Treatment strategy for atypical ulnar fracture due to severely suppressed bone turnover caused by long-term bisphosphonate therapy: a case report and literature review

Abstract

Background Atypical fractures may occur due to the combined effect of severely suppressed bone turnover (SSBT) caused by long-term bisphosphonate treatment and chronic repetitive bone microdamage. Atypical fracture of the ulna due to SSBT is a rare entity; there is no standardized treatment strategy for this condition. We successfully treated a patient with atypical fracture of the ulna. Herein, we present this patient, review the relevant literature, and discuss the treatment strategy. Case presentation An 84-year-old woman presented with atypical fracture of the left ulnar shaft due to SSBT. She had a history of bisphosphonate therapy (ibandronate and alendronate) since more than 10 years; her bone turnover was severely suppressed. We performed open reduction and internal fixation (ORIF) using dual plate with some additional treatments. These included drilling and decortication, use of autogenous bone graft, low-intensity pulsed ultrasound (LIPUS) treatment, and administration of teriparatide. Finally, bone union was observed at 11 months after surgery. Conclusions Based on the literature review and our experience with this case, ORIF alone may not be adequate to achieve bone union; drilling, decortication, and use of cancellus bone graft is important to achieve favorable outcomes. Administration of teriparatide and LIPUS may facilitate early bone union, although further studies are required to provide more definitive evidence. Furthermore, ORIF using dual plate may help avoid implant failure owing to the long time required for bone union.

Atypical Fracture of the Scapular Spine: A Case Report

“…Moreover, Tsuchie et al reported that the administration of teriparatide after the occurrence of the first AFF and the use of active vitamin D3 after the completion of teriparatide therapy may prevent the recurrence of AFF [ 18 ]. Concerning the non-weight-bearing bones, Abe et al reviewed the reported cases of AUFs and described the difficulty in the treatment of AUFs as has been encountered with AFFs [ 13 ]. In the cases of the two reported patients and the present patient with atypical scapular fracture, BMA treatment was discontinued and the patients were treated conservatively.…”

Functional Outcome of Proximal Femoral Nail Antirotation (Pfna) in Proximal Femur Fracture

“…The adoption of the Russell-Taylor classification system for subtrochanteric fractures exemplifies this trend, providing a framework that informs surgical planning and implant selection (17). The management of atypical fractures, particularly those associated with long-term bisphosphonate therapy, further illustrates the complexity of treatment strategies, necessitating vigilant monitoring and, in some cases, prophylactic fixation to prevent complication progression (18). The management of proximal femur fractures requires a multifaceted approach that integrates the latest advances in surgical techniques, a deep understanding of bone biomechanics, and a personalized treatment strategy that considers the unique characteristics of each patient.…”

Case Report: Prophylactic Plate Fixation for Incomplete Atypical Ulnar Fractures Resulting From the Use of Denosumab for Bone Metastases

“…Furthermore, in recent years, there have been increasing incidence of atypical ulnar fractures (AUFs) in addition to AFFs caused by SSBT (7,8). AUF treatment is difficult, and many authors have reported that bone union is not achieved (9,10). Therefore, the discontinuation of bone resorption inhibitors, as well as the use of bone grafting, dual plate fixation, low-intensity pulsed ultrasound (LIPUS), and teriparatide are recommended (9,11,12).…”

“…AUF treatment is difficult, and many authors have reported that bone union is not achieved (9,10). Therefore, the discontinuation of bone resorption inhibitors, as well as the use of bone grafting, dual plate fixation, low-intensity pulsed ultrasound (LIPUS), and teriparatide are recommended (9,11,12). However, discontinuation of bone-resorbing drugs is problematic in patients with bone metastases, and AUFs treatment in such patients has been reported to be challenging (11).…”