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KMID : 0386420140270010010
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Journal of the Korean Fracture Society
2014 Volume.27 No. 1 p.10 ~ p.16
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Treatment and Prognosis of Femoral Insufficiency Fracture Associated with Prolonged Bisphosphonate Use
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An Ki-Chan
Park Dae-Hyun
Kong Gyu-Min
Kim Joo-Yong
Kim Sang-Bum
Sakong Seung-Yeob
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Abstract
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Purpose: This study was conducted to investigate and identify an appropriate fracture treatment method by analyzing patients in whom a femoral incompetence fracture occurred after receiving a long-term bisphosphonate administration.
Materials and Methods: The subjects of this study were 13 cases out of ten patients among those who had a history of receiving bisphosphonate for more than five years and had a fracture or an imminent fracture with a characteristic radiological finding in the femoral subtrochanteric region and the interfemoral region. The period of the drug administration, bone density, the existence of a prodromal symptom, and bilateral fracture were investigated.
Results: In seven out of the 13 cases, the patients complained of painat the femoral and pelvic parts as a prodrome (53.8%), and three of them showed a bilateral fracture (30%). An imminent fracture with a prodrome was observed in six cases (46.2%); for three of these cases, a prophylactic fixture pexis was performed by inserting a metal nail into the medullary cavity, and in two out of these three, a complete fracture was found within 11 months on average (3 to 19 months). In the three prophylactic fixture pexis performed cases, no postoperative complications were found, and a radiological finding of concrescence was seen within one year after the operation. Among the nine operation performed cases after the fracture, non-union was found in two.
Conclusion: In the patients who have received bisphosphonate for a long periodof time, a prodome may be a useful indicator of a fracture in the femoral subtrochanteric region and the interfemoral region; therefore, a careful observation is necessary. A prophylactic internal fixation is recommended for patients with imminent fracture with a prodome since they have a high risk of a complete fracture is high in them.
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KEYWORD
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Bisphophonate, Femoral incompetence fracture, Femoral imminent fracture
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