BILATERAL SIMULTANEOUS ATYPICAL FEMORAL PERIPROSTHETIC FRACTURE. A CASE REPORT AND REVIEW OF THE LITERATURE

L.N. Scaramuzzi¹ , L. Scialpi², I. Rausa¹, G. Sammarco², G. Solarino³

¹ Orthopaedic and Trauma Unit, School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Bari, Italy
² Orthopaedic and Trauma Unit, Santissima Annunziata Hospital, Taranto, Italy
³ Orthopaedics University of Bari “Aldo Moro”- AOU Policlinico Consorziale, Department of Translational Biomedicine and Neuroscience, Orthopaedic and Trauma Unit, Bari, Italy

Correspondence to:

Journal of Orthopedics 2023 September-December; 15(3): 148-153
https://doi.org/10.69149/orthopedics/2023v15iss3_2

Received: 4 October 2023 Accepted: 10 November 2023

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Abstract

Atypical femoral fracture is one of the many complications after the long-term use of bisphosphonates. Long-term use of bisphosphonates (BPs) has been associated with a specific type of tensile-side femoral stress fracture known as Atypical Femoral Fracture (AFF). The American Society for Bone and Mineral Research has officially excluded periprosthetic femoral fractures (PFFs) from the definition of atypical femoral fractures (AFFs). However, several case reports correlate prolonged BP use with the occurrence of a type of PFF with an atypical pattern (atypical PFF, APFF). The aim of the present study is to report a case of bilateral APFF after prolonged BP use. A 77-year-old female with a history of long-term bisphosphonate use (over 15 years) and a total bilateral hip replacement 7 and 8 years ago, after minimal domestic trauma, reported a bilateral periprosthetic femoral fracture. Investigative results (Rx, histological examination biopsy) allowed us to classify these fractures as atypical. This case is consistent with the definition of bisphosphonate-related atypical femoral fracture around a well-fixed, total hip replacement. These findings challenge the current definition of atypical femoral fractures that excludes peri-prosthetic fractures.

Keywords: atypical femoral fracture, bisphosphonate, bone, bone remodeling, osteoporosis