Banno Sammy, Baba Tomonori, Tanabe Hiroki, Ishii Seiya, Jinnai Yuta, Homma Yasuhiro, Watari Taiji, Kaneko Kazuo
Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
Trauma Case Rep. 2020 Dec 10;31:100381. doi: 10.1016/j.tcr.2020.100381. eCollection 2021 Feb.
In recent years, it has been reported that periprosthetic femoral fractures in the form of atypical femoral fractures (AFFs) are found occasionally as difficult-to-treat conditions. To date, there have been no reports of interprosthetic femoral fractures (IPFFs) having the form of AFFs. We report a case of an atypical IPFF with breakage of the plate due to abnormal femoral alignment.
A 70-year-old woman was admitted. She underwent left knee replacement and left hemi-arthroplasty at ages 61 and 60. And she had been taking bisphosphonate for 5 years. A plain X-ray revealed IPFF. The fracture was a complete transverse fracture with circumscribed thickening of the lateral cortical bone ("beak sign") at the fracture site. She underwent surgery. A reversed condylar locking compression plate (LCP) was used for internal fixation. Subsequently, she could walk without particular pain. Five months after the operation, she heard the snap of a bone breaking, and had difficulty walking. Plain X-ray revealed a re-fracture of the fracture site and breakage of the plate at the same high position. She underwent re-operation. A valgus osteotomy was performed at an angle of 15°. A reversed condylar LCP was used on the lateral side of the femur. A bone grafting was performed focusing on the fracture site. In addition, a short-LCP was fixed anteriorly to the femur. The bone union 1 year and 6 months postoperatively. She could walk, with no impairment being noted regarding ADL.
We performed osteosynthesis for an IPFF having the characteristics of AFF, but the patient suffered breakage of the plate and re-fracture. Bone union was achieved as a result of re-operation that consisted of valgus osteotomy of the fracture site in combination with autologous bone grafting and double orthogonal plating.
近年来，有报道称，非典型股骨骨折（AFF）形式的假体周围股骨骨折偶尔被发现为难治性疾病。迄今为止，尚无关于AFF形式的假体间股骨骨折（IPFF）的报道。我们报告一例因股骨对线异常导致钢板断裂的非典型IPFF病例。
一名70岁女性入院。她在61岁和60岁时分别接受了左膝关节置换术和左半关节置换术。并且她已经服用双膦酸盐5年。X线平片显示为IPFF。骨折为完全横形骨折，骨折部位外侧皮质骨有局限性增厚（“喙征”）。她接受了手术。使用反向髁锁定加压钢板（LCP）进行内固定。随后，她能够行走且无特殊疼痛。术后5个月，她听到骨头折断的响声，行走困难。X线平片显示骨折部位再次骨折，且钢板在同一高位断裂。她接受了再次手术。以15°角进行外翻截骨术。在股骨外侧使用反向髁LCP。针对骨折部位进行植骨。此外，在股骨前方固定一块短LCP。术后1年6个月骨愈合。她能够行走，日常生活活动（ADL）无受损情况。
我们对具有AFF特征的IPFF进行了骨固定，但患者出现了钢板断裂和再次骨折。通过包括骨折部位外翻截骨术、自体骨移植和双正交钢板固定的再次手术实现了骨愈合。
