J Korean Fract Soc.  2016 Oct;29(4):258-264. 10.12671/jkfs.2016.29.4.258.

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

• Moon NH
• Jang JH
• Hwang TH
• Park KY

• KMID: 2355431
• DOI: http://doi.org/10.12671/jkfs.2016.29.4.258

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.

Keyword

Atypical femoral fracture; Osteoporosis; Femoral neck insufficiency fracture

MeSH Terms

Aged, 80 and over
Consensus
Female
Femoral Fractures*
Femur Neck*
Fracture Fixation, Intramedullary*
Fractures, Stress*
Humans
Osteoporosis

Figure

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  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.

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  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.

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  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.

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  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.

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