing the simple x-ray images with the computed tomography images, and the types of fractures were classified via computed tomography images. For clinical course evaluation, we investigated comorbid complications, and compared the walking ability scale before and 6 months after the fracture.
RESULTS
A total of 42 patients were included, with an average age of 76.5 years. All were female except one case. In 5 cases where the initial medical examination was from another institution, the fracture was not found in 3 cases. All cases received conservative treatment. After the diagnosis of pelvic bone fracture using a simple x-ray imaging, additional fractures were found in 81.0% of the study population using a computed tomography. Initiation of gait occurred at an average of 2.8 weeks, and every case except 1 (97.6%) fully recovered their gait ability.
CONCLUSION
We concluded that there was a limitation with diagnosing pelvic insufficiency fracture using only a simple x-ray imaging technique. In general, cases in this study showed conservative treatment yielded favorable clinical outcome with relatively less critical complications.

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Oncogenic Osteomalacia with Multiple Insufficiency Fractures: A Case Report: Young Chang Park, Joon Oh Seo, Kyu Hyun Yang; J Korean Fract Soc 2017;30(3):146-150. Published online July 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.3.146

Abstract PDF: Oncogenic osteomalacia is a rare paraneoplastic syndrome, characterized by hypophosphatemia, renal phosphate wasting, osteomalacia, and multiple insufficiency fractures, as a result of the tumor. A wide excision of the causative tumor is considered as the treatment of choice, following which, a dramatic recovery is expected. Authors report a case in which the symptoms and bone mineral density were dramatically recovered after an excision of the causative tumor around the tibialis posterior muscle in oncogenic osteomalacia.

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Atypical Fracture-Like Insufficiency Fracture of the Tibia with Prolonged Bisphosphonate Drug: A Case Report: Min Jung Park, Su Jin Lee, Jin Hwa Kam, Yun Tae Lee, Ju Hyung Yoo, Hyun Cheol Oh, Joong Won Ha, Yung Park, Sang Hoon Park, Seong Hoon Kim, Han Kook Yoon; J Korean Fract Soc 2017;30(3):137-141. Published online July 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.3.137

Abstract PDF

Atypical femoral fracture related to a long-term bisphosphonate therapy has commonly been reported; however, a fracture at the site other than the femur has rarely been reported to date. Herein, we report a case of a patient on long-term bisphosphonate therapy who presented atypical tibial insufficiency fracture at the anterolateral aspect of diaphysis, without trauma. We, for the first time in Korea, present this case with a literature review.

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Atypical Femoral Fracture Occurring at a Proximal Screw Insertion Site after Plate Removal in a Distal Femoral Fracture
Jin Woo Jin, Sung Jin Shin, Jong Min Jeon
Journal of the Korean Orthopaedic Association.2024; 59(4): 314. CrossRef

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Insufficiency Fracture of the Femoral Neck after Intramedullary Nailing for the Treatment of Atypical Femoral Fracture - A Case Report -: Nam Hoon Moon, Jae Hoon Jang, Tae Hyuk Hwang, Ki Young Park; J Korean Fract Soc 2016;29(4):258-264. Published online October 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.4.258

Abstract PDF: Although several publications have reported delayed or non-union, there is a consensus that the standard treatment for atypical femoral fracture (AFF) is an intramedullary nailing. However, no case of tensile insufficiency fracture of femoral neck associated with intramedullary nailing in patients with AFF have been reported. Here, we report an 82-year-old woman with tensile type of insufficiency fracture of the femoral neck after intramedullary nailing for the treatment of AFF.

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Insufficiency Fracture of Proximal Femur Shaft without Bisphosphonate Therapy: Report of Three Cases: Suk Kyu Choo, Dae Yeon Jo, Hyoung Keun Oh; J Korean Fract Soc 2013;26(3):217-220. Published online July 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.3.217

Abstract PDF: 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.

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Usefulness of Kyphoplasty in Sacral Insufficiency Fracture: A Case Report: Soo Uk Chae, Yeung Jin Kim, Jung Hwan Yang, Ji Wan Lee; J Korean Fract Soc 2011;24(2):174-177. Published online April 30, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.2.174

Abstract PDF

Kyphoplasty has recently attended as a potential treatment for sacral insufficiency fracture. We report a 85-years-old female patient with osteoporotic S1 insufficiency fracture with absence of trauma history treated with kyphoplasty which has no symptom improve with conservative treatment. Kyphoplasty is an effective and useful procedure in the treatment of the sacral insufficiency fracture, additionally reviewed of the literatures.

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Pelvic Insufficiency Fracture in Severe Osteoporosis Patient
Woong Chae Na, Sang Hong Lee, Sung Jung, Hyun Woong Jang, Suenghwan Jo
Hip & Pelvis.2017; 29(2): 120. CrossRef

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Repetitive Insufficiency Fractures of the Femoral Shaft: A Case Report: Ji Hwan Kim, Young Ho Cho, Young Soo Byun, Jung Hoon Shin, Chung Yeol Lee, Tae Gyun Kim; J Korean Fract Soc 2010;23(1):109-112. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.109

Abstract PDF: Stress fractures occur when the loads applied to a bone exceed the mechanical resistance and fall into two groups. Fatigue fractures, in which abnormal mechanical stress is applied to a normal bone, and insufficiency fractures, in which fracture occurs when stress of normal activity is applied to a bone that has decreased elastic resistance. Femoral shaft insufficiency fractures are reported rarely in patients with postmenopausal osteoporosis. We report a case of repetitive insufficiency fractures of the femoral shaft in 70 year-old female with marked osteoporosis.

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Insufficiency Fractures of the Femoral Shaft Associated with Osteoporosis: Hae Seok Koh, Yong Koo Kang, Han Yong Lee, Kee Won Rhyu, Joo Hyoun Song, Jin Young Jeong, Eun Seong Song; J Korean Fract Soc 2004;17(1):19-24. Published online January 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.1.19

Abstract PDF

PURPOSE
To present a clinical experience of the insufficiency fractures of the femoral shaft associated with osteoporosis MATERIALS AND METHODS: From January 1995 to December 2002, four patients (8 cases, four females) more than 1-year follow up were reviewed retrospectively. The mean age was 61 years (range, 55 to 73). Medical records and roentgenograms were reviewed.
RESULTS
The fractures were bilateral. Plain film revealed fracture line in six among seven cases excluding 1 displaced fracture at initial presentation. All cases presented osteoporosis, anterolateral bowing of the femur, and hot spot in bone scan. Five cases (four displaced, one impending displaced fracture) underwent interlocking intramedullary nailing and all five of them manifested no evidence of delayed union. The preoperative thigh and knee joint pain improved postoperatively.
CONCLUSION
Femoral shaft insufficiency fracture could occur rarely in patients with anterolateral bowing of the femur and postmenopausal osteoporosis. Careful history taking, radiography and bone scan are necessary, and bone scan is helpful for early diagnosis. Once diagnosed as the insufficiency fracture with fracture-related symptoms, prophylactic nailing may be necessary lest complete displaced fracture should occur.

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Research on the Coverage Expansion and Optimization Strategy of Unemployment Insurance System Based on the Comparison between China and Britain
Ruolan Xiao, M. Md Husin
SHS Web of Conferences.2024; 193: 01039. CrossRef
Pelvic Insufficiency Fracture in Severe Osteoporosis Patient
Woong Chae Na, Sang Hong Lee, Sung Jung, Hyun Woong Jang, Suenghwan Jo
Hip & Pelvis.2017; 29(2): 120. CrossRef
Femoral Shaft Fracture of a Middle-aged Male Adult during Playing Baseball
Ho-Seung Jeon, Young-Kyun Woo, Seok-Ha Hwang, Seung-Pyo Seo, Ho-Won Jeong, Sung-Tae Lim
The Korean Journal of Sports Medicine.2017; 35(1): 57. CrossRef
Surgical Treatment of Atypical Femoral Fracture
Kyung-Jae Lee, Yong-Wook Kwon, Yong Chan Ha, Young-Kyun Lee, Beom-Soo Kim, Byung-Woo Min
Journal of the Korean Orthopaedic Association.2013; 48(3): 185. CrossRef
Letter: Repeated Metal Breakage in a Femoral Shaft Fracture with Lateral Bowing - A Case Report -
Hae Seok Koh
Journal of the Korean Fracture Society.2012; 25(3): 240. CrossRef
Association of Low-energy Femoral Shaft Fractures and Bisphosphonate Use
Hae Seok Koh
Orthopedics.2012; 35(9): 736. CrossRef
Repetitive Insufficiency Fractures of the Femoral Shaft - A Case Report -
Ji-Hwan Kim, Young-Ho Cho, Young-Soo Byun, Jung-Hoon Shin, Chung-Yeol Lee, Tae-Gyun Kim
Journal of the Korean Fracture Society.2010; 23(1): 109. CrossRef

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Lateral Insufficiency Fracture of the Femur caused by Osteopenia & Varus angulation after Hip Arthroplasty: Case Report: Myung Sik Park, Yong Min Kim; J Korean Soc Fract 2001;14(3):358-363. Published online July 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.3.358

Abstract PDF: Lateral femoral insufficiency fracture in total hip arthroplasty occur due to osteopenia and varus positioning of the femoral component. The presentation of these fractures usually involves the insidious onset of unexplained thigh or groin pain. The insufficiency fracture generally occur at the level of the femoral stem tip on the lateral cortex of the femur. Recommended treatment involves revision to a long stem femoral component. This is the first report of lateral femoral insufficiency fracture simply regarded as periprosthetic fracture of the femur.

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