Rare case of atypical femoral fracture with blocked medullary canal associated with bisphosphonate therapy

Shetty, Anupkumar; Shenoy, Pritom M; Bari, Abdul; Swaminathan, Raja

doi:10.1016/j.jcot.2018.04.016

Cited by 4 publications

(5 citation statements)

References 7 publications

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“…We found three cases [ 4 - 6 ] of obliterated intramedullary canals during intramedullary nailing for atypical femoral fractures. Such an abnormal morphology is scarcely documented.…”

Section: Discussionmentioning

confidence: 99%

“…Only 1.1% of femoral fractures are accounted for atypical causes [3]. Although it is rare, the increment of this kind of atypical fracture diagnosis has led to more reporting cases of complications and technical difficulty during the intraoperative period [4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…It is widely acknowledged that bisphosphonates modify the activity of osteoclasts, hence bone remodeling capacity that leads to the accumulation of microscopic damage and the development of stress fractures [ 3 ]. In some rare occurrences, a change in the femur's intramedullary canal structure can obstruct intramedullary nailing, a situation rarely encountered [ 4 - 6 ]. In this article, we present a case involving a blocked intramedullary canal in the context of an atypical femoral fracture, detailing its management.…”

Section: Introductionmentioning

confidence: 99%

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A Rare Case of Obliterated Femoral Canal in Atypical Femoral Shaft Fracture Related to Bisphosphonate Therapy

Febrian Kunta Adjie,

Bajuri,

Nik Abdullah

et al. 2023

Cureus

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Bisphosphonates have been accepted as the first-line treatment for postmenopausal osteoporosis. Atypical femoral shaft fracture is one of the side effects of long-term bisphosphonate therapy. The mainstay treatment of this atypical fracture is bisphosphonates cessation and stabilization with internal fixation. We are reporting a rare case of a blocked intramedullary femoral canal found during surgery of an 85-year-old Indian lady with an atypical femoral shaft fracture related to her five-year alendronate therapy. We found difficulty in passing the guidewire through the fracture site during the closed method, which renders open reduction to manage the obliterated intramedullary canal. The importance of changing decisions intraoperatively should be highlighted to avoid further complications. Fracture union is achieved during our follow-up in the clinic.

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“…We found three cases [ 4 - 6 ] of obliterated intramedullary canals during intramedullary nailing for atypical femoral fractures. Such an abnormal morphology is scarcely documented.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Rare Case of Obliterated Femoral Canal in Atypical Femoral Shaft Fracture Related to Bisphosphonate Therapy

Febrian Kunta Adjie,

Bajuri,

Nik Abdullah

et al. 2023

Cureus

View full text Add to dashboard Cite

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“…Still to no avail, they drilled the proximal fragment using a 3.2 mm guide pin. 6 Since no such ideal protocol is still there to deal with blocked medullary canal. Make drill hole with K-wires, then insert guide wire under C-ARM guidance and then ream over it is a guided technique to deal with blocked intramedullary canal.…”

Section: Discussionmentioning

confidence: 99%

How to manage blocked intramedullary canal while reaming during hip arthroplasty

Bansal,

Jajoriya,

Verma

2023

Int J Res Orthop

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Blockage of femoral canal while doing hemiarthroplasty is rare finding. Before inserting the femoral stem trial we should manage this blockage adequately to prevent iatrogenic fracture. Herein, we present a case of fracture neck of femur right in a 79-year-old male who presented with history of right hip pain and later was diagnosed with neck of femur fracture subcapital type that was treated with cementless hemiarthroplasty. In conclusion, if the canal is blocked, start with small diameter (K-wire), then insert guide wire and then reaming over it to open the blocked canal, do not hammer directly to prevent iatrogenic fracture. Go sequentially to open the blockage. First open the marrow then insert trial stem.

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“…A minimal number of cases reported atypical fractures of the femur which are related to long-term treatment of bisphosphonates or denosumab [10,11]. ese studies indicated a fracture distinct from the common osteoporosis induced subtrochanteric or femoral sha fracture, while researchers deduced that the possible mechanisms might be microdamage accumulation, increased mineralization, reduced mineralization heterogeneity, variations in bone turnover rates and reduced vascularity and anti-angiogenic e ect related to BPs treatment [12,13].…”

Section: Introductionmentioning

confidence: 99%

Skeletal Site-Specific Response of Jawbones and Long Bones to Surgical Interventions in Rats Treated with Zoledronic Acid

Wang

Huo

et al. 2019

BioMed Research International

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Bisphosphonates (BPs) have been extensively used for management of bone diseases with pathologically high resorption. Despite the great clinical benefits, a severe complication known as medication-related osteonecrosis of the jaw (MRONJ) has been reported. It is found that most of the reported MRONJ cases were limited in the jawbones/craniofacial bones instead of long bones. The present study aims to investigate the differential bone response to surgical procedures between jawbones and long bones exposed to BPs. Forty-eight skeletal mature Sprague Dawley female rats were administered oncologic dose of zoledronic acid (ZA) or normal saline for 4 weeks and then subjected to tooth extraction on the mandible and maxilla, and a bone defect creation on the femur. After surgical procedures, ZA or saline treatment were continued until sacrifice at week 2, week 4, and week 8, post-operatively. The samples were subjected to micro-computerized tomography (micro-CT) and histological assessment. Osteonecrosis was only found in jawbones in ZA-treated rats. ZA-treated rats showed significantly higher bone mineral density with greater bone volume in all surgical sites than that in the controls. The length of exposure of ZA did not seem to affect trabecular microstructure, and it only showed higher bone volume and BMD with longer healing time which is expected in the healing process.

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Rare case of atypical femoral fracture with blocked medullary canal associated with bisphosphonate therapy

Cited by 4 publications

References 7 publications

A Rare Case of Obliterated Femoral Canal in Atypical Femoral Shaft Fracture Related to Bisphosphonate Therapy

A Rare Case of Obliterated Femoral Canal in Atypical Femoral Shaft Fracture Related to Bisphosphonate Therapy

How to manage blocked intramedullary canal while reaming during hip arthroplasty

Skeletal Site-Specific Response of Jawbones and Long Bones to Surgical Interventions in Rats Treated with Zoledronic Acid

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