Journal of Musculoskeletal Trauma

Case Report

Paradoxical hypertrophy as a cause of femoral insufficiency fractures analyzed through differences in force application in Korea: three case reports: Yong-Uk Kwon, Dae-Hyun Park, Hyoung-Gu Kang; J Musculoskelet Trauma 2026;39(2):174-180. Published online April 23, 2026; DOI: https://doi.org/10.12671/jmt.2025.00388

Abstract PDF: Previous studies have extensively examined the association between femoral insufficiency fractures and prolonged bisphosphonate therapy. However, alternative etiologies remain insufficiently characterized. This study aimed to analyze nonpharmacologic factors associated with femoral insufficiency fractures, with particular emphasis on paradoxical cortical hypertrophy and altered biomechanical load distribution. We reviewed three cases of femoral insufficiency fracture that were surgically treated at our institution between January 2018 and January 2022. None of the patients had a history of bisphosphonate use. Clinical histories—including underlying comorbidities, prior surgical procedures, and radiographic findings—were evaluated. Serial radiographs obtained before and after fracture occurrence were analyzed to characterize fracture morphology and associated cortical changes. Case 1 involved a patient with posttraumatic hip synostosis; case 2 involved a patient with osteogenesis imperfecta; and case 3 involved a patient who had previously undergone intramedullary nailing for an intertrochanteric fracture. Lateral femoral bowing and cortical hypertrophy preceded fracture development in two cases, whereas focal cortical hypertrophy at the distal locking screw site was observed in the third case. No history of bisphosphonate therapy was identified in any patient. Fractures developed at sites characterized by increased cortical remodeling and abnormal load concentration. Femoral insufficiency fractures can occur in the absence of bisphosphonate therapy. Paradoxical cortical hypertrophy and altered biomechanical force distribution appear to be important contributing factors. Level of evidence: IV.

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Original Article

Spontaneous Correction of Angular Deformity after femoral Shaft Fracture in children: Eu Sub Chung, Jong Bone Lee, Boyung Ho Lee; J Korean Soc Fract 1998;11(3):644-649. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.644

Abstract PDF

Remodeling of long bones in children after posttraumatic deformity was accomplished by two distinctive mechanisms that axially oriented compression forces will slow physeal growth and simillarly oriented tensile forces tend to enhance physeal growth, which occur at the fracture site and physis. We reviewed 17 childrens with unilateral fractures of femoral shaft who had an angular deformity after union of 10degreewere selected and measured by C-T scans. The average correction rate was 84.9% of the initial deformity and was no relation between the remodeling rate and degree of malunion. The correction of angulation, only 25% had occurred at the fracture site and 75% at physis. Under the 10 years old, malunion as much as 23degreein any plane will remodel enough to give normal alignment of the joints surfaces.

Citations

Citations to this article as recorded by

Stiff Knee by Entrapment of Quadriceps Femoris Tendon at Fracture Site in Paediatric Distal Femur Shaft Fracture
Suk Kang, Jong Pil Kim, Chung Soo Hwang, Phil Hyun Chung, Young Sung Kim, Sang Ho Lee, Jin Wook Chung
Journal of the Korean Fracture Society.2007; 20(4): 339. CrossRef

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