Bisphosphonate ; Cephalomedullary nail ; Subtrochanteric insufficiency fracture
Abstract
The authors report a case of nonunion and failure of cephalomedullary nail which was inserted for treatment of subtrochanteric insufficiency fracture in a patient who was under long-term alendronate therapy. Subtrochanteric fracture had all major features of insufficiency fracture: short oblique configuration, noncomminuted, complete fracture with a medial spike and association with minimal trauma. It also had several minor features such as localized perisosteal reaction, generalized increase in cortical thickness, prodromal symtopms (thigh pain), delayed healing, and use of bisphosphonate. These major and minor features are reported by the task force team of the American Society of Bone and Mineral Research for atypical femoral fracture at the end of September 2010.