Tateiwa Daisuke, Outani Hidetatsu, Iwasa Saya, Imura Yoshinori, Tanaka Takaaki, Oshima Kazuya, Naka Norifumi, Araki Nobuhito
Musculoskeletal Oncology Service, Osaka International Cancer Institute, Osaka, Japan.
J Orthop Surg (Hong Kong). 2017 Sep-Dec;25(3):2309499017727916. doi: 10.1177/2309499017727916.
Atypical femoral fractures (AFFs) are recently observed as a complication of long-term bone-modifying agent (BMA; bisphosphonate or denosumab) therapy for bone metastases. We describe the cases of two women diagnosed with breast cancer who developed incomplete AFF associated with BMAs prescribed for bone metastases. Radiographs of their femurs revealed thickening of the lateral subtrochanteric cortex, and tomosynthesis revealed a visible fracture line in the thickened cortex. They were initially treated with conservative management; however, the incomplete fracture resulted in a complete fracture. These cases highlight two major implications. First, symptomatic incomplete AFF associated with BMAs prescribed for bone metastases should be treated with surgical prophylaxis, given the fact that fracture healing is expected to require a longer duration and an incomplete fracture might potentially progress to a complete fracture during long-term conservative management. Second, tomosynthesis is useful in identifying radiolucent fracture lines that are reliable predictors of fracture propagation.
非典型股骨骨折（AFFs）最近被发现是长期使用骨改良剂（BMA；双膦酸盐或地诺单抗）治疗骨转移瘤的一种并发症。我们描述了两名被诊断为乳腺癌的女性病例，她们因骨转移瘤而接受了BMA治疗，随后发生了不完全性AFF。她们股骨的X线片显示转子下外侧皮质增厚，断层合成显示增厚皮质中有可见的骨折线。她们最初接受了保守治疗；然而，不完全骨折导致了完全骨折。这些病例突出了两个主要问题。第一，鉴于骨折愈合预计需要更长时间，且不完全骨折在长期保守治疗期间可能进展为完全骨折，对于因骨转移瘤而接受BMA治疗相关的有症状不完全性AFF应进行手术预防。第二，断层合成有助于识别透亮骨折线，这些骨折线是骨折进展的可靠预测指标。
