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Atypical periprosthetic femoral fracture with stem breakage: a case report

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Abstract

Although the American Society for Bone and Mineral Research definition of atypical femoral fracture excludes periprosthetic fractures, fractures around the prosthesis with clinical features of atypical femoral fractures have been reported in the literature. All fractures reported thus far have been distal to the prosthetic segment; however, we encountered a case of a stress fracture in the middle of the femoral component segment. An 86-year-old woman with a history of bisphosphonate osteoporosis treatment and revisional total hip arthroplasty visited our outpatient clinic complaining of pain in the left thigh and groin. We diagnosed an incomplete atypical femoral fracture around the hip prosthesis; medical treatment was implemented. Two months later, the patient visited the emergency department with a complete subtrochanteric fracture with stem breakage. Without revision of the broken stem, two plates were applied after reduction. In this case, we recognized the possibility of a stress fracture but overlooked the possibility of stem breakage in an atypical femoral fracture. Even if it is not evident on the radiograph before complete fracture, clinicians should be alert to the signs of stress fracture in the middle of the femoral component segment, as they may be clues to atypical periprosthetic femoral fracture with stem failure. Isolated medical treatment plans are not recommended for incomplete subtrochanteric atypical periprosthetic femoral fracture. Instead, concomitant prophylactic plate fixation is recommended.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, South Korea

    J. M. Lee & J.-T. Kim

  2. Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, South Korea

    C. H. Park

  3. Department of Orthopedics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea

    J.-I. Yoo

  4. Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, 95 Dunsan-Seoro, Seo-gu, Daejeon, 302-799, South Korea

    Y. Cha

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  1. J. M. Lee
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  2. C. H. Park
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  3. J.-I. Yoo
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  4. J.-T. Kim
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  5. Y. Cha
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Corresponding authors

Correspondence to J.-T. Kim or Y. Cha.

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Ethical approval

After reviewing our study protocol, the institutional review board approved the exemption of the present report.

Statement of human and animal rights

Informed consent was obtained from the patient whose case is reported here.

Conflicts of interest

This work was supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government (MSIT) (No. 2022R1G1A1003299).

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Jung-Taek Kim and Yonghan Cha contributed equally to this work and should be considered co-corresponding authors.

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Lee, J.M., Park, C.H., Yoo, JI. et al. Atypical periprosthetic femoral fracture with stem breakage: a case report. Osteoporos Int 33, 2043–2047 (2022). https://doi.org/10.1007/s00198-022-06463-2

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  • DOI: https://doi.org/10.1007/s00198-022-06463-2

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