Nam Hoon Moon; Jae Hoon Jang; Tae Hyuk Hwang; Ki Young Park

doi:10.12671/jkfs.2016.29.4.258

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Case Report
Insufficiency Fracture of the Femoral Neck after Intramedullary Nailing for the Treatment of Atypical Femoral Fracture - A Case Report -: Nam Hoon Moon, M.D., Jae Hoon Jang, M.D., Tae Hyuk Hwang, M.D., Ki Young Park, M.D.; Journal of the Korean Fracture Society 2016;29(4):258-264.
DOI: https://doi.org/10.12671/jkfs.2016.29.4.258
Published online: October 20, 2016

Department of Orthopaedic Surgery, Pusan National University Hospital, Korea.

^*Department of Orthopaedic Surgery, Good Sansun Hospital, Busan, Korea.

Address reprint requests to: Nam Hoon Moon, M.D. Department of Orthopaedic Surgery, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea. Tel: 82-51-240-7248·Fax: 82-51-247-8395, namhoonmoon@gmail.com

• Received: January 5, 2016 • Revised: July 7, 2016 • Accepted: July 29, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
NOTES
REFERENCES

Abstract

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.
Key words: Atypical femoral fracture, Osteoporosis, Femoral neck insufficiency fracture

None.

REFERENCES

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2. Das De S, Setiobudi T, Shen L, Das De S. A rational approach to management of alendronate-related subtrochanteric fractures. J Bone Joint Surg Br, 2010;92:679-686.
3. Borrelli J Jr, Lane J, Bukata S, Egol K, Takemoto R, Slobogean G. Atypical femur fractures. J Orthop Trauma, 2014;28:S36-S42.
4. Visekruna M, Wilson D, McKiernan FE. Severely suppressed bone turnover and atypical skeletal fragility. J Clin Endocrinol Metab, 2008;93:2948-2952.
5. Weil YA, Rivkin G, Safran O, Liebergall M, Foldes AJ. The outcome of surgically treated femur fractures associated with long-term bisphosphonate use. J Trauma, 2011;71:186-190.
6. Egol KA, Park JH, Rosenberg ZS, Peck V, Tejwani NC. Healing delayed but generally reliable after bisphosphonate-associated complete femur fractures treated with IM nails. Clin Orthop Relat Res, 2014;472:2728-2734.
7. Bonifacio L, Syson P. Construct failure in an atypical femoral fracture treated with intramedullary nailing: a case report. Malays Orthop J, 2014;8:82-84.
8. Iwamoto J, Takeda T. Insufficiency fracture of the femoral neck during osteoporosis treatment: a case report. J Orthop Sci, 2002;7:707-712.
9. Kitajima I, Tachibana S, Mikami Y, Mori T, Hirota Y, Nakamichi K. Insufficiency fracture of the femoral neck after intramedullary nailing. J Orthop Sci, 1999;4:304-306.
10. Yang KH, Min BW, Ha YC. Atypical femoral fracture: 2015 position statement of the Korean society for bone and mineral research. J Bone Metab, 2015;22:87-91.

Fig. 1

Representative radiographs of an 82-year-old female with atypical femoral fracture (AFF) treated with long-term bisphosphonate. (A) Preoperative radiographs demonstrate findings consistent with AFF, including transverse fracture lines with periosteal thickening of the lateral cortex, and non-comminuted complete fracture lines with medial spikes. (B) Internal fixation was performed using a standard intramedullary nail.

Fig. 2

Patient had a subtrochanteric fracture on the contralateral side while weight bearing on the left leg. (A) Preoperative radiographs also demonstrate atypical femoral fracture. (B) Internal fixation was performed using a long proximal femoral nail anti-rotation 2.

Fig. 3

(A, B) Plain x-ray and computed tomography images showing no fracture line can be seen. (C) Coronal T1-weighted spin echo coronal image showing a focal area of low signal intensity on the tension side of the right femoral neck. (D) Coronal fat saturated T2-weighted image showing similar focal area of florid marrow edema on the tension side of the right femoral neck.

Fig. 4

(A, B) Postoperative radiographs presenting the internal fixation with multiple cannulated screws for the treatment of tensile type insufficiency fracture of the femoral neck. (C, D) At 6-month follow-up, there was no evidence of screw loosening or fixation loss.

Figure & Data

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Insufficiency Fracture of the Femoral Neck after Intramedullary Nailing for the Treatment of Atypical Femoral Fracture - A Case Report -

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

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Insufficiency Fracture of the Femoral Neck after Intramedullary Nailing for the Treatment of Atypical Femoral Fracture - A Case Report -

Fig. 1 Representative radiographs of an 82-year-old female with atypical femoral fracture (AFF) treated with long-term bisphosphonate. (A) Preoperative radiographs demonstrate findings consistent with AFF, including transverse fracture lines with periosteal thickening of the lateral cortex, and non-comminuted complete fracture lines with medial spikes. (B) Internal fixation was performed using a standard intramedullary nail.

Fig. 2 Patient had a subtrochanteric fracture on the contralateral side while weight bearing on the left leg. (A) Preoperative radiographs also demonstrate atypical femoral fracture. (B) Internal fixation was performed using a long proximal femoral nail anti-rotation 2.

Fig. 3 (A, B) Plain x-ray and computed tomography images showing no fracture line can be seen. (C) Coronal T1-weighted spin echo coronal image showing a focal area of low signal intensity on the tension side of the right femoral neck. (D) Coronal fat saturated T2-weighted image showing similar focal area of florid marrow edema on the tension side of the right femoral neck.

Fig. 4 (A, B) Postoperative radiographs presenting the internal fixation with multiple cannulated screws for the treatment of tensile type insufficiency fracture of the femoral neck. (C, D) At 6-month follow-up, there was no evidence of screw loosening or fixation loss.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Insufficiency Fracture of the Femoral Neck after Intramedullary Nailing for the Treatment of Atypical Femoral Fracture - A Case Report -