Insufficiency Fracture of Proximal Femur Shaft without Bisphosphonate Therapy - Report of Three Cases -

Choo, Suk Kyu; Jo, Dae Yeon; Oh, Hyoung Keun

doi:10.12671/jkfs.2013.26.3.217

J Korean Fract Soc. 2013 Jul;26(3):217-220. Korean.
Published online Jul 15, 2013.
https://doi.org/10.12671/jkfs.2013.26.3.217

Case Report

Insufficiency Fracture of Proximal Femur Shaft without Bisphosphonate Therapy - Report of Three Cases -

Suk Kyu Choo, M.D., Dae Yeon Jo, M.D. and Hyoung Keun Oh, M.D.

Author information

Author notes

Copyright and License

- Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea.
Address reprint requests to: Hyoung Keun Oh, M.D. Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 411-706, Korea. Tel: 82-31-910-7968, Fax: 82-31-910-7967, Email: osd11@paik.ac.kr

Received October 10, 2012; Revised March 20, 2013; Accepted April 29, 2013.

This is anOpen Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords

Proximal femur; Bisphosphonate; Insufficiency fracture

Figures

Fig. 1
(A) The radiograph shows typical patterns; lateral cortical hypertrophy, transverse fracture line and medial spike. (B) After left side operation, whole body radionuclide scan shows a focal uptake of right femur shaft.

Click for larger image

Fig. 2
Femur shaft shows severe lateral bowing, so internal fixation was done using locking compression plate.

Click for larger image

Fig. 3
(A) An anteroposterior radiograph obtained 5 months after the first operation demonstrates metal breakage and displaced fragment. (B) Using long proximal femur nail antirotation and auto bone graft, the revisional operation was done.

Click for larger image

References

1. Bone HG, Hosking D, Devogelaer JP, et al. Ten years' experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 2004;350:1189–1199.
  PubMed
  
  CrossRef
1. Hodgson SF. Corticosteroid-induced osteoporosis. Endocrinol Metab Clin North Am 1990;19:95–111.
  PubMed
  
  CrossRef
1. Huusko TM, Korpela M, Karppi P, Avikainen V, Kautiainen H, Sulkava R. Threefold increased risk of hip fractures with rheumatoid arthritis in Central Finland. Ann Rheum Dis 2001;60:521–522.
  PubMed
  
  CrossRef
1. Kim JW, Kim JJ, Lee HS, Choo SK, Oh HK, Chang JS. Low energy femur shaft and subtrochanteric fracture with bisphosphonate therapy. Korean J Bone Metab 2010;17:19–23.
1. Kiuru MJ, Pihlajamaki HK, Ahovuo JA. Fatigue stress injuries of the pelvic bones and proximal femur: evaluation with MR imaging. Eur Radiol 2003;13:605–611.
  PubMed
1. Kwek EB, Goh SK, Koh JS, Png MA, Howe TS. An emerging pattern of subtrochanteric stress fractures: a long-term complication of alendronate therapy? Injury 2008;39:224–231.
  PubMed
  
  CrossRef
1. Nawata H, Soen S, Takayanagi R, et al. Subcommittee to Study Diagnostic Criteria for Glucocorticoid-Induced Osteoporosis: Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research (2004). J Bone Miner Metab 2005;23:105–109.
  PubMed
  
  CrossRef
1. Yang KH, Sim DS. Clinical consideration on insufficiency fracture of femur. Korean J Bone Metab 2009;16:37–41.